Vaginal Reconstruction/Scarless neovagina

A woman born without a functioning vagina is deprived of both coitus and childbearing. She is deeply disturbed psychologically, emotionally and doubts her femininity. Such Females are born with some syndromes, Mullerian agenesis  with absent uterus, cervix, vagina but ovaries are present. They have adequate female hormone of estrogen, produced by ovaries; so they have normal female secondary sexual characterisitics like fully developed breast, pubic & axillary hairs etc. Thus, they have a normal looking female body with female karyotype ( chromosome). They may have normal looking vulva and absent vagina or vagina may be present as shallow dimple.This may pose difficulty in their marriage as they have no vagina and uterus.

If neovagina is reconstructed, they may  consummate their marriage and can have proper marital relations with their husband and lead a normal married life and later can have their own biological children by surrogacy with their own ovum.

Vaginoplasty is reconstruction of a new vagina which has evolved over the time and is a boon for the females born with absent uterus and vagina.

Vaginal reconstruction has always been a formidable surgical challenge.A number of different procedures have been described with different success rates. In old times, skin grafts were used from the thigh to reconstruct vagina which had the drawback of contraction, dryness,use of a stent for a long time, hairy and without sensation.
Others use, groin, hip (gluteal ) graft but they have scar in that area, moreover it was hairy, required long term dilatation and prone to dryness and devoid of any sensation.

An ideal to vagina must be:
➡️ Located at an appropriate place.
➡️  Of adequate dimensions
➡️  Lined by elastile tissue either by full thickness skin or mucosa
➡️  Neither permanently moist nor malodorous.
➡️  Hairless
➡️  Sensate at the introitus level
➡️  Surgical method must be simple,single staged with less chances of contracture.

Recently, a breakthrough unique technique of ‘Sensate Lateral Labial Free Flap’, or “ “Horse shoe flap Vaginoplasty ” has been invented in which labia minora flaps are used to recreate vagina. This technique is done at very few centers in India and we are fortunate that our Plastic Surgeon ‘Dr.Sourabh Rawat’ is well versed with this technique and already we have done 8 vaginal reconstruction in patients with Primary vaginal agenesis.