Hum. Reprod. Advance Access originally published online on June 24, 2005
Human Reproduction 2005 20(10):2954-2957; doi:10.1093/humrep/dei152
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Gynaecology |
Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia
1 Department of Obstetrics and Gynecology, 2 Department of Reproductive Medicine, Hopital E.Herriot, 69437 Lyon, cedex 03, France and 3 Department of Obstetrics and Gynecology, Ospedale San Martino, 16132 Genova, Italy
4 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Pavillon L, Hopital E.Herriot, 69437 Lyon, cedex 03, France. E-mail: patrice.mathevet{at}chu-lyon.fr
BACKGROUND: Several surgical techniques have been described for the treatment of patients with vaginal agenesis. The simplest intervention that gives good sexual results should be the surgical technique of choice. METHODS: We report anatomic and functional outcome in 28 women after vaginoplasty using laparoscopic Davydov operation. This surgery includes three steps: two laparoscopic and one perineal. The patient then has to use a mould or a vaginal dilatator for 1 month. The functional outcome was assessed by a brief and valid self-report questionnaire evaluating female sexual life (Female Sexual Function Index, FSFI). A control group was recruited to compare the results. RESULTS: Two intra-operative bladder and ureteric injuries were repaired without sequels. Two post-operative complications were observed: one abdominal migration of the mould, which was treated successfully with the laparoscope, and one vesico-vaginal fistula. No patient was lost to follow-up. The anatomical result was judged to be satisfactory (>6 cm) in 26 of the 28 patients: the mean vaginal length was 7.2 ± 1.5 cm. Among the 28 operated women, 19 had a good or very good result. No statistical difference was found between our operated patients and French controls in all six domains of the FSFI. CONCLUSIONS: Laparoscopic Davydov may be considered a good option for the surgical treatment of women presenting vaginal agenesis. This technique offers advantages such as: short operating time and hospital stay, no particular instrumentation required and no external scars. Sexuality approaches so-called ‘normal sexuality’.
Key words: laparoscopic Davydov/peritoneum/Rokitansky syndrome/sexuality/vaginal agenesis