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Long-Term Psychosexual and Anatomical Outcome after Vaginal Dilation or Vaginoplasty: A Comparative Study

Authors

  • Nina Callens MA,

    Corresponding author
    1. Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, Ghent, Belgium
      Nina Callens, MA, Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, De Pintelaan 185, Ghent 9000, Belgium. Tel: 0032 9 332 03 51; Fax: 0032 9 332 38 75; E-mail: nina.callens@ugent.be
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  • Griet De Cuypere MD, PhD,

    1. Department of Sexology and Gender Problems, University Hospital Ghent, Ghent, Belgium
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  • Katja P. Wolffenbuttel MD,

    1. Department of Urology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
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  • Catharina C.M. Beerendonk MD, PhD,

    1. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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  • Yvonne G. van der Zwan MD,

    1. Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
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  • Marjan van den Berg MD, PhD,

    1. Department of Urology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
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  • Stan Monstrey MD, PhD,

    1. Department of Plastic Surgery, University Hospital Ghent, Ghent, Belgium
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  • Maaike E. Van Kuyk MA,

    1. Radboud University Nijmegen Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
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  • Petra De Sutter MD, PhD,

    1. University Hospital Ghent, Department of Obstetrics and Gynecology, Ghent, Belgium
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  • Belgian-Dutch Study Group on DSD,

  • Arianne B. Dessens PhD,

    1. Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
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  • Martine Cools MD, PhD

    1. Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, Ghent, Belgium
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    • 1Joint senior authorship.


  • Belgian-Dutch Study Group on DSD (not including the authors mentioned in the list of authors):

  • 1. University Hospital Ghent: Piet Hoebeke, MD, PhD, Eline Van Hoecke, PhD, Steven Weyers, MD, PhD, Birgit Van Hoorde, MA, Sabine Stockman, PhD, Petra De Sutter, MD, PhD, Kristien Roelens, MD, PhD, Guy T'Sjoen, MD, PhD.

  • 2. Erasmus Medical Center Rotterdam: Stenvert L.S. Drop, MD, PhD, Gerard C. Madern, MD, PhD, Joop S.E. Laven, MD, PhD, Marianne J. ten Kate-Booij, MD, PhD, Hanneke M. Bolt, MD.

  • 3. Radboud University Nijmegen Medical Center: Maaike van Kuyk, PhD, Bartho J. Otten, MD, PhD, Hedi L. Claashen-van der Grinten, MD, PhD, Barbara B.M. Kortmann, MD, PhD, Jet H. van Kuppenveld.

Nina Callens, MA, Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, De Pintelaan 185, Ghent 9000, Belgium. Tel: 0032 9 332 03 51; Fax: 0032 9 332 38 75; E-mail: nina.callens@ugent.be

ABSTRACT

Introduction.  In patients with disorders of sex development requiring creation of a neovagina, a number of techniques are available, including surgical vaginoplasty and self-dilation therapy. Vaginal dilation therapy has been recommended as a first-line treatment because of its less invasive character and high success rate. However, no data exist on long-term psychosexual functioning after vaginal dilation as compared with that after vaginal surgery.

Aims.  The aim of this study is to compare the psychosexual and anatomical outcome of women with congenital vaginal hypoplasia followed in the same clinical setting after vaginoplasty with that after vaginal dilation.

Methods.  The sexual quality of life of 35 women at least 2 years after vaginoplasty (N = 15), vaginal dilation therapy (N = 8), or coital dilation/no treatment (N = 12) was investigated and compared with the Dutch test validation population (as control).

Main Outcome Measures.  Psychosexual functioning was assessed with the Female Sexual Function Index, the Female Sexual Distress Scale-Revised, and a semi-structured interview. A gynecological examination was performed to determine the anatomical outcome after both vaginal treatment regimens.

Results.  After either treatment, 26% of these women had a shortened vaginal length of less than 6.6 cm, i.e., more than two standard deviations below the published mean value (9.6 ± 1.5 cm). Irrespective of the treatment, 47% of the patients had (a) sexual dysfunction(s) and experienced sexual distress. However, after vaginoplasty, patients reported significantly more problems with lubrication (P = 0.025) than after self-dilation therapy.

Conclusion.  Both psychological and physical factors are predisposing for sexual difficulties. To optimize psychosexual comfort, the clinical management of women with vaginal hypoplasia needs to be multidisciplinary and individually tailored. With high success rates reported, vaginal dilation should remain the cornerstone of treatment. Callens N, De Cuypere G, Wolffenbuttel KP, Beerendonk CCM, van der Zwan YG, van den Berg M, Monstrey S, Van Kuyk ME, De Sutter P, Belgian-Dutch Study Group on DSD, Dessens AB, and Cools M. Long-term psychosexual and anatomical outcome after vaginal dilation or vaginoplasty: A comparative study. J Sex Med 2012;9:1859–1868.

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