Laparoscopic Davydov-Moore vaginoplasty tied to satisfactory anatomic and sexual outcomes in MRKH syndrome: Study
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is defined as a congenital absence or hypoplasia of the uterus, cervix, and vagina due to malformations in the Müllerian ducts’ development, despite the presence of typical external genitalia. It affects 1 out of 5000 women with normal phenotypes and karyotypes (46, XX). Most of the cases are diagnosed between 15–17 ages due to primary amenorrhea. It is subdivided into two types, type 1 (MRKH I), related only to organs developing from the Müllerian ducts, and type 2, where additional malformations including renal and skeletal systems occur (MRKH II). The diagnostic process includes 3D ultrasonography or MRI of the pelvis along with hormonal assay.
The diagnosis of MRKH is not only connected to physical ailments, but also may have psychological impact related to an absence of menstruation, challenges with sexual activity along with the inability to conceive. In women with MRKH and desire for sexual activity, the treatment is a vaginal reconstruction. Treatment options include form non-invasive methods using dilators in case of the presence of a rudimentary vagina, to more invasive ones such as an operative creation of a neovagina or uterus transplantation, as the first true infertility treatment. Taking into account that no standardized treatment is maintained, the surgical approach is based on the operating surgeon’s experience. One of the most common surgical procedures used to create neovagina is Davydov vaginoplasty, which includes the use of peritoneal graft. It can be performed separately or combined with the procedure described by Moore et al., where vaginoplasty includes the reconstruction of the posterior vaginal canal and introitus together with the modification of the final diameter and caliber of the vagina.
Given the clinical significance of MRKH, author Magdalena Piróg and team investigated the postoperative outcomes and sexual satisfaction in women with MRKH following neovaginal creation after Davydov Moore vaginoplasty.
In the case-series study, authors described seven women, at a median age of 22.6± and BMI 22.8±2.3 kg/m2. They measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6 months after vaginoplasty.
All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1 min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81 mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22 weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times).
This study is the first to show that neovaginal creation with the Davidov-Moore approach is a safe treatment in women with MRKH. Authors also demonstrated the high effectiveness of the procedure reflected by prolonged vaginal length and good sexual function after this surgery.
In conclusion, laparoscopic Davydov-Moore vaginoplasty may be considered as a safe procedure with satisfactory anatomic and sexual outcomes, however, women need to be aware of possible complications. Further research is needed to investigate possible long-term outcomes and their clinical consequences.
Source: Magdalena Piróg, Magdalena Bednarczyk, Katarzyna Barabasz; Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-024-07830-6
