title: Functional, social and psychosexual adjustment after vaginal reconstruction.
abstract: OBJECTIVE
  We assessed the long-term functional, social and psychosexual outcome in children who underwent vaginal reconstruction.
  
  
  METHODS
  We interviewed and assessed the psychological development of 16 women 17 to 28 years old (mean age 22) who underwent vaginal reconstruction only or in combination with other urogenital reconstructive procedures at ages 11 months to 18 years (mean 8.8). Psychological measures included the Beck Depression Inventory, Draw-a-Person test and Linkowski acceptance of disability scale as well as a standard questionnaire evaluating the sexual adjustment, social adjustment and ability for self-support of these women.
  
  
  RESULTS
  Mean Beck Depression Inventory was 8.5 with less than 9 defined as minimal depression. Mean acceptance of disability score was 83.9 (range 54 to 94), indicating that patients were well adjusted with respect to the disability. Functionally 10 women were satisfied with the appearance of the vagina, 4 were neutral and 2 were dissatisfied. A total of 12 patients had no doubts about their female identity but 2 had occasional, 1 had significant and 1 had chronic doubts. Of the 16 patients 12 have completed high school, 3 are still in high school and 1 has withdrawn from high school. Of the 12 women who have completed high school 9 are currently in college and 3 have completed college. Socially all 16 participants rated family relationships as good and 13 were at least satisfied with their social life. Of the 16 women 12 have had a sexual encounter, including 1 who did not achieve orgasm. Six women are involved in long-term relationships, of whom 1 is married. In regard to the future all patients believe that they will be independent and financially stable with a fulfilling career.
  
  
  CONCLUSIONS
  While women who have undergone vaginal reconstruction may be at risk for avoiding interpersonal relationships and sexual intimacy, we did not note this finding in our series. The majority of these patients were well adjusted to their physical condition, and had a high level of education and a stable family life.
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Vates
authors.forename: P
authors.initials: P
authors.lastname: Fleming
authors.forename: J P
authors.initials: JP
authors.lastname: Leleszi
authors.forename: J S
authors.initials: JS
authors.lastname: Barthold
authors.forename: R
authors.initials: R
authors.lastname: González
authors.forename: A D
authors.initials: AD
authors.lastname: Perlmutter
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D011606:Psychosexual Development; D012917:Social Adjustment; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery*