ANDROGEN-INSENSITIVITY SYNDROME - LONG-TERM RESULTS OF SURGICAL VAGINAL CREATION

The McIndoe split thickness graft technique for vaginal creation has been used successfully in women with congenital absence of the vagina, including patients with androgen-insensitivity syndrome (AIS) and mullerian agenesis (MA). Endocrinologically, adult AIS patients differ from women with MA in having undergone a gonadectomy at or before their vaginoplasty, requiring estrogen replacement and being resistant to androgens. The long-term result of the McIndoe procedure in 14 AIS patients, operated on between 1958 and 1976 at the Johns Hopkins Hospital, was retrospectively determined. The average age at surgery was 19.7 years, with an average follow-up time of 10.2 years. Preoperative vaginal depth averaged 2.6 cm and measured between 10 and 12 cm postoperatively. Vaginal graft take was excellent in all patients. Nevertheless, only 10/14 (72%) had fully satisfactory intercourse postoperatively, 3/14 (21%) had a partial success, complaining of mild to moderate discomfort, and 1 (7%) had severe dyspareunia. Compared to the 100% success rate previously reported by us in 79 MA women (Rock et al. Fertil Steril 1983;39:809), this represents a significant difference (p < 0.05). The higher frequency of discomfort or dyspareunia following vaginoplasty in AIS compared to MA patients may relate to their different endocrine milieus.