title: Secondary vaginoplasty for disorders for sexual differentiation: is there a right time? Challenges with compliance and follow-up at a multidisciplinary center.
abstract: OBJECTIVE
  We present the experience of a multidisciplinary center for disorders of sexual differentiation (DSD) in treating females requiring vaginoplasty. Specifically, we evaluate outcomes and compliance with follow-up protocols in patients undergoing secondary vaginoplasties.
  
  
  METHODS
  We retrospectively reviewed consecutive DSD patients who underwent feminizing genitoplasties in 2006-2010. A subset of patients were instructed in vaginal self-dilation at time of secondary vaginoplasty. Through follow-up visits and administered questionnaires we assessed outcomes, compliance and overall satisfaction.
  
  
  RESULTS
  Twenty-two feminizing genitoplasties were completed during the study interval. There were no postoperative complications; average blood loss was 74 ml and mean length of stay was 3 days. Ten females underwent secondary vaginoplasty. The response rate to questionnaires was 5 of 9. Age of initiation for self-dilation ranged from 8 to 24 years. Initial compliance two months postoperatively was good, but diminished 12-24 months after surgery. Responses to the quality-of-life questionnaire were diverse, reflecting a range of patient ages and varied experiences.
  
  
  CONCLUSIONS
  A multidisciplinary, comprehensive approach is necessary to care for patients with DSD due to psychosexual, medical and reconstructive concerns. A secondary vaginoplasty to facilitate menarche and psychosocial concerns is feasible with minimal complications, though compliance and toleration with regard to post-surgical dilation regimens is variable.
authors.affiliation: Pediatric Urology, Department of Urology, University of Minnesota, Amplatz Children's Hospital, 420 Delaware Street, SE, MMC 394, Minneapolis, MN 55455, USA. willi293@umn.edu
authors.forename: Katie H
authors.initials: KH
authors.lastname: Willihnganz-Lawson
authors.forename: Sumit
authors.initials: S
authors.lastname: Isharwal
authors.forename: Jane M
authors.initials: JM
authors.lastname: Lewis
authors.forename: Kyriakie
authors.initials: K
authors.lastname: Sarafoglou
authors.forename: Anne
authors.initials: A
authors.lastname: Boisclair-Fahey
authors.forename: Aseem R
authors.initials: AR
authors.lastname: Shukla
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004106:Dilatation; D012734:Disorders of Sex Development / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007223:Infant; D010349:Patient Compliance; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D012648:Self Care; D014621:Vagina / Q000473:pathology / Q000601:surgery*; D055815:Young Adult