Long-term results after operative correction of vaginal aplasia

OBJECTIVE: We evaluated the long-term results after operative correction of vaginal aplasia with special interest in sexual and psychologic rehabilitation. STUDY DESIGN: Forty-four patients who had undergone surgical construction of an artificial vagina took part in follow-up. The operative result was assessed by a gynecologic examination. A structured interview and five questionnaires allowed an evaluation of psychosexual rehabilitation. RESULTS: The measured length of the vagina ranged between 3.5 and 15 cm. Unimpaired sexual intercourse could be ensured in a vagina with a minimum length of ≥6 cm. The early onset of regular sexual intercourse played an important role for the long-term success of the operation. Patients were considered for an operation if they had a steady partner and hence could guarantee early and regular coitus. This concept was substantiated in our follow-up investigation. The increase in self-confidence thanks to sexual rehabilitation was striking. In a preoperative and postoperative survey 27 of the 44 patients displayed an impressive increase in self-confidence. However, infertility still posed a problem after successful surgical intervention. The overwhelming majority of patients were still depressed about infertility many years after the operation. One way to solve this problem may be adoption. CONCLUSIONS: After surgery 82% of patients achieved a functional satisfactory postoperative result combined with overall psychosexual rehabilitation. An intensification of medical and psychologic care after discharge could further improve the long-term results. Special support is needed to solve the problem of infertility. (Am J Obstet Gynecol 1996;175:617-24.)