Adequate anatomic and physiologic functions of the genitalia are fundamental prerequisites for sexual well-being and reproduction. To assess the psychosexual effect of vaginal reconstruction using the laparoscopic Vecchietti technique in patients with MRKHS. Their partners also were interviewed. A control group of 45 age-matched, childless, sexually active women were examined during the same period. A gynecologic examination Mayer-johnson wife sexual dysfunction performed to determine the anatomic outcome.
Average neovagina length 7.
Sexual function in women with MRKHS can be restored successfully by vaginoplasty; however, they have higher rates of distress and are less satisfied with their genitals. "Mayer-johnson wife sexual dysfunction" clear genetic cause of the syndrome has been established. These women can have a child by adoption, assisted reproduction, or gestational surrogacy, and uterine transplantation UTx also can provide women with MRKHS the opportunity to have their own biological child. Vaginal agenesis can be treated by non-surgical dilatation methods or surgically.
Williams vulvovaginoplasty with suturing of the labia majora into a perineal pouch 9 ; Vecchietti vaginoplasty, in which the vagina increases in size by gradually Mayer-johnson wife sexual dysfunction traction to the vaginal vault 1011 ; and methods involving the creation of a neovagina within the rectovesical space lined with various types of tissue, such as skin McIndoe techniqueperitoneum Davydov procedureintestine, or—perhaps in the future—tissue engineering of the vaginal mucosa.
Some methods have definite advantages over others: The Vecchietti neovagina, which is covered by non-keratinized squamous epithelium, is the only option that meets the two criteria.
The technique, which enables the creation of a neovagina with good anatomic and functional results, is a simple and effective procedure.
The principle of the Vecchietti technique is to create a neovagina by gradual stretching of the patient's own vaginal skin. An olive-shaped device is placed on the vaginal dimple and drawn up gradually by threads that run through the olive from the perineum into the pelvis and out through the abdomen, where they are attached to a traction device. To create a neovagina, the tension is increased on the traction device to pull the thread and stretch the vagina by approximately 1 to 1.
It is formed by emotional, relationship, and other social aspects. Furthermore, satisfaction with one's own body and perception can have substantial significance to female sexuality. The purpose of this study was to investigate the sexual well-being, satisfaction with genitals, and level of distress in women who have an anatomically functional neovagina but no Mayer-johnson wife sexual dysfunction for natural motherhood.
We wanted to determine whether these characteristics would be different from those of the general population and the views of sexual partners of women with a neovagina.
From through95 women with MRKHS underwent surgery at our gynecologic department using laparoscopic Vecchietti vaginoplasty. Of 95 letters sent out inviting them for a check-up, 9 were returned because of a change of address.
Fifty-five women 17 to 38 years old responded to our invitation, and 42 arrived for examination. All women had a heterosexual orientation and Mayer-johnson wife sexual dysfunction not taking any long-term medication.
Each woman was instructed about the essential regular use of a dilatator, application of a lubricant, and appropriate sexual positions before and after the operation. The investigation was performed during All interviews and investigations were performed by one gynecologist with a background in sexology and psychology. Semistructured interviews were conducted with all participants to identify anamnestic information and assess sexual partnerships. In addition, a structured interview with the patient's current partner was included in the research.
He was asked whether he was aware that partner had undergone the neovagina surgery, how satisfied he had been with his sexual life, and whether infertility might be a reason to leave the relationship. The control group consisted of 45 age-matched 18—38 years oldsexually active, childless patients who Mayer-johnson wife sexual dysfunction our contraceptive advisory services.
These women used the intrauterine delivery system containing levonorgestrel All had a heterosexual orientation and did not take any long-term medication. Exclusion criteria were age younger than 18 or older than 40 years, current or previous pregnancy, no sexual partner, history of gynecologic operations, or current severe gynecologic illness. Control subjects underwent the same tests and completed the same questionnaires.
They signed the informed consent, and their examination was performed during the same period and by the same expert as women with a neovagina. "Mayer-johnson wife sexual dysfunction" evaluating the sexual life of women with a neovagina, only the partners from a current relationship lasting longer than 1 year were included.
Information about their age, total number of sexual relationships, severe illness history, and sexual problems was collected. They were asked when they had found out about the partner's neovagina and whether they would leave the relationship based on infertility. The gynecologic examination consisted of assessing basic somatic characteristics body mass index, hair, and breasts Mayer-johnson wife sexual dysfunction primary focus on the genitals; assessment of external genitalia labia majora and minora, clitoris, vaginal introitus, urinary meatus, and perineum length ; and speculum examination vagina length and spaciousness, tissue estrogenization, vaginal discharge, strictures, and pelvic floor tone.
Vaginal length in women with a neovagina was measured as the distance from the posterior fourchette to the most proximal part of the blind-ending vagina by using a sketched scale on the investigator's index finger. Vaginal spaciousness was estimated based on the number of inserted fingers. If interested, these women could be included in a UTx program. Therefore, they were examined by ultrasound with a focus on the size and structure of the ovaries and assessment of follicular activity.
