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 Students exact tests.
Results: Mean age was 26.5 years (1841). 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.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology