Restorative Surgeries for Congenital Vaginal Defects

Development of the female genital tract is a complex process. Failure of any one of these processes results in a congenital defect.

Anomalies of the hymen and vagina may interfere with menstruation, sexual activity, fertility, or childbirth. These typically present after puberty and with delay in menstruation. 

Our approach is to work with patients and their families to determine the least invasive and most effective approach, and to ensure that the timing of the surgical repair takes into consideration each patient’s goals, physical and emotional maturity, and desire to undergo the procedure. 

Symptoms associated with this condition

• Cyclic pelvic pain with delay in menstruation 
• Absence or shortening of the vagina
• Absence of menses (“primary amenorrhea”) 
• Inability to perform intercourse 
• Pain and discomfort during intercourse

Surgical Treatments

Hymenoplasty for Imperforate Hymen

For some young women, the hymen completely covers / blocks the vaginal opening.   Opening the hymen, known as “hymenoplasty”, is a simple outpatient procedure that can be performed at any age, and is associated with a quick recovery. 

Vaginal Septum Removal and Vaginoplasty 

Vaginal septum refers to an extra flap of skin running across the vaginal tube. When the septum runs across the vaginal tube it is called transverse, and when it runs parallel to the vaginal tube it is called longitudinal. These disorders can be resolved with fairly simple outpatient vaginal surgery for the vast majority of patients. Treatment involves complete resection of the septum, with care to avoid compromise to the bladder and rectum. “Vaginoplasty” refers to plastic surgery to restore the normal vaginal shape, and is often a component of vaginal septum removal.  

Treatments for Vaginal Agenesis 

Vaginal Agenesis refers to the congenital absence of the vagina. If you’ve been diagnosed with this condition, you’re not alone. This condition is more common than often assumed and treatments are available. Vaginal length and function can be created using several techniques. Patients with vaginal agenesis who wish to become sexually active will need the creation of what is referred to as a “neovagina.” This process does not always require surgery, and we often assist young patients with dilators and physiotherapy, which in some cases may be all that’s needed. However when surgery is required to establish normal vaginal shape and function, our team is skilled and experienced in several minimally invasive surgical methods.

McIndoe Procedure for Vaginal Agenesis 

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), also known as Vaginal Agenesis, is a condition affecting around 1 in 5000 women, leading to absence of the vagina despite functioning ovaries producing normal female hormones. The McIndoe Procedure is a traditional operation performed to create a new vaginal tube or “neovagina.” This vaginal procedure is often performed after an initial attempt at vaginal dilation to create at least a small amount of vaginal length. At our center, we have particular expertise utilizing soft biological grafts that are commercially available, allowing us to construct a neovagina without harvesting a graft from the patient. This operation is performed vaginally, with no abdominal incision. We have used biografts in hundreds of cases over the past 20 years, and for certain MRKH cases it provides a great option, performed in less than an hour usually on an outpatient basis.  

Modified Vecchietti Procedure

This operation, also for the treatment of MRKH / Vaginal Agenesis, is an excellent option that creates a functioning vagina while requiring no graft or implant. The procedure involves creation of a neovagina using an acrylic “olive” that is placed against the vaginal dimple, and then is attached to a traction device that rests on the abdomen and is secured with an elastic belt. The attachment between the dilator olive, and the traction device, is made using a suture (stitch) that is placed using a laparoscopic (‘keyhole’) technique. Gradual traction is applied to the olive to produce 1.0 to 1.5 cm of vaginal length each day, and this process results in normal vaginal length in approximately 7-9 days. Once the neovagina has been created, active dilation is required until regular sexual activity is initiated. Success rates for the Vechietti procedure are excellent. Patients typically require an overnight stay in the hospital, with the timing of hospital stay determined by how quickly the vagina dilates, and also the patient’s degree of comfort with the procedure.