Rokitansky’ego-Küstera-Hausera Morphology of the neovagina and sexual functioning of patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent modified Wharton vaginoplasty

Abstract

Objectives: To evaluate the anatomical results of Wharton vaginoplasty performed with Friebe modification for the surgical correction of vaginal aplasia in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and to assess multidimensionally the sexual functioning of the women. Material and methods: 20 out of 36 patients with MRKH syndrome who underwent surgical creation of neovagina between October 1995 and September 2009 participated in the study. In the group 11 women (55%) had the typical form, 3 women (15%) had the atypical form and 6 women (30%) had the MURCS type of the MRKH syndrome. The dimensions of the vagina (length and width) and the quality of vaginal epithelium (Schiller test) were evaluated. The sexual functioning of the patients was assessed with the Female Sexual Function Index (FSFI) questionnaire and scored in 6 domains (desire, arousal, lubrication, orgasm, satisfaction and pain). Results: The patients underwent the surgery at the median age of 21.7 years (range 16.3-36.6) and were followed–up from 6 months to 11.3 years (median 1.9 years) after the surgery, at the median age of 24.7 years (range 18.3-37.3). The vaginal length and width ranged from 4.5 to 12cm (median 6.3) and from 1.5 to 4cm (median 3), respectively. The total FSFI score and 6 domains scores (medians and ranges) obtained within the group of 18 patients (2 patients reported no sexual activity) were as follows: desire 3.6 (1.2-6), arousal 4.5 (2.4-6), lubrication 5.7 (1.2-6), orgasm 4.2 (1.2-6), satisfaction 5.6 (2.4-6), pain 4.8 (0-6), total score 28.2 (10.8-36). No correlation was found between the vaginal dimensions and the total FSFI scores but in 16 (80%) patients the value of the latter was higher than the cut-off value of 26.55, discriminating women with and without sexual dysfunction. Conclusion: The modified Wharton vaginoplasty enables women with MRKH syndrome to get a functional vagina of normal anatomy.