ESPE Abstracts (2016) 86 P-P1-339

Global and Sexual Quality of Life in Patients with Rokitanski Syndrome: A Comparative Study Between Surgical vs Non Surgical Management of Vaginal Agenesis in a French Cohort of 130 Patients

Maud Bideta,b, Alaa Cheikhelardb,c, Louis-Sylvestre Christineb,e, Paniel Bernard Jeanb,f, Morcel Karineh, Viaud Magalia,b, Baptiste Amandineg, Elie Carolineg, Aigrain Yvesb,c & Polak Michela,d


aDépartement d’Endocrinologie, Gynécologie et Diabétologie Pédiatriques, APHP Hôpital Necker Enfants Malades, Paris, France; bCentre de Référence des Pathologies Gynécologiques Rares, Paris, France; cDépartement de Chirurgie Pédiatrique Viscérale et Urologique, APHP Hôpital Necker Enfants Malades, Paris, France; dAffilie Institut Imagine, Paris, France; eService de Chirurgie Gynécologique, Institut Mutualiste Montsouris, Paris, France; fService de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, Creteil, France; gUnité de Recherche Clinique Paris Descartes Necker, Paris, France; hPôle Obstétrique, Gynécologique et Médecine de la Reproduction, CHU Rennes, Rennes, France


Background: Vaginal agenesis (VA) in MRKH syndrome can be managed either by surgery or autodilatations.

Objective and hypotheses: To compare different managements of MRKH-VA in terms of quality of life, sexual function, anatomical results and complications.

Method: National Multicentric observationnal study including 130 patients older than 18, at least one year after completing VA management, from October 2012 to April 2015. 84 had a surgical intervention (SG), 26 autodilatations (DG) and 20 spontaneous intercourse (IG). All had medical evaluation including normalized pelvic exam, and filled WHOQOL-BREF (General QOL), FSFI and FSDS-R (Sexual QOL) scales. Data were compared using ANOVA, Student, Kruskal-Wallis, Wilcoxon and Student’s exact tests.

Results: Mean age was 26.5 years (18–41). Delay between management and first intercourse was 6 months (NS). In SG 40% (N=34) had complications, requiring 20 secondary surgeries. In DG, 13 (50%) needed maintenance dilatations. Median vaginal depth was shorter (P=0.039) in DG (9.25 cm, Sd 1.88) compared to SG (11 cm, Sd 1.7) and IG (11 cm, Sd 1.67), but not between surgeries. 70 patients (53%) had dyspareunia (NS). In all groups, WHOQOL scores were similar to the general population except for a lower Social Interaction dimension score. Global FSFI scores showed similar significant sexual dysfunction in the SG and DG (respectively 25.95 and 24.5), but not in the IG (30.2, P=0.04), who had a higher score only in the Satisfaction dimension (P=0.004). However, the scores in other dimensions of FSFI were similarly low in all groups. The FSDS-R scores were respectively 17, 20 and 10 in the SG, DG and IG (NS), with a sexual distress in 71% of patients.

Conclusion: Surgery is not superior to dilatation in term of sexual function, bears more complications, and therefore is not advisable as a first line treatment. Psychological counselling seems essential at diagnosis and during therapeutical management.