Morcel k, Lavoue V, Jaffre F, Paniel BJ, Rouzier R. Eur J Obstet Gynecol Reprod Biol. 2013 Jul.

DOI: 10.1016/j.ejogrb.2013.03.005   

Abstract    

Objective:
To compare nonsurgical and surgical procedures for creation of a neovagina in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome in terms of sexual satisfaction.

Study Design:
We report a cross-sectional study of 91 women with MRKH syndrome undergoing a neovagina creation procedure. They were members of the French National Association of Women with MRKH syndrome. We analyzed all answers to a questionnaire mailed to each woman. The questionnaire solicited short answers concerning the diagnosis and the neovagina procedure, and included the standardized FSFI (Female Sexual Function Index) questionnaire. All analyses were performed using the chi-squared test and Student’s t-test. A p-value of <0.05 was considered statistically significant.

Results:
Forty women answered the questionnaire. Twenty had been treated by Frank’s method (non-surgical group) and 20 had undergone a surgical procedure, sigmoid vaginoplasty (12 cases) or Davidov’s technique (8 cases) (surgical group). The mean time after neovagina creation was 7 years (range 1-44 years). The population characteristics did not differ significantly between the nonsurgical and surgical groups. The total FSFI score indicated good and similar functional results in the two groups (25.3±7.5 versus 25.3±8.0).

Conclusions:
Functional sexual outcomes after nonsurgical and surgical methods were similar. Therefore, the Frank’s method should be proposed as first line therapy because it is less invasive than surgical procedures. In the case of failure of this technique or of refusal by the patient, surgical reconstruction may then be offered.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Summary  

Few studies have compared sexual function after surgical versus nonsurgical interventions for the construction of a neovagina in females with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Morcel et al.’s cohort of 40 French women (mean age at surgery: 18.8 ± 4.0; 20 surgical, 20 nonsurgical) were recruited from a national MRKH support group (response rate: 44%) and asked to complete the Female Sexual Function Index (FSFI) {1}, a standardized questionnaire focusing on respondent’s sexual desire, arousal, lubrication, orgasm, satisfaction, and comfort in the past four weeks. Seven women (8%) were excluded from the assessment and analysis as they had not recently experienced sexual activity. Overall sexual function was reported as ‘good’ and not statistically different between groups. Surgical interventions included the Davydov technique or sigmoid vaginoplasty. The nonsurgical group had undergone Frank’s method for neovagina creation. No participants in the surgery group had undergone the laparoscopic Vecchetti’s modified technique or the Abbé-McIndoe operation, and it is not stated if any procedures were performed secondary to failure using Frank’s method. As no differences were found between groups, the authors deferred to the nonsurgical method as is currently recommended as a first-line approach by the American College of Obstetricians and Gynecologists.

The stated purpose of this study was “to use a standardized questionnaire to evaluate and compare sexual satisfaction in a larger series of patients with MRKH syndrome after nonsurgical and surgical procedures.” While the authors met this objective, this study does not include a concurrent clinical assessment of vaginal length nor reports on adherence to the nonsurgical method. Perhaps most important would be insights into the adaptation of the non-responders (56%) and others (8%) who were eligible to participate but were excluded because they were not sexually active. Strategies to achieve more complete follow-up investigations are critical to informing provider and patient decision making.

In any study of sexual function, consideration should be given to the quality of the relationship between the partners. A study of a national probability sample of U.S. women (20-65 years old) showed that 24% experienced marked distress about their sexual relationship and/or their own sexuality; indicators of general emotional well-being and emotional relationship with the partner during sexual activity were the best predictors of sexual distress. In contrast, physical aspects of the sexual response, including arousal, vaginal lubrication, and orgasm, were poor predictors {2}. The relevance of such findings to the study and clinical management of persons with MRKH, or any disorder of sex development, should be obvious but is often neglected.

Despite the discussed limitations, this study adds valuable information to the literature regarding surgical and nonsurgical methods for constructing a neovagina in those with MRKH. Future implications of this study encourage concurrent broad clinical and psychosocial assessments that produce a multi-faceted analysis among chart-selected respondents.

References:

1.  The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R. J Sex Marital Ther 2000 Apr-Jun; 26(2):191-208
PMID: 10782451 DOI: 10.1080/009262300278597

2.  Distress about sex: a national survey of women in heterosexual relationships.
Bancroft J, Loftus J, Long JS. Arch Sex Behav 2003 Jun; 32(3):193-208
PMID: 12807292

Recommendation Citation:

Sandberg D and Sharp M: F1000Prime Recommendation of [Morcel K et al., Eur J Obstet Gynecol Reprod Biol 2013,169(2):317-20]. In F1000Prime, 09 Sep 2013