Bilateral Labial Flap Reconstruction: A Novel Modification of the McIndoe Vaginoplasty for Vaginal Agenesis

Primary amenorrhea and sexual dysfunction may be caused by congenital vaginal agenesis, which is frequently associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. The aim of surgical reconstruction is to restore the anatomy, function, sensation, and aesthetics, thereby improving quality of life by reconstructing the vagina, particularly with a novel bilateral labia majora flap vaginoplasty technique.

This was a retrospective interventional case series (2014-2024) conducted in Baghdad that involved women aged 18-30 years with MRKH syndrome and complete vaginal agenesis. Following the preoperative evaluation, patients received neovagina reconstruction using bilateral labial flaps and split-thickness grafts. Postoperative treatment included antibiotics, progressive vaginal dilation, estrogen therapy, and follow-up. Outcomes were assessed in terms of anatomy and function, complications, operative outcomes, cosmetic outcomes, and partner satisfaction. The data were described using descriptive statistics.

Twelve patients (mean age 21.2 y) were subjected to modified McIndoe vaginoplasty. The average operative time was 2.5 hours, and there was minimal blood loss and no transfusion. One patient developed a hematoma that required secondary grafting. The mean neovaginal length at 6 months postoperative was 7.4 cm; 83.3% of patients were sexually active, the majority reported satisfaction with the procedure, dyspareunia was minimal, and partners reported satisfaction. Cosmetic outcomes were very good in 91.7% of patients.

Modification of the McIndoe vaginoplasty technique using bilateral labia majora flaps seems to be safe, effective, and aesthetically superior in patients with MRKH syndrome, as it enhances functionality and cosmesis; larger studies are required to validate the long-term results and assess cost-effectiveness.