Faculty

Rebecca Deans

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Urogenital surgery

Enlargement procedures for vaginal hypoplasia include self-dilatation therapy or surgical vaginoplasty. These interventions are offered to improve psychological and sexual outcomes. The concept of surgery for DSD conditions has become increasingly controversial in the last decade. Vaginal dilatation therapy is the first line treatment for vaginal hypoplasia due to the absence of surgical risk, but success depends on the motivation of the patient, and underlying anatomy. Concomitant psychological support improves outcomes. Surgical vaginoplasty methods depend on the genital configuration, previous attempts at genital surgery and surgeon’s personal expertise and preference. There are many vaginoplasty techniques described: tension via an external traction device, peritoneal, buccal and amnion, skin, and
bowel grafting, as well as muscle and skin flaps. Each method has different risks and benefits. The surgical risks include malignancy, contracture leading to introital stenosis or loss of vaginal length, vaginal prolapse, dry vagina or excessive vaginal discharge. There is a lack evidence to inform management regarding the optimum surgical technique to use, and long-term data on success is lacking, particularly with respect to sexual function. Regardless of the vaginal reconstruction technique, patients should be managed in a multidisciplinary team where there is adequate emotional and psychological support available.

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