University College Hospital, Institute of Women's Health, London, UK.
Sex Dev. 2010 Sep;4(4-5):292-9. doi: 10.1159/000316231. Epub 2010 Jul 24.
Patients with disorders of sexual development (DSD) requiring vaginal reconstruction are complex and varied in their presentation. Enlargement procedures for vaginal hypoplasia include self-dilation therapy or surgical vaginoplasty. There are many vaginoplasty techniques described, and each method has different risks and benefits. Reviewing the literature on management options for vaginal hypoplasia, the results show a number of techniques available for the creation of a neovagina. Studies are difficult to compare due to their heterogeneity, and the indications for surgery are not always clear. Psychological support improves outcomes. There is a paucity of evidence to inform management regarding the optimum surgical technique to use, and long-term data on success is lacking, particularly with respect to sexual function. In conclusion, vaginal dilators remain the cornerstone of treatment of women with vaginal hypoplasia and should be used as the first-line technique. Surgical vaginoplasty has a role in complex patients with previous failed dilation and surgical intervention, particularly those cases where there is significant scarring from previous surgery. Regardless of the vaginal reconstruction technique, patients should be managed in a multidisciplinary team where there is adequate emotional and psychological support available.
需要阴道重建的性发育障碍（DSD）患者表现复杂多样。阴道发育不全的扩大手术包括自我扩张疗法或手术阴道成形术。有许多阴道成形术技术已被描述，每种方法都有不同的风险和益处。回顾关于阴道发育不全管理选择的文献，结果显示有许多技术可用于创建新阴道。由于其异质性，研究很难进行比较，并且手术的指征并不总是明确。心理支持可改善结果。关于使用最佳手术技术的管理缺乏证据，并且缺乏长期的成功数据，特别是关于性功能。总之，阴道扩张器仍然是治疗阴道发育不全女性的基石，应作为一线技术使用。对于以前扩张失败和手术干预的复杂患者，手术阴道成形术具有一定作用，特别是对于那些由于先前手术而存在严重瘢痕的病例。无论采用何种阴道重建技术，患者都应在多学科团队中进行管理，以便提供足够的情感和心理支持。
