Acquired Complete Obliteration of the Vaginal Canal-Surgical Techniques for Management

Acquired vaginal obliteration, or agglutination, is a condition where the vaginal walls are fused above the hymen and is associated with inflammatory skin conditions or iatrogenic causes. In this video, we present a 60-year-old patient who presented with dyspareunia and was found to have agglutination of the vaginal walls thought to be secondary to a combination of lichen sclerosus and vaginal laser therapy.

The goal for vaginal reconstruction is to restore a patent vaginal canal. When the vaginal epithelium is present but adherent as in the case of vaginal agglutination, the surgery is focused on separating the planes of the anterior and posterior vaginal epithelium. Additional techniques such as vaginoplasty with use of grafts and flaps may be used to provide the additional tissue to substitute as vaginal epithelium.

Preoperatively, the patient presented with a vaginal length of 1 cm and a genital hiatus of 1 cm. With our technique, we restored the vaginal length to 9 cm and the genital hiatus to 4 cm without any intraoperative or postoperative complications.

Management of vaginal agglutination depends on the etiology and the goals of care. This video illustrates an individualized and minimally invasive treatment approach to restoring vaginal length and sexual function.