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Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study

Nina Callens (UGent) , Steven Weyers (UGent) , Stan Monstrey (UGent) , Sabien Stockman (UGent) , Birgit Van hoorde (UGent) , Eline Van Hoecke (UGent) , GRETA DE CUYPERE (UGent) , Piet Hoebeke (UGent) and Martine Cools (UGent)
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Abstract
OBJECTIVE: Vaginal dilation treatment has been shown to be a (cost) effective first-line alternative to surgery in normalizing vaginal length and improving sexual function in women with vaginal hypoplasia. There remains, however, a need for prospective studies, with long-term assessment of multiple outcomes. STUDY DESIGN: This was a prospective, single-centre observational study of 16 women with Mayer-Rokitansky-Kuster-Hauser syndrome (n = 12) or 46,XY disorders of sex development (n = 4). All women underwent an outpatient vaginal dilation program supervised by a psychologist and physiotherapist. At baseline (TO), stop of treatment (T1) and 1 year follow-up (T2), semistructured interviews, and validated questionnaires assessed sexual function and distress, self-esteem, vaginal perceptions, and health-related quality of life. Gynecological examinations evaluated vaginal dimensions. RESULTS: Ten women completed the program, 3 are still in the program, and dilation failed in 3 and chose vaginoplasty. Sixty-nine percent reached a normal vaginal length (>= 6.5 cm) in 5.8 +/- 3.3 months. Seventy percent were sexually active with pleasurable experiences at Ti, 57% at T2. The significant decrease in sexual distress at Ti (P <.05) was followed by a nonsignificant increase at T2. Depressive mood symptomatology remained high at Ti and T2, related to loss of bodily integrity and fertility. The majority refused further psychological counseling. CONCLUSION: Vaginal dilation treatment should remain the cornerstone of treatment in women with vaginal hypoplasia. However, the diagnosis remains to have a negative impact on emotional well-being in the long term. The role of psychological intervention as both a primary and adjuvant treatment needs clear evaluation.
Keywords
Mayer-Rokitansky-Kuster-Hauser syndrome, complete androgen insensitivity syndrome, psychosexual functioning, vaginal dilation, vaginal reconstruction, ANDROGEN INSENSITIVITY SYNDROME, KUSTER-HAUSER-SYNDROME, FEMALE SEXUAL FUNCTION, PSYCHOMETRIC PROPERTIES, MULLERIAN AGENESIS, CONGENITAL ABSENCE, INDEX FSFI, MANAGEMENT, SCALE, DISTRESS

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MLA
Callens, Nina, Steven Weyers, Stan Monstrey, et al. “Vaginal Dilation Treatment in Women with Vaginal Hypoplasia: a Prospective One-year Follow-up Study.” AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 211.3 (2014): 228.e1–228.e12. Print.
APA
Callens, N., Weyers, S., Monstrey, S., Stockman, S., Van hoordeBirgit, Van Hoecke, E., DE CUYPERE, G., et al. (2014). Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 211(3), 228.e1–228.e12.
Chicago author-date
Callens, Nina, Steven Weyers, Stan Monstrey, Sabien Stockman, Van hoordeBirgit, Eline Van Hoecke, GRETA DE CUYPERE, Piet Hoebeke, and Martine Cools. 2014. “Vaginal Dilation Treatment in Women with Vaginal Hypoplasia: a Prospective One-year Follow-up Study.” American Journal of Obstetrics and Gynecology 211 (3): 228.e1–228.e12.
Chicago author-date (all authors)
Callens, Nina, Steven Weyers, Stan Monstrey, Sabien Stockman, Van hoordeBirgit, Eline Van Hoecke, GRETA DE CUYPERE, Piet Hoebeke, and Martine Cools. 2014. “Vaginal Dilation Treatment in Women with Vaginal Hypoplasia: a Prospective One-year Follow-up Study.” American Journal of Obstetrics and Gynecology 211 (3): 228.e1–228.e12.
Vancouver
1.
Callens N, Weyers S, Monstrey S, Stockman S, Van hoordeBirgit, Van Hoecke E, et al. Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. 2014;211(3):228.e1–228.e12.
IEEE
[1]
N. Callens et al., “Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study,” AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, vol. 211, no. 3, pp. 228.e1-228.e12, 2014.
@article{4262712,
  abstract     = {{OBJECTIVE: Vaginal dilation treatment has been shown to be a (cost) effective first-line alternative to surgery in normalizing vaginal length and improving sexual function in women with vaginal hypoplasia. There remains, however, a need for prospective studies, with long-term assessment of multiple outcomes. 
STUDY DESIGN: This was a prospective, single-centre observational study of 16 women with Mayer-Rokitansky-Kuster-Hauser syndrome (n = 12) or 46,XY disorders of sex development (n = 4). All women underwent an outpatient vaginal dilation program supervised by a psychologist and physiotherapist. At baseline (TO), stop of treatment (T1) and 1 year follow-up (T2), semistructured interviews, and validated questionnaires assessed sexual function and distress, self-esteem, vaginal perceptions, and health-related quality of life. Gynecological examinations evaluated vaginal dimensions. 
RESULTS: Ten women completed the program, 3 are still in the program, and dilation failed in 3 and chose vaginoplasty. Sixty-nine percent reached a normal vaginal length (>= 6.5 cm) in 5.8 +/- 3.3 months. Seventy percent were sexually active with pleasurable experiences at Ti, 57% at T2. The significant decrease in sexual distress at Ti (P <.05) was followed by a nonsignificant increase at T2. Depressive mood symptomatology remained high at Ti and T2, related to loss of bodily integrity and fertility. The majority refused further psychological counseling. 
CONCLUSION: Vaginal dilation treatment should remain the cornerstone of treatment in women with vaginal hypoplasia. However, the diagnosis remains to have a negative impact on emotional well-being in the long term. The role of psychological intervention as both a primary and adjuvant treatment needs clear evaluation.}},
  author       = {{Callens, Nina and Weyers, Steven and Monstrey, Stan and Stockman, Sabien and Van hoorde, Birgit and Van Hoecke, Eline and DE CUYPERE, GRETA and Hoebeke, Piet and Cools, Martine}},
  issn         = {{0002-9378}},
  journal      = {{AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY}},
  keywords     = {{Mayer-Rokitansky-Kuster-Hauser syndrome,complete androgen insensitivity syndrome,psychosexual functioning,vaginal dilation,vaginal reconstruction,ANDROGEN INSENSITIVITY SYNDROME,KUSTER-HAUSER-SYNDROME,FEMALE SEXUAL FUNCTION,PSYCHOMETRIC PROPERTIES,MULLERIAN AGENESIS,CONGENITAL ABSENCE,INDEX FSFI,MANAGEMENT,SCALE,DISTRESS}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{228.e1--228.e12}},
  title        = {{Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study}},
  url          = {{http://dx.doi.org/10.1016/j.ajog.2014.03.051}},
  volume       = {{211}},
  year         = {{2014}},
}

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