Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, Ghent, Belgium.
J Sex Med. 2012 Jul;9(7):1842-51. doi: 10.1111/j.1743-6109.2012.02747.x. Epub 2012 Apr 30.
In patients with disorders of sex development requiring creation of a neovagina, a number of techniques are available, including surgical vaginoplasty and self-dilation therapy. Vaginal dilation therapy has been recommended as a first-line treatment because of its less invasive character and high success rate. However, no data exist on long-term psychosexual functioning after vaginal dilation as compared with that after vaginal surgery.
The aim of this study is to compare the psychosexual and anatomical outcome of women with congenital vaginal hypoplasia followed in the same clinical setting after vaginoplasty with that after vaginal dilation.
The sexual quality of life of 35 women at least 2 years after vaginoplasty (N = 15), vaginal dilation therapy (N = 8), or coital dilation/no treatment (N = 12) was investigated and compared with the Dutch test validation population (as control).
Psychosexual functioning was assessed with the female sexual Function index, the female sexual distress scale-revised, and a semi-structured interview. A gynecological examination was performed to determine the anatomical outcome after both vaginal treatment regimens.
After either treatment, 26% of these women had a shortened vaginal length of less than 6.6 cm, i.e., more than two standard deviations below the published mean value (9.6 ± 1.5 cm). Irrespective of the treatment, 47% of the patients had (a) sexual dysfunction(s) and experienced sexual distress. However, after vaginoplasty, patients reported significantly more problems with lubrication (P = 0.025) than after self-dilation therapy.
Both psychological and physical factors are predisposing for sexual difficulties. To optimize psychosexual comfort, the clinical management of women with vaginal hypoplasia needs to be multidisciplinary and individually tailored. With high success rates reported, vaginal dilation should remain the cornerstone of treatment.
在需要创建新阴道的性发育障碍患者中，有多种技术可供选择，包括手术阴道成形术和自我扩张疗法。阴道扩张疗法因其侵袭性较小和成功率高而被推荐为一线治疗方法。然而，与阴道手术后相比，目前尚无关于阴道扩张后长期的性心理功能的数据。
本研究旨在比较在同一临床环境中接受阴道成形术和阴道扩张治疗的先天性阴道发育不良女性的性心理和解剖结局。
至少 2 年接受阴道成形术（N=15）、阴道扩张治疗（N=8）或性交扩张/无治疗（N=12）的 35 名女性的性健康状况进行了调查，并与荷兰测试验证人群（作为对照组）进行了比较。
性心理功能采用女性性功能指数、女性性困扰量表修订版和半结构化访谈进行评估。进行妇科检查以确定两种阴道治疗方案后的解剖结局。
两种治疗方法后，这些女性中有 26%的阴道长度短于 6.6cm，即比公布的平均值（9.6±1.5cm）短两个以上标准差。无论采用何种治疗方法，47%的患者存在（一种或多种）性功能障碍并经历性困扰。然而，与自我扩张治疗相比，阴道成形术后患者报告的润滑问题明显更多（P=0.025）。
心理和生理因素都会导致性困难。为了优化性心理舒适度，需要对阴道发育不良的女性进行多学科和个体化的临床管理。由于报道的成功率较高，阴道扩张应仍然是治疗的基石。
