An observational study of women with müllerian agenesis and their need for vaginal dilator therapy.

OBJECTIVE: To assess vaginal development, sexual activity, and the efficacy of vaginal dilator therapy in women with vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).

DESIGN: Retrospective case review.

SETTING: Tertiary referral university teaching hospital clinic for disorders of sexual development and differentiation (DSDD).

PATIENT(S): Eighty cases of Rokitansky syndrome.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Sexual activity and vaginal dimensions.

RESULT(S): The retrospective case review examined vaginal dimensions and sexual activity at presentation with further evaluation at completion of vaginal dilator therapy. Eleven of 80 patients had undergone surgery in the past; six of these 80 women had received dilator training elsewhere, and four were sexually active. Sixty-three of 80 patients had not undergone any previous treatment. Seventeen were having satisfactory sexual intercourse, 16 were having unsatisfactory sexual intercourse, and 26 had never been sexually active; for four women, no information had been recorded. A total of 32 patients underwent vaginal dilator treatment, and 25 completed the therapy. Their vaginal length increased from 3.2 cm (range: 0 to 7 cm) to 6.1 cm (range: 3 to 9 cm).

CONCLUSION(S): Diagnosis and management of müllerian agenesis may be achieved without the need for surgery in the majority of cases. Dilator treatment for vaginal agenesis should be offered as first-line treatment, coordinated by a specialist nurse with input from a psychologist.