Treatment

Research and medical studies present possibilities of clinical and surgical treatment for the development of the vaginal canal in individuals with Rokitansky Syndrome. Currently, treatment with dilators is the first recommendation among specialists in Rokitansky Syndrome around the world. The option for surgery always involves risks, requires general anesthesia, and does not eliminate the use of dilators after the vast majority of surgical techniques. Therefore, they should only be considered when there is no success with dilation. The doctor can clarify all the procedures and accompany the woman’s choice when she is safe and confident to make her decision.

Dilators

The technique of progressive dilation was defined in 1938 and is known as the Frank Method. It consists of daily use of plastic dilators of different and progressive sizes. Sessions should last 20 to 30 minutes for successful treatment. Generally, dilator sets are composed of 3 or 6 different sizes, ranging from 3 to 15 cm in length. The first dilator is similar to a thin vaginal tampon. As the vagina expands, the dilator should be replaced by the next size until completing the treatment with the larger dilators. The duration of treatment varies between 6 and 12 months and should be guided and accompanied by a health professional.

We indicate the correct way of using the dilators below:

All doubts or insecurities should be shared with the medical team or someone capable of guiding the woman during this period.

Surgeries

Surgery to construct the vagina is called vaginoplasty or neovaginoplasty, and is indicated when treatment with dilators is not successful. The medical team should discuss with the patient and their family the surgical possibilities and the team’s experience with each technique. The known surgical procedures are:

  • Davydov surgery: uses part of the peritoneum for vaginal construction. After the surgery, some women reported cases of discomfort and umbilical pain caused by traction;
  • McIndoe-Bannister surgery: used skin grafts on a rubber mold, and evolved in relation to molds and grafts, currently using other materials. After surgery, daily use of dilators is required for approximately 3 months;
  • Williams surgery: uses the skin of the labia majora to form a “vaginal pouch.” Reports of discomfort during sexual activity, due to the axis of the new vagina, and hair growth have been reported by women who have chosen this procedure;
  • Vecchietti surgery: performed by laparoscopy to fix external wires to the traction system in the abdomen. The high cost, the care required with the equipment, and the need for a second surgery to remove the device were considered discouraging for some women.

It is very important that all doubts about each procedure are clarified and that the woman is confident about deciding when the surgery will be performed.