title: Primary vaginal dilation for vaginal agenesis: strategies to anticipate challenges and optimize outcomes.
abstract: Primary vaginal dilation is patient controlled, safe, less painful, and much lower cost compared with operative vaginoplasty and is considered first-line treatment for vaginal agenesis for women with Mayer-Rokitansky-Küster-Hauser syndrome and androgen insensitivity syndrome.
  
  
  
  This review will highlight studies that assess the optimal methods of primary vaginal dilation and clarify ideal counseling, frequency of dilation, management of side-effects, and long-term physical and psychological outcomes.
  
  
  
  Providers who care for women with vaginal agenesis should be prepared to not only teach the technical skill of dilation, but also to assess readiness and troubleshoot symptoms associated with dilation.
authors.affiliation: aDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington bDepartment of Obstetrics and Gynecology, Hofstra-Northwell School of Medicine, Hempstead, New York, USA.
authors.forename: Anne-Marie Amies
authors.initials: AM
authors.lastname: Oelschlager
authors.forename: Katherine
authors.initials: K
authors.lastname: Debiec
authors.forename: Heather
authors.initials: H
authors.lastname: Appelbaum
mesh_terms: D058489:46, XX Disorders of Sex Development; D000728:Androgens / Q000378:metabolism; D000013:Congenital Abnormalities / Q000601:surgery*; D004106:Dilatation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D009095:Mullerian Ducts / Q000002:abnormalities; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery; D014623:Vaginal Diseases / Q000601:surgery*
chemical_list: D000728:Androgens