Research
Gynecology
Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study

Part of this research was presented in oral format at the 18th Dutch-Flemish IGO Doelen Annual Scientific Meeting of the Dutch Society for Obstetrics and Gynecology, Rotterdam, The Netherlands, April 17-19, 2013.
https://doi.org/10.1016/j.ajog.2014.03.051Get rights and content

Objective

Vaginal dilation treatment has been shown to be a (cost) effective first-line alternative to surgery in normalizing vaginal length and improving sexual function in women with vaginal hypoplasia. There remains, however, a need for prospective studies, with long-term assessment of multiple outcomes.

Study Design

This was a prospective, single-centre observational study of 16 women with Mayer-Rokitansky-Küster-Hauser syndrome (n = 12) or 46,XY disorders of sex development (n = 4). All women underwent an outpatient vaginal dilation program supervised by a psychologist and physiotherapist. At baseline (T0), stop of treatment (T1) and 1 year follow-up (T2), semistructured interviews, and validated questionnaires assessed sexual function and distress, self-esteem, vaginal perceptions, and health-related quality of life. Gynecological examinations evaluated vaginal dimensions.

Results

Ten women completed the program, 3 are still in the program, and dilation failed in 3 and chose vaginoplasty. Sixty-nine percent reached a normal vaginal length (≥6.5 cm) in 5.8 ± 3.3 months. Seventy percent were sexually active with pleasurable experiences at T1, 57% at T2. The significant decrease in sexual distress at T1 (P < .05) was followed by a nonsignificant increase at T2. Depressive mood symptomatology remained high at T1 and T2, related to loss of bodily integrity and fertility. The majority refused further psychological counseling.

Conclusion

Vaginal dilation treatment should remain the cornerstone of treatment in women with vaginal hypoplasia. However, the diagnosis remains to have a negative impact on emotional well-being in the long term. The role of psychological intervention as both a primary and adjuvant treatment needs clear evaluation.

Section snippets

Study design, outcome variables, and population

This was a prospective, longitudinal, single-center study of all women with vaginal hypoplasia and without a previous history of vaginal surgery, who were prescribed vaginal dilation treatment, between March 2010 and April 2013. Participants followed the treatment protocol outlined in Figure 2. The outpatient program was designed based on previous experiences and careful exploration of the literature, especially motivational and behavioral psychology.10, 15

At baseline (T0), at the stop of

Results

Of the 18 women approached, 16 agreed to participate (Figure 3). Two women were reluctant to discuss this sensitive issue, but both did start with the dilation program. The characteristics of the participants are displayed in Table 2.

Maintenance Dilation

In women who completed the program, only 2 women (numbers 1 and 7) continued to dilate during the first 6 months after the stop (once a week), especially before having sexual intercourse. Only 1 woman (number 7) dilated at the time of follow-up (approximately 4 times a month for 10 minutes) because she felt that she lost vaginal depth when not being sexually active and because she wanted to gain additional depth. She had a significantly longer vaginal length at follow-up (11 cm vs 6.5 cm [6.5-7

Comment

The present study demonstrates that in the majority of women with vaginal agenesis (77%, 10 of 13), vaginal dilation therapy, following a strict protocol and with continuous psychophysiological support, can effectively create a vagina within normal ranges (6.5–13 cm)21, 22 in a period of approximately 6 months, which corroborates previous study findings.1, 4, 10, 23, 24 With higher dilation frequency, the total duration of therapy decreased and vaginal end length increased, irrespective of

Acknowledgments

We thank the women who took part in the study and all members of the multidisciplinary disorders of sex development teams at Ghent University Hospital, Belgium, and Erasmus Medical Centre Rotterdam, The Netherlands for their continuing encouragement of this research.

References (44)

  • J.M. Ingram

    The bicycle seat stool in the treatment of vaginal agenesis and stenosis: a preliminary report

    Am J Obstet Gynecol

    (1981)
  • F. Bryans

    Management of congenital absence of the vagina

    Am J Obstet Gynecol

    (1981)
  • V.M. Jasonni et al.

    The management of vaginal agenesis: report of 104 cases

    Fertil Steril

    (2007)
  • R.E. Lappöhn

    Congenital absence of the vagina—results of conservative treatment

    Eur J Obstet Gynecol Reprod Biol

    (1995)
  • J.G. Heller-Boersma et al.

    Psychological distress in women with uterovaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome, MRKH)

    Psychosomatics

    (2009)
  • L. Derogatis et al.

    Validation of the Female Sexual Distress Scale-revised for assessing distress in women with hypoactive sexual desire disorder

    J Sex Med

    (2008)
  • P.C. Gargollo et al.

    Should progressive perineal dilation be considered first line therapy for vaginal agenesis?

    J Urol

    (2009)
  • C. Quigley et al.

    Androgen receptor defects: historical, clinical, and molecular perspectives

    Endocr Rev

    (1995)
  • R. Deans et al.

    Management of vaginal hypoplasia in disorders of sexual development: surgical and non-surgical options

    Sex Dev

    (2010)
  • L. Michala et al.

    Surgical approaches to treating vaginal agenesis

    BJOG

    (2007)
  • I.S. Ismail-Pratt et al.

    Normalization of the vagina by dilator treatment alone in complete androgen insensitivity syndrome and Mayer-Rokitansky-Kuster-Hauser syndrome

    Hum Reprod

    (2007)
  • J. Alderson et al.

    A nonsurgical approach to the treatment of vaginal agenesis

  • Cited by (0)

    This study was supported by a research grant from the Flanders Research Foundation (FWO Vlaanderen).

    The authors report no conflict of interest.

    Cite this article as: Callens N, Weyers S, Monstrey S, et al. Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study. Am J Obstet Gynecol 2014;211:228.e1-12.

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