Vaginal aplasia: Critical overview of available treatment options

Abstract

Aim: To critically evaluate treatment options for patients with vaginal aplasia and present an algorithm taking into account the complexity, the advantages and the potential risks of each vaginoplasty method.Brief description of the reviewed data: Current available techniques for creating a neovagina range from conservative to complex surgical. No comparative studies exist between methods and at present most centers appear to prefer one method over another. Based on the best available evidence, it seems that vaginal dilation, being risk free and non-invasive, is the first line treatment option for patients with a vaginal dimple present and no previous perineal surgery. Patients with failed vaginal dilation should be directed to surgical traction techniques or peritoneal vaginoplasty depending on the presence or not of a vaginal dimple and on the familiarity of the surgical team with these techniques. Peritoneal vaginoplasty could be also applied in cases of failed surgical traction. Skin and intestinal vaginoplasties should be kept only for failures of other surgical techniques and for complex cases.Clinical implications: While the superiority of each method remains to be assessed objectively, we propose indications for each available method and a treatment algorithm.Open issues for further research: Evidenced based comparisons in the form of randomized controlled trials are required in order to objectively assess the place and superiority of each available method.