Creation of a Neovagina by Laparoscopic Modified Davydov Vaginoplasty in Patients with Partial Androgen Insensitivity Syndrome

Abstract

Study objective: To evaluate the feasibility, safety, and outcome of laparoscopic modified Davydov vaginoplasty in subjects with partial androgen insensitivity syndrome (PAIS).

Design: A retrospective cohort study (Canadian Task Force classification III).

Setting: A tertiary referral center.

Patients: Ten continuous patients operated on between October 2008 and May 2014.

Interventions: Laparoscopic modified Davydov vaginoplasty. The surgical technique was tailored on PAIS subjects who presented a male pelvic anatomy and, frequently, anomalies of the external genitalia.

Measurements and main results: Anatomic success was defined as a neovaginal width allowing the insertion of 2 fingers and a neovaginal length of at least 5 cm. Functional success was defined as the presence of regular sexual intercourse. Laparoscopic modified Davydov vaginoplasty was successfully performed in all patients without surgical complications. At hospital discharge, anatomic success was achieved in all patients. At the 12-month follow-up, anatomic success was achieved in 9 patients and functional success in 7 patients. Two patients with anatomic success did not start any sexual activity by personal choice. One patient had an anatomic failure with a neovaginal length of 2 cm. This patient had not complied with the postoperative use of vaginal dilators.

Conclusion: This is the first study reporting the outcomes of laparoscopic modified Davydov vaginoplasty in subjects with PAIS. Postoperative long-term outcomes were comparable with those achieved in women with Rokitansky syndrome. The laparoscopic modified Davydov operation may represent the procedure of choice for the creation of a neovagina and the concomitant correction of anomalies of the external genitalia in subjects with PAIS.

Keywords: Androgen insensitivity syndrome; Creation of neovagina; Laparoscopic vaginoplasty; Vaginal hypoplasia.