Williams' vulvovaginoplasty after supralevator total pelvic exenteration

Seven patients had delayed Williams' vulvovaginoplasty after supralevator total pelvic exenteration. Of the three patients who died of carcinoma of the cervix (at 2, 5, and 15 months after vulvovaginoplasty), the first died before having a chance to attempt intercourse, but the other two had reported intercourse on at least two occasions after the reconstruction. One of the patients described the experiences as neither pleasant nor unpleasant but stated that her husband seemed satisfied. The other patient described the experience as satisfactory to both herself and her husband. The remaining four patients are alive with no evidence of recurrent disease at 28, 42, 56, and 106 months after operation. Two of these patients have reported entirely satisfactory sexual relations approximating pre-exenteration frequency, but the remaining two have not had sexual relations since surgery. Both give the main reason for this as lack of opportunity. The Williams' vulvovaginoplasty appears to be a reasonable alternative for vaginal reconstruction in patients who will have and especially who have had exenteration. To improve results, other methods of vaginal reconstruction should continue to be evaluated.