Vaginal Reconstruction

Suggested for women who have congenital vaginal atresia, patients undergoing partial or complete vaginectomy and patients who develop fistula formation

What is vagina?

The vagina is a muscular and tubular part of the female genital tract, which in humans extends from the vulva to the cervix. The outer vaginal opening may be partly covered by a membrane called the hymen. At the deep end, the cervix (neck of the uterus) bulges into the vagina. The vagina allows for sexual intercourse and childbirth, and channels menstrual flow, which occurs periodically as part of the menstrual cycle.

What is vaginal reconstruction?

It is a reconstructive surgery to create a new vagina that can enable you to have vaginal sexual intercourse.

The aims of the surgery are to facilitate:

  • Sexual functioning
  • Psychosocial health
  • Restoration of body image
  • Pelvic support to prevent rectal, bladder, and pelvic prolapse

Vaginal reconstruction in atresia ?

In Vaginal atresia, there is congenital partial or total absence of vagina due to failure of development.

Vaginal atresia is a congenital defect resulting in uterovaginal outflow tract obstruction. It occurs when the caudal portion of the vagina, contributed by the urogenital sinus, fails to form. This caudal portion of the vagina is replaced with fibrous tissue. Vagina atresia and agenesis are congenital anomalies of the female genitourinary tract and may occur as an isolated developmental defect (extremely rare) or as part of a complex of anomalies (more common).

Advances in care have made it possible to reconstruct the vagina in cases of congenital defects.

Vaginal reconstruction in cancer?

Advances in the delivery of cancer care led to a decrease in surgical morbidity, increased survival after surgery, radiation therapy and chemotherapy, and greater life expectancy with a good quality of life.

With these advances, contemporary treatment planning began to emphasize full and complete return to normal functioning of the patient and in particular the body segment undergoing reconstruction. The era of better informed consent with patient understanding of treatment options and outcome plays an important role in treatment planning and in the recovery process.

Other reasons for emphasizing restoration to full functioning include the following:

  • Increased longevity
  • Increased attention to preservation of body image
  • Maintenance and enhancement of physiologic activity
  • Improvement in psychosocial well-being

What are the types of the surgeries?

The techniques used in reconstructive procedures on the female genital tract range from simple procedures involving the application of split-thickness skin grafts to very complicated procedures in which large segments of skin and underlying tissue, including muscle, are used as flaps to cover gaping defects created at the time of radical or ultra radical surgery. These techniques include grafting procedures, realignment of standard incisions, the use of vascular pedicle flaps, and organ substitution.

Which individuals are eligible for the surgery?

Women who are the right candidate for vaginal reconstruction surgery include those who:

  • Have congenital vaginal atresia
  • Patients undergoing partial or complete vaginectomy
  • Patients experiencing contraction, constriction, erosion, or ulceration of the vagina after irradiation for cervical, vaginal, or endometrial cancer
  • Patients who develop fistula formation

What is the ideal time for reconctruction?

In Vaginal atresia patients

  • With absent uterus

In the patient with functional ovarian tissue but an absent uterus and vagina, reconstruction of the genital tract is not medically urgent.

  • In patients with functional uterus and ovarian tissue

Surgical intervention is usually delayed until the late teens so the patient is mature enough to comply with postoperative care. Surgical or medical intervention must be started sooner than this if a patient presents with vaginal outflow obstruction, abdominal or pelvic pain, or a risk for secondary endometriosis

In cancer patients

Current-day recommendation for reconstructive procedures on the female genital tract in cancer patients:

  • Reconstruction should be performed at the time of surgery rather than after a recuperation period unless dictated by special circumstances.
  • Early reconstruction accelerates the return to physical functioning. Better functional results are obtained.

How should I prepare for the surgery?

Your surgeon will discuss with you about the instructions to be followed before surgery and will advise you when to discontinue or resume the activities.

  • Quit smoking and drinking for a particular period before the surgery.
  • Avoid taking drugs that could interfere with your surgery or healing process.
  • Get detailed post-operative instructions from your surgeon or nurses.
  • Do not eat and drink for at least 12 hours before your surgical appointment time.
  • Get a medical evaluation performed as ordered by the doctor.

What is the aftercare of the surgery?

  • Your surgeon or nurse will advise you to have salt baths or use a vaginal douche to keep the area clean during the process of healing.
  • After healing, your surgeon recommends you to use dilators regularly to keep your vagina open.
  • After about three months, you can use the dilators less often which depends on your sexual activity.
  • Depending on the donor site you may or may not use the dilators or lubricants.

What are the postsurgical considerations?

Vaginal reconstruction surgery is associated with few complications:

  • Loss of viability of the graft
  • Narrowing of the vagina
  • Fistulas formation
  • Vaginal dryness
  • Vaginal prolapsed
  • Occasionally hair growth in the new vagina

Vaginal reconstruction is also associated with complications related to sex post-surgery. Women who have undergone this surgery often report changes in sensation during sex and also problems in reaching orgasm. You may be having difficulty while sexual intercourse, but later on you can feel it like normal vagina.

Vaginal dilators need to be regularly used to keep the vaginal canal stretchy and intact, as narrowing of the vagina is a major complication associated with this surgery. You need to use lubricants before coitus as the newly constructed vagina may not lubricate itself like the old one. Chances of bleeding or spotting are common after intercourse.

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