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Intensive vaginal dilation using adjuvant treatments in women with Mayer‐Rokitansky‐Kuster‐Hauser syndrome: retrospective cohort study
Author(s) -
Ketheeswaran Ashradha,
Morrisey Jennifer,
Abbott Jason,
Bennett Michael,
Dudley Jan,
Deans Rebecca
Publication year - 2018
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12715
Subject(s) - medicine , dilator , cervical dilation , retrospective cohort study , cohort , adjuvant , surgery , gynecology , pregnancy , gestation , biology , genetics
Aims To evaluate the effect of adjuvants during intensive vaginal dilator therapy for functional and anatomical neovagina creation in women with Mayer‐Rokitansky‐Kuster‐Hauser syndrome ( MRKH ). Methods This retrospective cohort study included 75 women with MRKH undergoing intensive vaginal dilator treatment between 2000 and 2014. One specialist nurse performed non‐surgical vaginal dilation aided by adjuvants, during inpatient admissions for several dilation sessions per day. Following discharge, women continued dilation at home and were advised to attend fortnightly follow‐up appointments. Results Outcomes from 68 women were analysed. The median age of starting treatment was 18 years (range: 13–36). There was a mean of 3 days per admission (range 1–5) with a median of 10 dilation sessions per admission. Adjuvant treatment was used by 48/68 (71%) women: oestriol cream 29/68 (43%), 50:50 nitrous oxide and oxygen 44/68 (65%), diazepam 8/68 (12%), lidocaine ointment 26/68 (39%), paracetamol 35/68 (51%) and naproxen 2/68 (3%). There were no statistically significant differences for changes in vaginal parameters. Women receiving adjuvants had a median increase of 4.5 cm (0.5–7 cm) in neovaginal length compared with women not receiving adjuvants who had a median increase of 3.25 cm (0–7 cm) during intensive treatment. Women who received adjuvants tolerated more dilation sessions per day (10 vs 6.5 median sessions respectively) than those who did not ( P < 0.001). Of those with documented length at discharge, 42/56 (75%) women had an anatomical neovagina of 7 cm or greater length. Conclusions Vaginal dilation delivered by intensive treatment and supplemented by adjuvant treatments in a multi‐disciplinary centre is a rapid and effective method for creation of a neovagina in women with MRKH .