Frequently Asked Questions Regarding MRKH / Neovagina
1. What is the average age that MRKH is diagnosed between?
Between 15-18 years old. Please reference our Diagnosis page for more information
2.What tests can be performed to confirm an MRKH diagnosis?
An initial pelvic exam can be performed to confirm diagnosis, however, additional testing is usually required. A pelvic ultrasound or MRI is done to confirm whether or not a uterus can be seen and to confirm if the patient has 1 or 2 kidneys. Additional tests, suck as a blood test may be done to confirm karyotype (female genes) and ovarian function.
3. I do not live near Atlanta or Los Angeles, how do I get a consultation with Dr. Miklos and Dr. Moore?
Most of our MRKH/AIS patients do not live in the Atlanta or Los Angeles area. Before deciding if our Laparoscopic Davydov procedure is the right one for you, please call our Patient Care Coordinator, Susie to set up a phone consultation with Dr. Miklos or Dr. Moore.
If you decide to have surgery with Dr. Miklos and Dr. Moore, we can arrange for you to have a consultation and surgery in the same week. Our staff is very experienced in working with patients that elect to have next day surgery. We will make sure all your questions are answered and needs are met prior to your arrival date.
4. How does the procedure work?
Please reference http://www.mrkh-surgeons.com/overview.php for a detailed description of the procedure using step-by-step drawings to help explain the procedure. You can also view a video of the surgery on this page: http://www.mrkh-surgeons.com/videos.php.
In brief, Dr. Moore and Dr. Miklos utilize the peritoneal lining of the pelvis as the lining of the new vaginal canal. They open the introitus up and this brings them into the pelvis from below and between the bladder and the rectum. They then pull the peritoneum down to the opening and suture this with absorbable sutures. Dr. Moore and Dr. Miklos then do a pursestring suture at the top of the pelvis to create the new top of the vagina.
Over time, typically 6-12 months, the peritoneum actually transforms and thickens and becomes true vaginal epithelium (e.g. if you looked under a microscope). It is almost like stem cell placement. Studies have been done on sexual function including arousal, lubrication, sensation, and orgasm and have been found to be equivalent to matched controls with normal developed vaginas.
5. What are the risks of this procedure, both relating to the surgery and the anesthetic?
The surgery only takes about 1.5 - 2 hours and is under general anesthesia, however Dr. Moore and Dr. Miklos work with excellent anesthesiologists and therefore given the length of the surgery, this is a very minimal risk. Risks of this type of Neovagina surgery are actually the lowest of any of the abdominal approach and probably even lower than some of the vaginal approaches as no skin grafts are needed to be taken or used, nor any muscle flaps from the thighs, etc.
Any time you do the dissection for the Neovagina, there is a risk of bladder or bowel injury, however it is very minimal and even if it occurs, it can typically be repaired at the time of surgery and sequalae results. Please note: Dr. Moore and Dr. Miklos have never had a bowel injury and have only had only one bladder injury when performing this surgery and they (Dr. Moore and Dr. Miklos) have been doing this for almost 10 years now.
6. How successful is this procedure?
The success of the procedure is over 95%. Of course the patient does have something to do with this, as she has to be vigilant in the first few months by maintaining the length and passing dilators a couple times a day. She does not have to dilate per se, however, she does have to pass a dilator a few times per day to ensure the vagina is not scarring down or sticking together. She typically does not have to dilate for length. Dr. Moore and Dr. Miklos have had a couple very young patients that were not compliant after surgery and this did affect their outcome, however ultimately they did fine and have functional vaginas. Ultimately, it is important to stick with our protocol.
7. How much length can be added to the vaginal canal with the procedure?
Dr. Moore and Dr. Miklos typically end up with 12cm of length (which is phenomenal) though they do know that over time and with healing a patient can usually lose a couple of centimeters and most patients end up with about 10cm. This is more than adequate length however, as studies have shown, as long as a woman has more than 7 or 8 cm, then sexual function should be o.k.
8. What are the chances that I might need more than one surgery?
Very, Very low. Dr. Moore and Dr. Miklos have had only one patient that needed a follow up surgery and that was secondary to the fact she was not compliant with passing the dilator (she was very young) and the lower vaginal walls stuck down to each other. They were able to release the vaginal walls easily and after surgery, she did great. She now has a normal functioning vagina and is sexually active with no problems.
9. How painful is the procedure?
Typically most women state that it is not very painful at all. There will be some general cramping in the pelvis after surgery for a few days and there is a little tenderness at the opening of the vagina (especially when passing a dilator for the first couple of weeks), but typically pain medication can help control the pain and most women are up and about after a couple of days. Within a week, they are back to normal activities; (of course no exercise, heavy lifting, etc. for a period of time, however, she can return to school/work or go to the movies just a few days after surgery).
10. How long does it take to perform?
About 1.5 hours to 2 hours
11. How long will I have to stay in the hospital after the surgery and how long before I will be able to travel back home (if from out of State/Country)?
Patients will stay one night in the outpatient extended recovery unit at the hospital. They next day they can return to their hotel for additional rest. Dr. Moore and Dr. Miklos recommend that she stay in the area for about 10 days after surgery to ensure all is healing well prior to travelling home. Most patients will be seen by our medical staff an additional two times prior to going home.
12. How long after the surgery will I be fully recovered and when could I expect to have a sexual relationship?
Within 6 to 8 weeks after surgery, as long as the patient is comfortable passing the appropriate dilator and there is no bleeding or spotting with the passage, then they can become sexually active.
13. What kind of follow-up care will I need, i.e. how often will I need to see a gynecologist / come back to see you (Dr. Moore and Dr. Miklos)?
Most of our patients travel to us from other states or other countries; therefore once home, patients can follow up with their gynecologist or primary care provider should any issues or concerns come up. Dr. Moore and Dr. Miklos are also available for a phone consultation with the patient’s gynecologist or primary care physician if needed.
As long as the patient is passing their dilator to the proper depth without any complications, then they do not need a follow up exam until 6 weeks after surgery and all that is really needed is a quick check to make sure she has healed properly. If all is going well, Dr. Moore and Dr. Miklos do not necessarily need to see the patient back in Atlanta or Los Angeles for follow-up; however, a patient can elect to come see them for a post-operative check-up.
14. Will I need to continue with the use of dilators after the surgery?
The patient will have to start passing a dilator up to the top of her new vagina a couple times per day (with estrogen cream) as soon as the packing comes out at 48-72 hours. The patient will start with a pink dilator (more narrow) just to ensure she can insert it to the top. After 3-4 days using the pink dilator, patient should attempt to switch to the blue dilator. This may take a couple of days. After 3-4 days of passing this one comfortably, she should then start working with the dilator kit and be working up to the third size dilator in the kit (we call this #3 – this dilator is the maintenance dilator, it is 10cm long). Patient should be using the third dilator by the 2nd week after surgery (this may take a little longer).
The #3 dilator will be the dilator the patient will use until she is sexually active. Typically once the patient is sexually active on a regular basis, she will not longer have to use the dilators. The goal is not to lengthen or dilate; it is just to maintain what Dr. Moore and Dr. Miklos have created during surgery and during the healing process to help prevent scarring down. This also helps the patient heal and prepare her for intercourse.