Neovaginal Reconstruction With the Modified McIndoe Technique

Abstract

The authors reviewed 32 patients who underwent vaginal reconstruction using a modified McIndoe procedure during the past 15 years. This technique consists of the application of split-thickness skin grafts into a new cavity created between the rectum, bladder, and urethra. The grafts are placed previously on a mold of Optosil, which is a silicon-based condensation curing impression material used by dentists. The mold is kept for 3 months 24 hours each day. During the next 3 to 4 weeks it is applied 12 hours per day. Later, according to sexual activity, the mold can be removed completely. In case of no sexual activity it should be used 1 hour per week. Parameters assessed during the follow-up were mold management, grade of pseudomucinous metaplasia of the skin grafts, sensation of the neovagina, neovagina size changes, sexual satisfaction, and complications. Postoperative complications included partial take of skin grafts (N = 3), postoperative anxiety (N = 2), donor site cheloids (N = 1), and neovaginal stricture in 3 patients who used the mold for 1 month only without having any further sexual activity. Patients who managed the mold correctly or who had constant sexual activity obtained satisfactory dimensions of the neovagina in terms of length, diameter, and elasticity.

Gender Role, Gender Identity and Sexual Orientation in CAIS (“XY-Women”) Compared With Subfertile and Infertile 46,XX Women

“…In most of these studies the focus was on assessing the outcome of neovaginal surgeries (e.g., Rajimwale, Furness, Brant, & Koyle, 2004;Seccia et al, 2002). The fact that both condition groups share a DSD diagnosis that includes infertility but that the following differences also exist makes MRKHS an appropriate comparison group for CAIS studies in general: In CAIS, a defect of the androgen receptor gene leads to infertility and a feminine phenotype despite the presence of inguinal testes and 46,XY karyotype.…”

Congenital malformations of the female genital tract: the need for a new classification system

“…This anomaly is associated with a lasting negative psychological impact on women. However, the main problems are the inability to establish a sexual life and reproductive problems, which could wait until beginning sexual activity (38,(109)(110)(111)(112)(113).…”

Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options

“…Different types of grafts have been used; split thickness skin graft harvested from various sites and rotational flaps (fasciocutaneus and muscolocutaneus). The main disadvantages of this procedure are the visible scar, including keloids and infection [Seccia et al, 2002;Klingele et al, 2003], inadequate lubrication and high rate of graft stenosis necessitating frequent and potentially life long dilation. Long-term sexual function results have not been validated; however, sexual satisfaction rates have been reported to be between 80 and 90% [Mobus et al, 1996;Keser et al, 2005].…”