1. No category

Vaginal Dilation in Mayer Rokitansky Kuster
Hauser (MRKH) Syndrome
Ashradha Ketheeswaran, Jennifer Morrisey,
A/Prof Jason Abbott, Dr. Rebecca Deans
Background and Objectives
Results
Patients with MRKH have failed formation of
Mullerian ducts causing an absent uterus
and shortened/absent vagina. Vaginal
dilation is the mainstay of treatment. The
aim of our study was to evaluate the effect
of adjuvant and analgesic agents at the time
of vaginal dilator therapy for the creation of
a functional neovagina in MRKH patients.
Demographics
-Median age at diagnosis: 17 years, (range
11-28); Median age beginning
treatment: 18 years, (range: 13-36)
-Median hospital admission length: 3
days, (range 1-5)
-Median episodes of treatment per
admission: 9, (range 2-15)
-60/63 (95%) of patients used adjuvants
during treatment
Functional Outcomes
-29/30 (97%) who had attempted
intercourse were satisfied posttreatment
-1/30 (3%) had tried unsuccessfully to
have sexual intercourse
Anatomical Outcomes
-Median change in vaginal length: 3.5cm
-Median change in vaginal width: 1.75cm
- 30/46 (65.2%) of patients had a full
anatomical neovagina (7cm or greater
in length) by the end of intensive
therapy
- 27/28 (96%) of patients achieved a
neovagina of 7cm or greater by first
follow up; median length to first
follow up: 46 days
Methods
Between 2000 and 2014, seventy-two
women with MRKH receiving vaginal dilator
treatment were identified from a tertiary
hospital. One specialist nurse performed the
intensive dilator treatments and
administered adjuvants, and counselled
subjects. Treatment consisted of a specialist
nurse-guided dilation sessions of one hour
length, several times per day depending of
patient’s motivation and ability to cope.
Adjuvant therapies used in conjunction with
dilation included; topical estriol cream,
anxiolytics (oral and inhaled), local
anaesthetic gels and oral analgesia.
Relevant patient demographics and
treatment outcomes were collected and
analysed
Vaginal length pre-Tx: 3cm (range: 0-7.5)
Vaginal length post-Tx: 7.25cm (range: 3-12)
p≤0.0001
0
Vaginal width pre-Tx: 1.75cm (range: 0-3.5)
Vaginal width post-Tx: 3.5cm (range: 1-4)
P≤0.001
Conclusion
Vaginal dilation delivered by
intensive treatment with the
use of adjuvants in a multidisciplinary context is an
effective first line treatment
for women with MRKH in the
creation of a neovagina.
References
1. Burel A, Mouchel T, Odent S, et al. Role of HOXA7 to HOXA13 and
PBX1 genes in various forms of MRKH syndrome (congenital absence of
uterus and vagina). J Negat Results Biomed. 2006; 5:4.
2. Ismail-Pratt IS, Bikoo M, Liao LM, et al. Normalization of the vagina by
dilator treatment alone in Complete Androgen Insensitivity Syndrome
and Mayer-Rokitansky-Kuster-Hauser Syndrome. Hum Reprod. 2007;
22:2020-2024.
3. Nakhal RS, Creighton SM. Management of vaginal agenesis. J Pediatr
Adolesc Gynecol. 2012; 25:352-357.