Long Term Anatomical and Functional Results of Modified McIndoe Vaginoplasty with Amnion Graft in Patients with Congenital Vaginal Aplasia Compared with a Control Group

Background: Vaginal aplasia is a rare congenital anomaly with different surgical techniques suggested for vaginal reconstruction.McIndoe vaginoplasty is an easy one of these surgical methods with a low morbidity rate, but its long-term results need to be further investigated. Therefore, the female genital anatomy and sexual function was examined after performing McIndoe vaginoplasty in patients with müllerian anomaly or androgen insensitivity syndrome. Materials and Methods: In this historical cohort study, the data of 25 patients undergoing McIndoe vaginoplasty with amniotic graft from 2006 to 2017 at four selected hospitals of Shiraz affiliated with Shiraz University of Medical Sciences in Iran were extracted from medical records. Then, the patients were called to refer for physical examination and fill the Female Sexual Function Index (FSFI) questionnaire. In addition, 31 women of the same age range and without a sexual problem, vaginal surgery, or delivery were selected as the control group. Finally, the results of vaginal measurements and FSFI scores of the two groups were compared together. Results: Theaverage vaginal length of the case and control groups were 5.60±2.38 and 8.47±1.31 cm, respectively. Furthermore, the mean proximal vaginal diameter in case and control groups were measured 2.94±0.92, and 4.12±0.70 cm, respectively (P<0.001). The mean FSFI score of the case group was 12.81±7.87, and 24.19±2.90 for the control group (P<0.001). The vaginal indices and FSFI of the patients using mold routinely were still lower than the control group (P<0.05) although theyhad a larger vagina (P<0.001). Conclusion: Vaginal reconstruction using McIndoe vaginoplasty with amniotic graft failed to provide normal vagina function and anatomy for patients with congenital vaginal aplasia in long-term follow-up.