Agenesis of the vagina. A discussion of surgical management and functional and morphologic comparison of end results, with and without skin grafting.

Abstract

Abstract Experience with the management of patients congenitally lacking the vagina is assayed to decide (a) the most satisfactory technique of reconstruction and (b) the degree to which the new epithelium mimics normal vaginal surface tissues. It is demonstrated that excavation of an adequate pocket and immediate insertion of a split-thickness autogenous skin graft on a mold rarely fails to give rapid healing and satisfactory function. Attention to technical details will facilitate this. Adherence to the concept that operation should be postponed until marriage is imminent is found to be unacceptable on emotional grounds. Comparison is made between normal and surrogate vaginal epithelia, cytologically, bacteriologically, and histologically, under endogenous and exogenous hormonal stimulation. Important differences are demonstrable between normal vaginal epithelium and grafted skin.