Vaginal Reconstruction Techniques in Congenital Agenesis

Congenital vaginal agenesis, most commonly encountered in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is characterised by the absence or severe underdevelopment of the vagina and often of the uterus in otherwise phenotypically normal 46XX females. Left untreated, it impairs sexual function, fertility options and psychosocial well-being. Therapeutic strategies span non-surgical methods, notably progressive dilation of the vaginal dimple, and a variety of surgical approaches. Classic operations include the McIndoe technique, which creates a neovaginal canal lined with split-thickness skin grafts; the Vecchietti procedure, in which gradual traction on a pelvic mould generates a new canal; and the Wharton-Sheares-George vaginoplasty, which mobilises adjacent perineal tissues. More complex interventions transplant segments of intestine or employ peritoneal tissue (Davydov procedure) to form a neovagina with mucosal characteristics. Emerging modalities encompass tissue-engineering platforms that combine biodegradable scaffolds with autologous epithelial or mesenchymal cells, and three-dimensional-printed intraluminal moulds. Such advances aim to restore natural epithelium, reduce donor-site morbidity and facilitate integration with surrounding pelvic structures. The global significance lies in improved quality of life, preservation of sexual health and the potential for subsequent uterus transplantation in select patients. Integrated care, involving gynaecological surgeons, reproductive specialists and psychological support, remains essential to optimise functional and long-term outcomes.

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Vaginal Reconstruction Techniques in Congenital Agenesis publication trend

The graph below shows the total number of articles in vaginal reconstruction techniques in congenital agenesis across all publications each year (not limited to Nature Index journals).

Technical terms

Congenital vaginal agenesis: A developmental anomaly in which the vagina and often the uterus fail to form due to Müllerian duct maldevelopment.

Neovagina: A surgically or mechanically created vaginal canal intended to replicate anatomical and functional properties of the natural vagina.

Autologous vaginal epithelial cells: Patient-derived mucosal cells expanded ex vivo for use in tissue-engineered grafts, reducing immune rejection risk.

Distraction vaginogenesis: A technique employing gradual mechanical tension to lengthen or form a vaginal canal through controlled tissue expansion.

Three-dimensional-printed mould: A custom-designed intraluminal scaffold produced by additive manufacturing to support neovaginal cavity creation and maturation.

References

1. Isolation of Vaginal Epithelial Cells: In Preparation of Autologous Vaginal Tissue Lining for Congenital Absence of Vagina Patients. International Journal of Molecular Sciences (2023).
2. ‘Distraction Vaginogenesis’: Preliminary Results Using a Novel Method for Vaginal Canal Expansion in Rats. Bioengineering (2023).
3. Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review. BJOG An International Journal of Obstetrics & Gynaecology (2019).
4. Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis. BMC Women's Health (2019).