Stricture and Atresia of Vagina When Primary Vaginal Dilation Has Not Achieved Functional Goals
Primary vaginal elongation by dilation is the initial approach for stricture and atresia of vagina. This protocol addresses patients for whom that first-line strategy has not reached its intended functional endpoint and a structured next-line plan is required.
Prior Treatment and Failure Criteria
The previous line — primary vaginal elongation by dilation (progressive dilators applied to the distal vaginal apex) — is considered unsuccessful when it has not achieved anatomic and functional success: a vagina functional for comfortable sexual activity, or a vaginal length meeting accepted anatomic criteria.
Next-Line Approach
When dilation has not met its goals, guidelines address surgical creation of a neovagina (vaginoplasty) as the next step. Multiple operative techniques are described in the evidence base. The full protocol specifies which procedure applies to the clinical situation and what postoperative management is required.
The clinical goal of this line is creation of a vaginal canal that allows penetrative intercourse.
References
DOI: 10.1097/AOG.0000000000002458
- Because primary vaginal dilation is successful for more than 90–96% of patients, surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy (26, 27) or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s).
- The primary aim of surgery is the creation of a vaginal canal to allow penetrative intercourse.