Talk:Vagina Development

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

http://www.ojrd.com/content/2/1/13

Surgical creation of a neovagina A number of techniques are appropriate for the correction of vaginal agenesis and there is no consensus regarding the best option, the approach being most often based on the surgeon's experience. Three methods are currently in use:

- The Abbe-McIndoe operation: this involves the dissection of a space between the rectum and the bladder, placement of a mold covered with a skin graft into the space, and diligent postoperative vaginal dilatation. Modifications of this procedure rely on spontaneous epithelialization or on the use of different materials such as peritoneum [111], minora labia grafting, or synthetic materials [112,113].

- The Vecchietti operation is a mixture of surgical and nonsurgical methods. It has been performed frequently in Europe over the last 20 years [70]. This procedure involves the creation of a neovagina via dilatation with a traction device attached to the abdomen, sutures placed subperitoneally by laparotomy, and a plastic olive placed in the vaginal dimple. A laparoscopic or celioscopic modification is often preferred and leads to comparable results [114].

- Sigmoidal colpoplasty: this technique involves vaginal replacement or creation of a neovagina by grafting a 12–18 cm long segment of sigmoid [115], providing that a single and/or left pelvic kidney does not impair the procedure. Sigmoidal colpoplasty is believed to be an efficient procedure giving excellent results, although complete adequacy for coital function often requires prolonged care and support [116].

Summary of differential diagnosis between MRKH syndrome and isolated vaginal atresia, WNT4 syndrome, and androgen insensitivity syndrome.
	MRKH/MURCS	Isolated vaginal atresia	WNT4 syndrome	Androgen insensitivity
Upper vagina	Absent	Variable	Absent	Absent
Uterus	Absent	Present	Absent	Absent
Gonads	Ovary	Ovary	Masculinized ovary	Testis
Breast development	Normal	Normal	Normal	Normal
Pubic-hair development	Normal	Normal	Normal	Sparse
Hyperandrogenism	No	No	Yes	No
Karyotype	46, XX	46, XX	46, XX	46, XY
Morcel et al. Orphanet Journal of Rare Diseases 2007 2:13   doi:10.1186/1750-1172-2-13

Baseline dimensions of the human vagina. Barnhart KT, Izquierdo A, Pretorius ES, Shera DM, Shabbout M, Shaunik A. Hum Reprod. 2006 Jun;21(6):1618-22. Epub 2006 Feb 14. PMID: 16478763

magnetic resonance imaging (MRI) to quantify distribution of a vaginal gel. Seventy-seven MRI scans were performed on 28 women before gel application to establish baseline vaginal measurements. Average dimensions were calculated for each woman and for the population. The influence of potential covariates (age, height, weight and parity) on these dimensions was assessed. ...Mean vaginal length from cervix to introitus was 62.7 mm. Vaginal width was largest in the proximal vagina (32.5 mm), decreased as it passed through the pelvic diaphragm (27.8 mm) and smallest at the introitus (26.2 mm)."

Complex malformations of the female genital tract. New types and revision of classification. Acién P, Acién M, Sánchez-Ferrer M. Hum Reprod. 2004 Oct;19(10):2377-84. Epub 2004 Aug 27. PMID: 15333604