Congenital absence of the vagina--results of conservative treatment.
OBJECTIVE
To assess the efficacy of a combination of Frank's mold therapy with intercourse as a treatment for congenital vaginal aplasia.


METHODS
From 1973-1993, thirty-three patients with congenital aplasia of vagina and uterus were seen by one gynecologist. Patients with a partner were instructed how to create a functional vagina by a modified form of coitus ('interfemoral intercourse'). Mold therapy (using modified molds) was used as a primary treatment when patients had no partner (n = 9) or added to the treatment of nine patients in whom interfemoral intercourse alone had failed. In case of failure of conservative treatment, the surgical creation of a neovagina (McIndoe procedure) was offered.


RESULTS
Conservative therapy in patients with a stable sexual relationship (n = 24) gave significantly better (p = 0.0104) results than when patients were single. In the former, a vaginal depth of > 8 cm was reached within six months at most with intercourse alone and four months if combined with mold therapy. With molds alone, 3 out of 9 obtained a satisfactory vagina. Treatment failures occurred (with one exception) only in patients who had no or unstable sexual relationships.


CONCLUSIONS
Intercourse as a treatment of vaginal atresia can be very successful, especially if practised together with modified mold therapy. A stable sexual relationship--implying a healthy self-concept--appears to be an important determinant of treatment outcome.
Lappöhn
R E
RE
Department of Obstetrics and Gynecology, Academisch Ziekenhuis Groningen, The Netherlands.
D000293:Adolescent; D000328:Adult; D001187:Artificial Organs / Q000592:standards*; D002648:Child; D003075:Coitus / Q000502:physiology; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D014599:Uterus / Q000002:abnormalities / Q000502:physiology; D014621:Vagina / Q000002:abnormalities* / Q000502:physiology / Q000601:surgery