Treatment

Treatment for vaginal agenesis often occurs in the late teens or early 20s, but you may wait until you're older. If your parents learned about your condition when you were an infant or young girl, you may start treatment earlier.

Depending on your individual condition, your doctor may recommend one of the following courses of treatment.

Self-dilation

As a first step, your doctor will probably recommend self-dilation. Self-dilation may allow you to create a vagina without surgery. You press a small, round rod (dilator) against your skin or inside your existing vagina for 30 minutes to two hours a day.

Your skin stretches more easily after a warm bath, so that may be the best time to do it. As the weeks go by, you switch to larger dilators. It may take a few months to get the result you want.

Vaginal dilation through intercourse

This method hasn't yet been well-studied, but an option for self-dilation is vaginal dilation through frequent intercourse for women who have willing partners.

Artificial lubrication is often needed. Bleeding and pain are possible side effects, especially in the beginning. If you'd like to give this method a try, talk to your doctor about the best way to proceed.

Surgery

If self-dilation doesn't work, surgery to create a functional vagina (vaginoplasty) may be an option. Doctors usually delay surgical treatments until you have the maturity to handle follow-up dilation.

Options for vaginoplasty surgery include:

• Using a skin graft (McIndoe procedure). In the McIndoe procedure, your surgeon uses skin from your buttocks to create a vagina. Your surgeon makes an incision in the area where you'll have your vagina, inserts the skin graft to create the structure and places a mold in the newly formed canal. The mold remains in place for one week.

  After that, you use a vaginal dilator, similar to a firm tampon, which you remove when you use the bathroom or have sexual intercourse. After about three months, you'll use the dilator only at night. Sexual intercourse with artificial lubrication and occasional dilation helps you maintain a functional vagina.

• Inserting a medical device (Vecchietti procedure). In the Vecchietti procedure, your surgeon places an olive-shaped device at your vaginal opening. Using a thin, lighted viewing instrument (laparoscope) as a guide, your surgeon connects the olive-shaped device to a separate traction device on your lower abdomen.

  You tighten the traction device every day, gradually pulling the olive-shaped device inward to create a vagina over about a week. After your doctor removes the device, you'll need further manual dilation. Sexual intercourse will likely require artificial lubrication.

• Using a portion of your colon (bowel vaginoplasty). In a bowel vaginoplasty, your surgeon diverts a portion of your colon to an opening in your genital area, creating a new vagina. Your surgeon then reconnects your remaining colon. You won't have to use a vaginal dilator every day after this surgery, and you're less likely to need artificial lubrication for sexual intercourse.