Congenital Absence of the Vagina, Treated by Means of an Indwelling Skin-Graft

Abstract

The patient now showv-n underwent an operation six months ago for the formation of an artificial vagina. She was referred to us by Mr. Chapman of Grimsby who, on examination, had found no trace of a vagina and advised her to come for treatment as the question of nubility had arisen. Examination, under an aniesthetic, revealed complete absence of the vagina, but a fairly well-formed vulva was present. On rectal examination a small knob was felt in the position of the uterus, but there was no trace of ovaries. The secondary characteristics were entirely feminine. Operation was decided upon and carried out on September 27, 1937, as follows:-A hollow vulcanite mould, completely closed at both ends, had been previously prepared by our dental colleague Mr. Alexander Kay, roughly the size and shape of a distended virgin vagina (fig. 1). This was intended to carry the skin-graft and to I~~~~~~~~~~ _ FIG. 1.-Hollow vulcanite mould uised to carry the skin graft. maintain the patency of the vagina during the entire contractile phase. A thin razor-graft was first cut from the inner surface of the left thigh where hair was least apparent. This graft was roughly 9-1 in. long by 2j in. wide. The patient was then placed in the lithotomy position and thorough sterilization of the vulva was carried out, care being taken to see that the anus was excluded from the operative field. An incision was made from a point half an inch posterior to the urethral meatus and carried vertically backwards to a point three-quarters of an inch in front of the anus. The plane of cleavage between the rectum and the bladder was then entered and by blunt dissection a cavity was established which was gradually enlarged upwards until it would just accommodate, under moderate tension, the vulcanite mould previously prepared. Bleeding proved to be almost negigible, and a dry field was easily obtained. The mould was then painted with mastisol and covered with the skin graft. raw surface outwards, in such a way that the combination of adhesive and the lie of the graft prevented the skin rucking-off during insertion. The skin-covered mould was finally inserted into the cavity and the labia minora were freshened and