Objectives: To evaluate the use of vaginoplasty with the pudendal thigh flap in patients with gynatresia caused by herbal pessaries in a multidisciplinary context.
Methods: The study included patients with herbal-pessary-induced vaginitis and gynatresia. Surgical treatment consisted of vaginoplasty with the pudendal thigh flap; patients with associated fibroids had a myomectomy during the same setting. The severity of the stenosis and the outcome after surgery were assessed with rating scales devised for the present study.
Results: The study included 21 patients (mean age 36.05 ± 1.69 years, range 18-50 years). The most common reason for herbal pessary use was fibroids with infertility. Prior to presentation, most patients had already undergone a median of 2 procedures involving vaginal adhesiolysis and dilatations without improvement. In total, 17 (80.9%) patients underwent surgery. Of these, 6 (35.3%) presented with both fibroids and gynatresia. Before surgery, all patients had poor sexual function with apareunia. Postoperatively, 11 (64.7%) patients reported painless sexual intercourse.
Conclusion: Joint management by plastic surgeons and gynecologists using the pudendal thigh flap for vaginoplasty in caustic gynatresia resulted in a functional vagina. Simultaneous myomectomy and vaginoplasty in patients with fibroids and gynatresia was safe.
Copyright © 2011. Published by Elsevier Ireland Ltd.