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Long-term urologic and gynecologic follow-up in anorectal anomalies: The keys to success
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Geri Hewitt, Daniel G. DaJusta, Christina B. Ching
If after careful evaluation the discharge is deemed physiologic, vaginal irrigation may help minimize the symptoms. This patient does not need vaginal dilation because she has no problem with penetrative sexual activity. Suppressive antibiotics will not impact the physiologic mucous secretions. Patients with bowel neovaginas require ongoing preventive reproductive care including contraception, screening for STIs, and HPV vaccination. Cytology screening is not recommended if the cervix is absent.
Variation of sex differentiation
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Anne-Marie Amies Oelschlager, Margarett Shnorhavorian
Vaginal dilation and surgery: Most patients with a well-developed distal vagina, for example, patients with CAIS and Mayer-Rokitansky-Küster-Hauser syndrome, are able to elongate the vagina without surgery through primary vaginal dilation with dilators or coital activity.74 With proper coaching and support, 86%–95% of patients will achieve adequate vaginal length with primary vaginal dilation alone.75 Compared to vaginoplasty, there is no significant difference in sexual desire, arousal, and satisfaction, but dilation is more cost effective than surgical intervention ($796 versus $18,520) and has much lower risk of complications.76 The process of vaginal dilation should be delayed until after puberty and when the patient herself is ready and committed to the process.
Vaginismus and Non-Consummation
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
Women presenting to clinic have often searched for diagnoses and interventions for their ‘vaginismus’ and may have purchased vaginal ‘dilators’ to help ease or widen the vagina. Although there is an understanding of the abnormal contraction of the vaginal muscles, the degree of physical control is frequently misunderstood by both patient and HCP. The contraction of the pelvic floor muscles is not necessarily seen as a protective mechanism but as something to be overcome. There is perceived to be a state of contracture of the muscles, for example as seen in scarring, that needs to be actively stretched and eased, rather than engagement in the physical and psychological relaxation of the normally functioning but abnormally reacting muscles. This requires an ability to squeeze as well as relax. For this reason, the coercion of the chaperone in a consultation, or the partner during intercourse, to ‘just relax’ will be counterproductive. The use of alcohol or locally acting muscle relaxants will also generally be unsuccessful as any sensation of pressure or pain will cause an involuntary spasm that will reinforce the separation of the mind and body.
Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Oluwasomidoyin Olukemi Bello, Imran Oludare Morhason-Bello, Olatunji Okikiola Lawal, Rukiyat Adeola Abdus-Salam, Ayodele Olukayode Iyun, Oladosu Akanbi Ojengbede
The management of AG may be non-surgical or surgical depending on the extent of tissue damage and degree of vaginal scarring. The non-surgical technique involves serial vaginal dilation with graded dilators. Surgical procedures like neovaginoplasty, flap or skin graft, buccal mucosa graft, oxidative cellulose and amnion membrane allografts have been used with varying degrees of success (Unuigbe et al.1984; Arowojolu et al. 2001; Kapoor et al. 2006; Ugburo et al. 2011). Pudendal thigh flap allows for robust tissue mobilisation that can be used to construct a neovagina while maintaining the natural angle and sensation. However, this may be complicated with hair growth and numbness of the vagina (Ugburo et al. 2011). Sigmoid vaginoplasty gives good results with the achievement of a good vaginal length and width because of its large lumen and adequate lubrication with a decreased need for postoperative dilation and a short recovery period. Its disadvantages include excess mucus production, prolapse of a neovagina, postoperative shrinking, and occurrence of colon diseases like ulcerative colitis and adenocarcinoma in the neovagina (Kapoor et al. 2006; Rawat et al. 2010; Kondo et al. 2012; Alsaleh et al. 2014; Ruegner et al. 2014; Kölle et al. 2019).
The XY Female: Exploring Care for Adolescent Girls with Complete Androgen Insensitivity Syndrome
Published in Comprehensive Child and Adolescent Nursing, 2020
A shortened vagina is common in girls with CAIS, and penetration difficulties are likely to occur when they become sexually active. This can be managed with vaginal dilation techniques, alongside nursing and psychological support, and can be successful in around 80% of cases (Michala & Creighton, 2010). Surgery is also an option, such as vaginoplasty. If these avenues are not explored, then it has been shown that women can be unhappy with the length of their vagina, resulting in a lack of sexual confidence and sexual satisfaction (Fliegner et al., 2014), although reports of orgasm satisfaction are reassuring (Sandberg, 2018), and the role of testosterone therapy in female sexuality has yet to be explored fully. Therefore, the balance between endocrinological and psychological interventions needs to be addressed in order to optimize physical and mental wellbeing; regular vaginal dilation should be encouraged, which can result in a depth sufficient for penetrative intercourse (Wilson et al., 2011)
The importance of topical steroids after adhesiolysis in erosive lichen planus and graft versus host disease
Published in Journal of Obstetrics and Gynaecology, 2019
S. Rajkumar, F. Lewis, R. Nath
Sixteen patients were identified from the vulval clinic database who had undergone surgery for severe vulvo-vaginal disease secondary to either the VVG syndrome (8 patients) or GVHD (8 patients) between January 2009 and September 2015. The preoperative symptoms and signs were recorded in the hospital notes. All of the patients were referred to a single gynaecologist for surgical management and details of the procedure were recorded. Following the surgery, a standard regimen of post-operative topical steroids was used. The patients were discharged with instructions to apply clobetasol propionate 0.05% ointment once daily to the vulva in conjunction with daily intravaginal Colifoam® (10% hydrocortisone acetate foam) if vaginal lesions were present. This was used daily for an initial period of 2 weeks and then reduced to alternate days for 2 weeks and then to twice weekly for 4 weeks. After two weeks, vaginal dilators were used daily. A follow-up assessment was done at 2 weeks, recording symptoms and signs and repeated at 6 weeks, 6 months, 1 year and 2 years following the surgical treatment.