Vaginal Agenesis

Treatment

You may be treated for vaginal agenesis in your late teens or early 20s, or you may wait until you're older. If your parents learned about your condition when you were an infant or young girl, you may have already begun treatment. Whatever your stage, a team of doctors in Minnesota trained in pediatrics, gynecology, urogynecology and colon and rectal surgery are ready to care for you.

You may find it helpful to talk with a counselor about your condition. Psychologists at Mayo Clinic can answer your questions and help you deal with any problems you may have managing the implications of your vaginal agenesis.

Depending on your individual condition, your doctor may recommend one of the following courses of treatment. As a first step, your doctor will probably recommend dilation.

Self-dilation

You may be able to create a vagina without surgery using self-dilation. You'll press a small, round rod (dilator) against your skin or inside your existing vagina for 15 or 20 minutes a day. Your skin stretches more easily after a warm bath, so that's the best time to do it. As the weeks go by, you'll switch to larger dilators. It may take a few months to get the result you want.

Surgery

If dilation doesn't work, you and your team may decide that surgery is the best option. The most appropriate surgery (vaginoplasty) depends on your age and condition. Two types of surgery may be used to create a functional vagina. These treatments are usually delayed until you have the maturity to handle follow-up dilation.

• Skin graft (McIndoe procedure). The most common surgery, skin graft uses skin from your buttocks to create a vagina. Your surgeon makes an incision in the area where you'll have your vagina, inserts the skin graft to create the structure and places a mold in the newly formed canal for one week. After that, you'll use a vaginal dilator, similar to a firm tampon, which you'll remove when you use the bathroom or have sexual intercourse. After a time, you'll use the dilator only at night. Sexual intercourse and occasional dilation helps you maintain a functional vagina.
• Vecchietti procedure. If you receive care at Mayo Clinic in Arizona, your treatment team may suggest the laparoscopic Vecchietti procedure to create your vaginal opening. Your doctor will place an olive-shaped device at your vaginal opening and with laparoscopic guidance connect it to a traction device on your lower abdomen. The traction device is tightened every day, gradually pulling the olive-shaped device inward to create a vagina over about a week. After your doctor removes the device, you'll need further manual dilation.
• Bowel vaginoplasty. Your surgeon may recommend a bowel vaginoplasty. In that procedure, your doctor diverts a portion of your colon to an opening in your genital area, creating a new vagina. Your remaining colon is then reconnected. You won't have to use a vaginal dilator every day after this surgery.