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Most young women are treated in their late teens or early 20s. Others may wait until they are older and sexually active. Treatment isn't urgent, but it is usually necessary before sexual intercourse.
Some patients can create a vagina without surgery using self-dilation. In this treatment, the patient presses a small rod (dilator) against the skin or the small vagina for 15 to 20 minutes per day. This is often done after bathing, when skin is more pliable. Progressively larger dilators are used to expand the vagina. Several months may be required to obtain the desired result.
Two types of surgery (vaginoplasty) are used to create a functional vagina. These treatments are usually delayed until the patient possesses the maturity to handle follow-up dilation. Mayo Clinic's experienced gynecological and colorectal surgeons perform many procedures each year.
The McIndoe procedure is the most commonly performed vaginoplasty. Mayo Clinic has a high success rate with this surgery and extensive experience determining the best timing of the operation and preparing patients for the best possible long-term outcomes. The procedure uses a skin graft from the buttock (which leaves only a slight disfigurement). The surgeon makes an incision where the vagina would normally develop and inserts the graft to create a vagina. A mold is placed in the newly formed vagina for seven days.
Following surgery, patients use a vaginal dilator, which is like a solid, large tampon. It is removed for urination, bowel movements or sexual intercourse. After a time, patients use the dilator only at night, then rely on sexual intercourse and occasional dilation to maintain a functional vagina. The vagina will constrict if there is no subsequent dilation or intercourse.
In a 2003 article in the American Journal of Obstetrics and Gynecology, Mayo Clinic doctors reported the results of a survey of Mayo patients who had the McIndoe procedure. Seventy-nine percent of respondents said that the procedure improved their quality of life; 91 percent reported being sexually active, with 75 percent able to achieve orgasm; 55 percent of women said their self-image was improved.
In a bowel vaginoplasty, a portion of the sigmoid colon is diverted to an opening in the genital area, creating a new vagina. The remaining colon is then reconnected. Potential complications include bowel leakage at the attachment site and mucus drainage for up to one year after the surgery. Daily use of a vaginal dilator is not required with this surgery. Some women will experience a tightening of the new vagina where it connects to the vulva. If this occurs, dilation is performed under anesthesia.
The Vecchietti procedure, offered at Mayo Clinic in Arizona, is a semi-surgical method that takes advantage of laparoscopy to accelerate dilation. An olive-shaped device, placed at the vaginal opening, is connected with sutures to a traction device on the lower abdomen. Under laparoscopic guidance, the traction device is tightened daily, gradually pulling the olive-shaped device inward to create a vagina. This takes approximately one week. The device is then removed and further manual dilation performed.
It is often useful for a patient to speak with a counselor about her condition. Psychologists at Mayo Clinic can assist women who have questions or experience difficulties managing the implications of vaginal agenesis.
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