Congenital atresia of the vagina

The correction of an absent vagina requires the creation of a canal either by surgical means or by the intermittent pressure technique of Frank. Both methods have drawbacks and, in our experience, it is difficult to persuade a patient to use a vaginal dilator alone, accurately and conscientiously for long enough to give a good result. A simple surgical alternative is described which gives good anatomic and functional results with minimal morbidity. It combines the positive features of the traditional McIndoe approach and the Frank method of vaginal development. The results of a study of 24 patients with vaginal agenesis confirmed that the condition is usually part of the Rokitansky-Kuester-Hauser syndrome with an absent or rudimentary uterus and tubes but normally functional ovaries (21 patients). There were three instances of testicular feminization with an XY karyotype, and the results of orchidectomy performed upon these patients after puberty showed the classical histologic findings. The uterus and tubes were absent. Since 1976, the new isograft technique has been performed upon 11 patients with excellent results and no complications.