BACKGROUND: Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia or male transsexualism, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. CASES: One patient with Mayer-Rokitansky-Küster syndrome developed a protrusion of the sigmoid neovagina almost 4 years after the initial operation. The prolapse was treated successfully using an abdominal approach to suspend the neovagina to a Cooper ligament. The second patient is a male-to-female transsexual who developed a prolapse 3 years after the creation of a sigmoid neovagina. After suspension of the neovagina to a Cooper ligament, the prolapse recurred; in a repeat approach, the neovagina was successfully suspended to the sacral promontory. The third patient, with Mayer-Rokitansky-Küster syndrome, complained of a protrusion immediately after creation of the neovagina. Initially, the redundant sigmoid was resected vaginally. However, the prolapse recurred, and an abdominal suspension to a Cooper ligament was performed. Finally, after 1 year, another recurrence was treated successfully with a vaginal approach. CONCLUSION: Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Both abdominal and vaginal approaches may be needed to restore the neovagina without compromising its function.
BACKGROUND: Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia or male transsexualism, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. CASES: One patient with Mayer-Rokitansky-Küster syndrome developed a protrusion of the sigmoid neovagina almost 4 years after the initial operation. The prolapse was treated successfully using an abdominal approach to suspend the neovagina to a Cooper ligament. The second patient is a male-to-female transsexual who developed a prolapse 3 years after the creation of a sigmoid neovagina. After suspension of the neovagina to a Cooper ligament, the prolapse recurred; in a repeat approach, the neovagina was successfully suspended to the sacral promontory. The third patient, with Mayer-Rokitansky-Küster syndrome, complained of a protrusion immediately after creation of the neovagina. Initially, the redundant sigmoid was resected vaginally. However, the prolapse recurred, and an abdominal suspension to a Cooper ligament was performed. Finally, after 1 year, another recurrence was treated successfully with a vaginal approach. CONCLUSION: Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Both abdominal and vaginal approaches may be needed to restore the neovagina without compromising its function.