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Female Genital & Vaginal Reconstruction

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There are several rare conditions that lead to either an absent vagina or a vagina that is not adequate for sexual function.  There are also rare conditions that can lead to other vagina anomalies or uterus anomalies.  In addition, there are conditions that lead to abnormal development of the external genitalia in females that may require surgical treatment.  To provide care for these complex patients the Female Genital and Vaginal Reconstruction Center was created.  Dr. Linda Baker is the pediatric urologist who leads this center and is nationally known for her efforts in pioneering surgical options for these patients.  

What to Expect

The management varies greatly by condition.  In general, a history and physical exam will be performed and any records from outside institutions will be reviewed.  An exam under anesthesia to fully define anatomy in order to make surgical recommendations is often performed.  If surgery is recommended, this will be explained in detail.  

Conditions We Treat

  • Absence of Vagina or Inadequate Vaginal Length
  • Ambiguous Genitalia
  • Duplicated Uterus and/or Vagina
  • Epispadias
  • Labial Adhesions
  • Mayer-Rokitansky-Küster-Hauser Syndrome
  • Obstructed Hemivagina and Unilateral Renal Anomaly Syndrome
  • Persistent Genitourinary Sinus
  • Urethral Prolapse
  • Urethral Stricture

About Female Development

Development of the female internal and external genitalia begins long before a child is born.  Through a complex cascade of hormonal signals and events, the internal and external female genitalia develop.  If this process is disrupted at any point, anomalies can occur.  Two paired structures called the mullerian ducts fuse to form the uterus, cervix, and top part of the vagina.  If the mullerian ducts do not exist or if the fusion does not happen correctly, uterus and vagina anomalies can develop.  In addition, if there is an excess of hormones called androgens, the female external genitalia may be atypical with an enlarged clitoris and potentially fusion of the labia.  

Buccal Mucosa Vaginoplasty

In females with an absent or inadequate vagina, several surgeries have been developed to create or improve the vagina.  Skin grafts have been used to create a vagina but have problems with hair growth as well as not having any natural lubrication.  Intestines or colon have been used as well but this requires a very invasive surgery and there can be problems with too much mucous production or with prolapsed tissue out of the vagina. 

Buccal mucosa is the lining on the inner part of the cheeks.  This tissue can be harvested and a vagina can be created with it.  The inner lining of the cheek usually heals quickly without any visible scars and only rare complications.  The advantages using buccal mucosa over skin grafts is that buccal mucosa has similar natural lubrication to normal vaginal tissue and the use of buccal mucosa does not leave any visible scars while use of skin graft leaves a large scar.   The advantages of using buccal mucosa over bowel are that buccal mucosa does not have overproduction of mucous, problems with prolapsed tissue out of the vagina, and does not require invasive bowel surgery.  Dr. Linda Baker is a nationally recognized expert in performing buccal mucosa vaginoplasties and is sought out by patients for her expertise.