There are typically two main forms of treatment for vaginal agenesis sufferers. Vaginal dilation, where sufferers’ symptoms are not severe enough to warrant invasive surgery, and for those who do require vaginoplasty (see section on this website) or other vaginal surgery. This surgery is also usually followed by a period of vaginal training using appropriate dilators.
In cases where non-surgical treatment is adequate, the 'Frank' or the now preferred 'Ingram' techniques are typical of the approaches adopted. Essentially a professional medical dilator is pushed into the vaginal cavity for sessions of about 20 to 30 minutes, perhaps several times daily. With the correct pressure applied over time, using professional dilators of increasing length and diameter, an acceptable vagina can often be created. Regular, typically monthly, consultation with an experienced therapist during this time is imperative. In many cases, long term treatment of this type can be very successful, although the motivation and commitment of the sufferer is of considerable importance.
Vaginoplasty is an invasive surgical procedure which, regrettably, is often necessary in order to adequately treat vaginal agenesis sufferers. Different surgeons use different techniques, but there are essentially two ways in which the procedure can be performed. The first ('McIndoe') technique is where a split-thickness skin graft (i.e. where the surgeon uses the outer layer of skin from one part of the body to create a covering for elsewhere) is taken from a donor site, typically from one of the upper thighs, and from this a tube is formed. This tube is then inserted into where the vagina should be, possibly by making an incision first. Following typically a week of bed rest, vaginal dilation will be started.
The second technique is when a section of the lower colon is removed through an abdominal incision. One end of the sectioned colon is then closed, whilst the remaining open end is sutured into place behind the vaginal opening, again resulting in the creation of a neo-vagina. A period of vaginal dilation will be necessary following this procedure as well, but there is no need to insert the dilator so close to the end of the neo-vagina during the first few weeks following surgery. It should be noted that some mucous discharge may come out from neo-vaginas constructed in this way, since this is a natural secretion from the inside colon mucosa. Furthermore, this surgical procedure is both more complicated and more invasive than that described earlier.
Vaginal agenesis sufferers who have had the skin graft procedure performed will usually have to use dilators of several months after surgery, indeed they may well find it necessary to use them for the rest of their lives during which they wish to have an active sex life. Vaginal stenosis, or tightening / shortening of the vagina (see elsewhere in this site for further information) is a frequent complication with this procedure, but this can usually be largely offset through correct use of professional dilators.
However, those who have had colon vaginoplasty usually have to dilate less frequently, although they also are likely to have to dilate to some degree for the time during which they wish to remain sexually active.
In both cases, maintaining a high degree of neo-vaginal cleanliness is essential, as is adequate consultation with a suitably qualified therapist.
What is Vaginal Agenesis? | Treatment | Long Term fertility | Use of Vaginal Dilators
Long Term fertility
Regardless of the actual treatment undertaken, the eventual ability of the sufferer to have children will depend entirely on the actual anatomy of the person concerned. If the sufferer has a normal uterus, ovaries and fallopian tubes, a normal pregnancy might well be possible. Also where only ovaries are present, it might be possible to harvest some eggs, fertilize them with her partner’s sperm, and then implant this into a surrogate mother. Otherwise, adoption is likely to be necessary.