Bowel vaginoplasty in children and young women: an institutional experience with 55 patients.

INTRODUCTION AND HYPOTHESIS: Absence of a vagina owing to congenital Mullerian defects or other acquired causes requires reconstruction of the female genital passage. We present our experience using various bowel segments. METHODS: Bowel vaginoplasty was performed in 55 patients from January 2004 through May 2014 for cervicovaginal atresia (20), Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (20), distal vaginal atresia (8), cloaca (2), cervical atresia (1), complex urogenital sinus (1), transverse vaginal septum (1), rhabdomyosarcoma of the vagina (1), and traumatic stricture of the vagina (1). The bowel segments used were sigmoid (50), ileum (2), anorectovestibular fistula ( 2), and loop rectovaginoplasty (1). RESULTS: Thirty-nine patients who had the proximal vagina or uterus anastomosed to the bowel segment reported regular menstrual flows. Three patients are sexually active with satisfactory coital function. None of our patients developed pyometra. Five patients had neovaginal mucosal prolapse. Two patients had severe stenosis requiring excision of the neovagina. Seven patients had mild stenosis requiring dilatations in 6 patients and V-Y meatoplasty for 1 patient. One patient had a descending colon anastomotic leak requiring a diversion ileostomy. CONCLUSIONS: Genital reconstruction with bowel vaginoplasty is a highly skilled operation that provides a durable and lubricated replacement of the vagina with good outcomes. Utero-coloneovaginoplasty is a safe procedure preserving the menstrual flow in patients with a functional uterine fundus.

Cervicovaginal atresia with hematometra: restoring menstrual and sexual function by utero-coloneovaginoplasty.

BACKGROUND: Cervicovaginal atresia is a rare Mullerian anomaly. The management of cervicovaginal atresia has evolved from historical recommendations of hysterectomy to various reconstructive procedures more recently. The latter carries a risk of significant morbidity and unknown fertility. We present our experience in the management of this complex anomaly. METHODS: Twenty patients with cervicovaginal atresia were operated in our hospital from January 2004 through December 2013. The details of their anatomical variations and functional outcomes were analyzed. RESULTS: Eighteen out of twenty patients had cervical agenesis. Two patients had cervical hypoplasia. All patients underwent utero-coloneovaginoplasty. Post operatively, all patients have regular menstrual cycles. One patient is married, sexually active and has satisfactory coital function. One patient had a bowel anastomotic leak that required a diversion ileostomy. Two patients developed mild stenosis. One patient has mild neovaginal mucosal prolapse. No patient has developed pyometra. CONCLUSION: Patients with cervicovaginal atresia need to be counselled about the various reconstructive options available and the potential risks. Social and economic factor play a significant role in determining the plan of management. For patients from conservative societies, utero-coloneovaginoplasty provides a safe conduit for the passage of menstrual flow and coitus, at the cost of permanent infertility.

Sexual dysfunction among young married women in southern India.

INTRODUCTION AND HYPOTHESIS: This study aimed to identify the nature, prevalence, and factors associated with female sexual disorders (FSD). METHODS: We assessed 150 women using the following instruments: Diagnostic and Statistical Manual IV (DSM IV), Sexual Disorders, Female Sexual Function Index, World Health Organization Quality of Life BREF (WHOQOL-BREF), an abbreviated version of the WHOQOL-100, and a pro forma to record sociodemographic and clinical details. Descriptive statistics were calculated and multivariable logistic regression models used to adjust for confounders. RESULTS: A third of the 150 women met DSM IV criteria for FSD. The common disorders were hypoactive desire (16.67 %) and arousal (14.67) and orgasmic disorders (18 %). Women with any DSM IV diagnosis of sexual disorder had a poorer QOL (t = -3.1; df = 148; p = 0.002) in general and had impaired social relationships (t = -3.5; df = 148; p = 0.001) and lower environmental scores (t = -2.8; df = 148; p = 0.005) in particular. CONCLUSIONS: A minority of women reported sexual dysfunction. Hypoactive desire and arousal and orgasmic disorders were the common conditions. The presence of dysfunction was associated with poor QOL.

Vitamin D deficiency in postmenopausal women with pelvic floor disorders.

INTRODUCTION: The aim of this study is to evaluate the association of vitamin D deficiency and pelvic floor disorders (PFD) including pelvic organ prolapse (POP) and stress urinary incontinence in postmenopausal women. MATERIALS AND METHODS: This is a prospective case control study on 120 women with or without symptoms of PFD. Relevant history and clinical examination were conducted. Serum 25-hydroxy vitamin D levels were measured in all women. Chi square and student t test were used to test significance of association. Logistic regression was used to adjust for age. Odds ratios and 95% confidence intervals were calculated. RESULTS: Of the 120 postmenopausal women included, 51 had PFD on clinical examination. Of the 51 cases, 28 women had POP and 14 women had stress incontinence (SUI) while nine women had both POP and SUI. The study showed that vitamin D levels were significantly lower in women with PFD than those without PFD. Menopausal status of more than 5 years was also significantly associated with PFD. CONCLUSION: Findings suggest association of vitamin D deficiency and PFD in postmenopausal women. In addition, postmenopausal women have a high prevalence of vitamin D deficiency indicating a need to evaluate vitamin D levels in these women.

Postpartum urinary retention after vaginal delivery.

OBJECTIVE: To determine the incidence of covert and overt postpartum urinary retention (PUR) after vaginal delivery and to determine obstetric variables contributing to PUR. METHODS: In a cross-sectional study, women who delivered vaginally underwent a transabdominal ultrasound scan for estimation of postvoid residual bladder volume and diagnosis of PUR. Patient data, including age, obstetric history, mode of delivery, and duration of labor, were compared between women with and those without PUR. RESULTS: Of the 771 participants recruited, 84 (10. 9%) had PUR: 82 (10.6%) with covert PUR and 2 (0.3%) with overt PUR. Women with instrumental delivery were more prone to develop PUR (P=0.03), with an odds ratio (OR) of 1.194 (95% confidence interval [CI], 0.56-1.90). A duration of labor of more than 700 minutes was a good predictor of PUR. The area under the receiver operating characteristic (ROC) curve was 0.634 (95% CI, 0.567-0.702; P<0.001), with an OR of 1.003 (95% CI, 1.001-1.004). CONCLUSION: Covert retention of urine was significantly associated with parturients who had an instrumental delivery and a duration of labor of more than 700 minutes.