title: The clinical, structural, and biological features of neovaginas: a comparison of the Frank and the McIndoe techniques.
abstract: To compare two methods of neovagina construction, the Frank and McIndoe techniques, in terms of structural and biological aspects.
  
  
  
  A total of 55 subjects were included in this retrospective study: 43 underwent the Frank technique (FT) and 12 underwent the McIndoe technique (MT). A clinical evaluation and a comparison of the structural (color, shine, presence of hair, and histology) and biological (bacteriological, pH, and hormonal determinations) features were performed. Statistical analysis was performed using the Fisher and Mann-Whitney tests.
  
  
  
  The time to achieve a functional neovagina using the FT was longer than when using the MT (9.8±5.3 versus 5.8±2.9 months) (p=0.01). The neovaginal wall of the MT skin grafts was more rigid and drier, and it did not exhibit a shine in the way that the FT skin grafts did. The lining of the cavity formed by the FT in all subjects was similar to that of vaginal mucosa, whereas the lining formed by the MT persisted as a skin graft in 83.3% of the cases. The pH was lower for the FT (p<0.01), and Döderlein bacilli were present in 90% of the FT neovaginas but absent from the MT neovaginas. In the latter, flora with anaerobic bacteria was present. Hormonal cytology showed estrogen activity in 100% of the FT neovaginas, but there was no such activity in the MT neovaginas.
  
  
  
  Our data suggest that the FT may be clinically, structurally, and biologically superior to the MT for the creation of neovaginas and is also less costly.
authors.affiliation: Disciplina de Ginecologia, Faculdade de Medicina, Universidade de São Paulo, Brazil. Electronic address: Sylvia.hayashida@gmail.com.
authors.forename: Sylvia A
authors.initials: SA
authors.lastname: Hayashida
authors.affiliation: Disciplina de Ginecologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Soares
authors.affiliation: Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: Elaine M F
authors.initials: EM
authors.lastname: Costa
authors.affiliation: Disciplina de Ginecologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: Angela M
authors.initials: AM
authors.lastname: da Fonseca
authors.affiliation: Disciplina de Ginecologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: Gustavo A R
authors.initials: GA
authors.lastname: Maciel
authors.affiliation: Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: Berenice B
authors.initials: BB
authors.lastname: Mendonça
authors.affiliation: Disciplina de Ginecologia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Baracat
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000601:surgery; D000293:Adolescent; D000328:Adult; D003116:Color; D000013:Congenital Abnormalities / Q000601:surgery; D004414:Dyspareunia / Q000209:etiology; D004967:Estrogens / Q000032:analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D009092:Mucous Membrane / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009095:Mullerian Ducts / Q000002:abnormalities / Q000601:surgery; D012189:Retrospective Studies; D019529:Sexuality; D016038:Skin Transplantation; D019738:Surgically-Created Structures / Q000382:microbiology / Q000502:physiology; D014621:Vagina / Q000002:abnormalities / Q000033:anatomy & histology* / Q000382:microbiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D004967:Estrogens
keywords: Frank technique; McIndoe technique; Primary amenorrhea; Vaginal agenesis