Normalization of the vagina by dilator treatment alone in Complete Androgen Insensitivity Syndrome and Mayer-Rokitansky-Kuster-Hauser Syndrome

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Abstract
Various surgical and non-surgical treatment options are available for women with congenital vaginal agenesis. We report results of vaginal dilation therapy delivered by a multi-disciplinary team as first line treatment for vaginal agenesis. Twenty-six women were recruited into a prospective observational study: 18 had Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) and 8 had Complete Androgen Insensitivity Syndrome (CAIS). All women underwent a vaginal dilation programme co-ordinated by a clinical nurse specialist with input from a clinical psychologist. Vaginal length was compared to a normal reference range, and psycho-sexual questionnaires were completed before and after therapy. Twenty-one (81%) patients completed the programme. Seventeen of these 21 (81%) were sexually active without any reported difficulties, whereas 4 were on a maintenance regime. In those who completed the programme the mean vaginal length increased from 4.0 to 8.5 cm and 86% achieved a vaginal length within the normal range. Subjective appraisal of vaginal size recorded that the number of women who reported that their vaginal size was 'more or less normal' increased from 1 to 12 following treatment. Questionnaire scores for sexual satisfaction and sexual depression improved in the CAIS group but did not alter significantly in the MRKH group. Non-surgical dilation delivered by a multi-disciplinary team is an effective alternative to vaginal surgery and usually normalizes vaginal length.