Reconstruction of the Female

22. August 2007

"Vaginoplasty" - the latest trend in the US for all those apparently having no other problems. For women with a vaginal dysplasia though, it often is the only chance to live a normal sexuality.

Body's own vaginal mucous membrane made in the lab

Those two women having undergone a plastic surgery on their vagina came neither for a general overhaul nor for a sex transformation to Pierluigi Benedetti Panici and his colleagues at the University “La Sapienza”. Actually they had a serious deficiency called vaginal aplasia.
This malformation is inborn and arises mainly from the Mayer-Rokitansky-Küster-Hauser-Syndrom (MRKHS). The affected woman is born with an incompletely developed vagina. Various numbers fluctuate regarding how many women are affected. The Roman gynecologists quote an estimated number of one up to 4,000-10,000 women. So far, the real cause of the malformation is unclear. The novelty of those two surgeries though: For the very first time the physicians successfully grafted a vaginal mucous membrane cultured of body's own stem cells.

Hope for women suffering from MRKHS

The first surgery took place in May 2006. The 28-year old woman had a reconstruction of her vagina by transplantation of body's own mucous membrane. One year later, the team of physicians of Professor Panici reported during a press conference for the first time about a second transplantation of vaginal mucosa on a 17-year old patient. This surgery was just as successful as the first one. The women both were diagnosed with MRKH. Both, procedure and experience were published recently in the professional magazine “Human Reproduction“.

Disadvantages in common skin transplants

Different surgical methods are used to reconstruct a vagina (the so-called neovagina). For Panici and many of his colleagues, the vaginoplasty by Abbè-McIndoe is the most trusted one. Today it is used in a modified manner. The procedure is to prepare a vaginal tunnel. Its septums are sealed up with a skin transplant afterwards. A great variety of materials were used – all with the risk of a possible rejection or infection. Another disadvantage was the scars left on the previous transplants and of course the relatively long time it took until the vagina was functional. The gynecologists in Rome succeeded in their search for a better alternative. They were the first ones using a vaginal cell culture in the lab, based on a biopsy of the vaginal front part, for epithelization of the vaginal septum.

Four months for a functional vagina

One square centimeter of mucous membrane from the vaginal front part was enough to culture 314 square centimeters of tissue on gauze for implantation. This cell culture was prepared in the laboratory for cell biotechnology at Sapienza University. The surgery itself took 18 minutes. After just 5 days it was obvious that more than 90 percent of the body's own mucosa tissue was taken on. After 4 months the patient had a fully functional neovagina. She reports that sexual intercourse – now possible for the first time – was satisfactory for both partners.

Normal epithelization of the grafted mucosa tissue

With a cut, the surgeons created a 10cm tunnel starting from the vaginal entry between bladder and intestine. A special formed piece with a diameter of 2cm and a length of 12cm made sure that the grafted mucosa tissue cannot relocate. This piece also added pressure on the gauze. The patient had to wear this support every night for about 6 weeks. Controls per colposcopy and vaginal biopsy confirmed an absolutely normal epithelization of the vaginal septum. The main reason for the decision to take tissue especially from the vaginal front part was made to avoid scars to the greatest possible extent. And body's own tissue has the additional advantage that the risk regarding infection or rejection can be excluded. Those promising results are encouraging Panici and his colleagues to continue in their researches.

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