Short Vagina In Adolescents With 46 Xy-Dsd: Vaginal Dilation As First-Line Treatment
Purpose Although Frank already described vaginal dilation therapy for treatment of a short vagina in 1938 patient selection criteria, treatment protocols and outcome parameters are still poorly defined. Since 2000 vaginal dilation is our first-line treatment in 46 XY-DSD with female gender. We present data of 15 consecutive patients. Material and Methods In 15 adolescents (mean age 16 years) vaginal length was measured under anesthesia and the compliance of the vaginal vault was assessed. Diagnosis was Androgen Insensitivity Syndrome in 9 (group A) and other cause, like T-synthesis disorder, in 6 (group B). In 5 patients from group A the vagina was considered sufficient. Four/9 from group A and all 6 from group B were considered candidates for selfdilation therapy. After psychological counseling and instruction patients were advised to dilate the vagina daily with a Hegar sound during 3-5 minutes. Results Mean vaginal length in group A was 5 (range 3-10) cm and in group B 3 (range 2-5) cm. Mean vaginal length in the 5/15 who did not require therapy was 7 (range 5-10) cm. Mean vaginal length in the therapy group was 3 (range 2-5) cm. Three/10 completed dilation therapy after 12-24 months with an average increase in vaginal length of 5,7 cm; 1/10 discontinued selfdilation after successful coitus. Three/10 are not yet ready for treatment; 3/10 are lost to follow-up. Conclusions Although follow-up is short and information on sexual function is lacking in most patients to allow definitive conclusions we consider vaginal self-dilation therapy as treatment of first choice in 46 XY-DSD patients with a short vagina. Patient motivation and a delicate approach in a multidisciplinary setting are keystones to a successful result of dilation treatment.