Surgical Strategies of Vaginoplasty for Vaginal Agenesis Patients with or without Functional Uterus: A Case Series

Abstract

Background: Vaginal agenesis, a key feature of conditions such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and androgen insensitivity syndrome (AIS), poses significant challenges to physical and psychological health. Surgical intervention is often required to create a functional vaginal canal, particularly in patients desiring sexual functionality or alleviation of associated symptoms. The presence of a functional uterus adds complexity to surgical planning due to potential menstruation and fertility considerations. This case series explores various surgical techniques, their indications, and outcomes in patients with or without a functional uterus.
Aim and Objective: To evaluate the surgical strategies and outcomes of vaginoplasty in patients with vaginal agenesis, focusing on differences in approaches for those with and without a functional uterus.
Material and Methods: This retrospective case series analyzed 25 patients undergoing vaginoplasty at a tertiary care center over a 1-year period. Techniques included non-graft methods (Vecchietti procedure, perineal dissection), graft-based methods (split-thickness skin grafts, intestinal grafts), and hybrid approaches. Patients were grouped by the presence or absence of a functional uterus, with assessments of surgical success, complications, and patient-reported outcomes.
Results: The study population had a mean age of 21.4 years, with 60% diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Non-graft techniques achieved high success rates (87.5%-100%) with minimal complications. Graft-based techniques provided excellent functional outcomes, particularly intestinal grafts, but were associated with mucus discharge in some cases. Patients with a functional uterus (24%) required additional menstrual management strategies; 1 case of hematometra was resolved successfully. Overall, 92% of patients reported high satisfaction with vaginal functionality, and 85% experienced significant psychosexual health improvement.
Conclusion: Vaginoplasty strategies should be tailored to individual patient anatomy and goals. Both non-graft and graft-based techniques offer high success rates with acceptable complication profiles. Multidisciplinary care is essential, particularly for patients with a functional uterus, to optimize outcomes and address complex needs.