Laparoscopic proximal neovaginoplasty using autologous peritoneal graft to correct short vagina

Abstract

Introduction and importance: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare condition characterized by congenital aplasia of the uterus and upper two-third vagina with normal secondary characteristics. Treatment of this condition consists of non-surgical and surgical management. After nonsurgical Frank method, neovaginal canal may be formed but sometimes the vaginal length may not be adequate to facilitate normal sexual intercourse.

Presentation of case: A 27-year-old woman, sexually active, complained about the difficulty of sexual intercouse. The patient was diagnosed with vaginal agenesis and uterine dysgenesis with normal secondary sexual characteristics and chromosome (46, XX). The patient has had nonsurgical treatment by Frank method for 6 years and as a result we found a 5 cm-vaginal indentation but she still complaint of pain and discomfort during intercourse. Laparoscopy proximal neovaginoplasty using autologous peritoneal graft was performed to add the proximal vaginal length.

Discussion: In our case, the patient may have a short vagina as the result from inadequate Frank method dilatation. This may cause dyspareunia and discomfort to her sexual partner. Therefore, laparoscopic proximal neovaginaplasty and uterine band excision were carried out to correct the anatomical restriction and improve her sexual function.

Conclusion: Laparoscopic proximal neovaginoplasty is a surgical method to increase proximal vaginal length by using autologous peritoneal graft which shows excellent result. This procedure should be considered in MRKH syndrome patients with unsatisactory nonsurgical treatment result.

Keywords: Davydov procedure; Excision uterine band; Frank dilator; MRKH; Short vagina.