Laparoscopic Correction for Absence of Vagina

April 2007

Center for Women’s Care & Reproductive Surgery First to Offer Minimally Invasive Solution for Rare Anomaly, MRKH Syndrome

Kristina Henry, a Texas woman in her early thirties who had experienced her first painful and terrifying surgery at age 16 to correct MRKH syndrome, or failure of vaginal development, recently sought out the Center for Women’s Care & Reproductive Surgery in Atlanta more than half her lifetime later for much-needed corrective work. 

Although her original surgery had been performed in a major, prestigious Eastern medical school, her emotional scars from the experience are still almost as palpable as the visible scarring on the insides of both thighs from the original procedure. 

“I remember waking up in the recovery room screaming in pain,” said patient Kristina Henry of her six-hour surgery, followed by a month’s recuperation.

“When my doctor would come to check on me, I felt like I was a test monkey. There were quite a lot of doctors and students that saw parts of me that very few people have seen to this day. The whole experience was painful and unbearable.” 

Describing one physician’s approach she said, “He thought I was going to go straight from surgery and start having sexual intercourse, so he took out my stent that was supposed to stay in, according to my original doctor. I was supposed to dilate and at 16 that was not a top priority for me. It hurt and I was so tired of pain. After time this made my length decrease and eventually it decreased to barely nothing. To this day I cannot wear a swimsuit without a cover-up because my scars are very noticeable.”

Problem Often Undetected Until Puberty

Up to a half million women in the U.S. are born with anomalies of the urinary and reproductive system.  In females thousands of these mullerian anomalies, including the absence of a vagina, may not be discovered until the girl reaches puberty. 

MRKH (Mayer-Rokitansky-Kuster-Hauser) syndrome includes failure of the vaginal development, whether or not the uterus is present. Adolescent girls with MRKH syndrome and obstruction defects may complain that they have not begun menstruation, labeled primary amenorrhea.

In some cases, female patients have discovered their anomaly after inability to have intercourse because of an absent vagina.  For many, multiple painful attempts of intercourse have led to distortion of existing external genital structures and scarring of the area, as well as chronic pelvic pain. 

In 2005, the Center for Women’s Care & Reproductive Surgery in Atlanta became the sole location in the U.S. to correct this problem laparoscopically with the use of pelvic peritoneum. 

Laparoscopy for Vaginal Aplasia, or Non-Development of the Vagina

Techniques for correction over the years involved use of segments of the rectum, sigmoid colon and small intestine, as well as skin graft. In 1993 Dr. L.V. Adamyan developed a laparoscopy-assisted technique for creation of the neovagina, using the pelvic peritoneum. 

This minimally invasive technique is far easier on the patient, as it involves only tiny incisions and is performed in less than an hour.  More than one thousand of them have been performed, proving their efficacy. 

The procedure allows achievement of adequate functional vaginal length and elasticity, and the peritoneal epithelium (cellular layer that lines the walls of the abdominal cavity) converts into normal vaginal epithelium within three months after surgery. 

World-renowned head of the Center for Women’s Care & Reproductive Surgery, Thomas L. Lyons, M.D., and his Fellow, Assia A. Stepanian, M.D., learned the technique firsthand from its author, and they are the only U.S. surgeons with experience in laparoscopic correction of MRKH syndrome using the pelvic peritoneum.

This procedure was used to correct Kristina’s post-surgical shortening of the vagina, which occurred from previous surgeries.

“It’s very unfortunate that so many women have these suboptimal procedures because they often fail,” said Dr. Lyons about the old style procedure, which Kristina endured originally.

“Most academic centers still use the old way, which involves stretching skin over a glass tube stent and a great deal of ‘hope’ that the tissue will re-vascularize (grow new blood vessels) and stay healthy,” he said.

Solution Over the Internet

Blessed with a loving husband who told her he didn’t see her scars, Kristina wanted to have a normal sex life but had lost most of her depth.

“I finally found Dr. Lyons online when all of my possibilities had run out,” she said. “He is a wonderful man, and so is his whole office. The surgery went great—little scars and very little pain. I really think a lot of both him and Dr. Assia Stepanian, who have been great through this whole ordeal.”

At her first check-up post-surgery, “I was never so happy. The depth was there, something I had never witnessed in my life. This meant a lot to me and I never thought that day would come. I felt just minor discomfort. This is a surgery for anyone with MRKH; this will not destroy anyone’s mental state. It has been more than four months since my surgery; my sex life is better and I am growing more confident with myself.”

Now Kristina is on a campaign to get her insurance company to pay for the surgery, which was not aware of this anomaly and had no code for it.

“This disease needs to be mentioned more and talked about, so there is more help for young girls going through this. The first step is this letter and trying to make people understand this issue, get them to talk to Dr. Lyons and go from there,” said the young woman who wants people to recognize that it the issue is more than physical; it is mental, emotional and spiritual as well.

Dr. Lyons’ advanced skills in laparoscopy and/or hysteroscopy can correct the majority of mullerian anomalies, as well as a wide spectrum of treatments for pelvic pain and endometriosis.

After researching the Internet and discovering the Center for Women’s Care at http://www.thomasllyons.com, patients come to Dr. Lyons from around the world for advanced laparoscopic techniques.  Offices are in Atlanta, Lake Oconee and Blue Ridge, Georgia. 

Communication and Support for those with MRKH

For those who are born with MRKH, it is not only important to obtain proper medical treatment, but to also have a support system.  Women involved with the issue have recently created a new support and information group for women who have MRKH, and Mothers with Daughters who have MRKH.  On the site they discuss the options open to neo-vaginal construction, and have recommended the laparoscopic method employed by the Center for Women's Care & Reproductive Surgery to those who seek a less invasive surgical solution.  They have requested us at the Center for Women's Care to provide a link, and we are glad to provide it. We hope this is beneficial and educational for those seeking more information and support:

 Here is the MRKH Yahoo Group URL: http://health.groups.yahoo.com/group/askaboutMRKH/

Email the Center for Women's Care

Center for Women's Care & Reproductive Surgery© 2006
1140 Hammond Drive, Suite F6230
Atlanta, Georgia 30328.
Copyright 2005
Toll Free 1 (888) 545-0400
Metro Atlanta (770) 352-0037

This page last updated 08/17/2009