Failure of laparoscopic Vecchietti procedure in a woman with androgen insensitivity syndrome

The authors describe a case with androgen insensitivity syndrome (AIS) who underwent the laparoscopic Vecchietti procedure for creation of a neovagina. Postoperatively, the patient achieved anatomic success, with a vaginal length of about eight cm, and she was advised to use vaginal dilators after discharge. The patient reported improved sexual function, but presented about six months later for shortening of her vagina and difficult vaginal intercourse. Physical examination revealed an obliterated vaginal canal about two cm long. Further examination revealed lack of vaginal epithelization. The patient was instructed to continue using vaginal dilators in combination with estrogen cream; however, the patient did not achieve a vaginal length > two cm. The authors believe that the laparoscopic Vecchietti procedure may not be appropriate for women with AIS due to lack of epithelization.