A basic hormonal evaluation was performed, including estradiol, follicle-stimulating hormone, and luteinizing hormone immunochemical analysis on days 3 to 5 and progesterone direct chemiluminescence on day 23 of the menstrual cycle to confirm a biphasic ovarian cycle. All women after vaginoplasty were genetically examined by karyotyping.
A non-validated, specially structured questionnaire about the general characteristics of their sexual life first postoperative intercourse, vaginal intercourse frequency, current sexual partner, length of current sexual relationship, total number of sexual partners, masturbation frequency, orgasm experience and satisfaction, and satisfaction with current sexual life was completed by all participants.
The comparison of the two groups of 45 women was initially planned, but three
Mayer-johnson wife sexual dysfunction with a neovagina did not come for the examination. Eventually, there were two statistically comparable groups Mayer-johnson wife sexual dysfunction 42 and 45 women to investigate. Statistical analysis was performed using SPSS All statistical tests were two-tailed.
The average time since neovagina creation with laparoscopic Vecchietti vaginoplasty was 4. We did not observe evidence of postoperative complications, vaginal stricture, scarring, or other anatomic irregularities.
No participants complained of vaginal discharge discomfort, dryness, or infections. All women had normal secondary sexual characteristics, 46,XX karyotype, and biphasic ovarian cycle according to hormonal and ultrasound examinations.
One woman, during the course of the study, opted for surrogate motherhood, and another adopted a child.
The control group consisted of 45 sexually active women with long-term partners and a mean age of The mean neovaginal length 7. Length of current long-term sexual partnership
Mayer-johnson wife sexual dysfunction was significantly longer 4.
The frequency of vaginal intercourse in the two groups was not significantly different. Women in the two groups masturbated with a similar frequency of approximately 2. Sexual function as indicated by FSFI total score was similar between groups, which did not significantly differ statistically However, the groups differed in four desire, lubrication, orgasm, and comfort of the six FSFI domains, with women with a neovagina reporting significantly more frequent orgasms and higher sexual desire but less lubrication and more discomfort pain during intercourse.
FGSIS assessment of genital perception showed a significantly lower score in women with a neovagina The mean age of the partners of women with a neovagina was At that time, the women had an average of 9. They did not have any severe illness or did not complain of sexual function disorders at the time of or before the study. Women with a neovagina disclosed their condition only to the partners they considered to Mayer-johnson wife sexual dysfunction possible life partners.
Short-term or casual sexual partners were not informed about their medical status. The main finding of our research is that women with MRKHS after laparoscopic Vecchietti vaginoplasty have an adequately spacious and functional neovagina to participate in coitus, with no problem.
They have a relatively satisfactory sexual life their FSFI score was not significantly different from the control groupbut they have more distress and lower satisfaction with their genitals. Female sexuality can involve various sexual practices, but vaginal coitus is the most frequently performed sexual activity of couples.
Female sexuality is determined by a broad complex of somatic, emotional, mental, partner, and social aspects. Satisfaction with one's own body and reproductive ability also are very important. Previous studies have evaluated sexual satisfaction based mainly on neovagina length, and they have focused less on other psychosocial aspects that are important for sexual life. According to Masters and Johnson, 34 the nulliparous vagina from the introitus to the posterior vaginal fornix measures 7 to 8 cm in Mayer-johnson wife sexual dysfunction unstimulated state and has a width of 2 cm.
However, the patients in our group did not complain of this problem.
The effect of treatment depends on the selected technique dilatation or surgerythe surgeon's experience, the patient's motivation and approach to sex, the partner's attitude, the interval from diagnosis to therapy, postoperative rehabilitation, and primarily psychological support. The management and comparison of various techniques are not subject of this study, because these have been summarized in other articles.
A shorter vagina was found mainly in patients who failed to comply with postoperative vaginal rehabilitation dilatation after the neovagina creation compared with women who followed recommendations.
Neglecting postoperative dilatation can result in shortening of an originally longer neovagina.
The frequency of vaginal discharge in women after laparoscopic Vecchietti vaginoplasty did not differ from the control group. As in most studies, no decrease in FSFI total score was observed in our study. Higher scores in the FSFI domains of desire and orgasm were found in women with a neovagina Mayer-johnson wife sexual dysfunction with the control group,
Mayer-johnson wife sexual dysfunction the hypothesis that sexual feelings are regulated at a central level and not always influenced by genital disorders.
However, studies evaluating the relation of orgasm and brain activity are widely discordant. Lower rates of achieving vaginal orgasm can be related to topographic and anatomic aspects of the clitoral complex and vaginas in women who have undergone surgery. Their lubrication also was worse, as in other studies.
This factor was attributed to the greater coital discomfort and more frequent dyspareunia reported in such patients.