Health Library

Vecchietti Vaginoplasty

Conditions Treated with Vecchietti Vaginoplasty

The main condition Vecchietti vaginoplasty helps with is Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. It can also help people with androgen insensitivity syndrome (AIS).

MRKH syndrome affects one in 4,500 females. It results in the underdevelopment of the uterus, cervix and upper vagina. An MRKH diagnosis usually happens at age 15 or 16 after a typical female puberty happens without onset of periods. Pelvic imaging, blood work and genetic testing help doctors confirm the diagnosis of MRKH.

Some people with MRKH choose to lengthen their vagina through dilation or surgery. There is no rush to decide about vaginal lengthening. The timing and treatment are unique to each person.

Most people can lengthen their vaginal canal with continued dilation. Dilation involves using an object called a dilator or lengthening the vagina with a partner (through sex). Dilators come in different sizes. Placing dilators into the vagina over time can help make the space longer without surgery. Support from a health care provider with expertise in dilation treatment is recommended to improve chances of success.

Is Vecchietti Vaginoplasty Right for My Teen?

Having surgery is a big decision. It requires full consent from the patient.

All vaginoplasty surgeries are second-line treatment for vaginal agenesis. That means patients always try a less invasive treatment before they consider surgery. Vecchietti vaginoplasty can help people who:

• Have a diagnosis of vaginal agenesis and desire penetrative, vaginal sex
• Have tried dilation but haven’t achieved a vaginal length that allows pain-free sex
• Do not plan to join a clinical trial for a uterine transplant

A person must not only be physically ready for surgery but also mentally ready. A big part of recovery requires dilation of the vaginal canal to prevent scarring. It’s important that those who have surgery are comfortable touching the vulva and placing and removing a vaginal stent or dilator on their own.

How the Vecchietti Procedure Works

The Vecchietti vaginoplasty is just one of many ways to lengthen the vagina. It’s a type of laparoscopic vaginoplasty, which is a minimally invasive procedure, done in an operating room. The surgeon uses small cuts and special tools to access the belly and pelvis.

The Vecchietti technique can speed up the dilation process compared to standard dilation, which happens over six to 12 months at home. However, it comes with surgical risks. Patients spend about seven days in the hospital. During the procedure, a surgeon places a small dilator against the vaginal opening. They attach it to a traction device on the abdomen using strings (sutures). Daily adjustments to the traction device pull the strings and dilator up. The tension stretches the tissue and lengthens the vagina.

After the procedure (post-op), pain is a big part of the vaginal lengthening process. Pain management includes an epidural catheter during the week-long hospital stay. Patients also must remain flat and in bed during this time.

After a week, patients return to the operating room for removal of the dilator and traction device. Then, the vaginal canal needs time to heal. Patients must continue to wear a dilator or stent all day to prevent scarring. The vaginal canal heals with natural vaginal mucosa (cells that form in the inner lining of the vagina).

What to Expect Before the Procedure

At Cincinnati Children’s, our MRKH Care Center gives patients access to a complete care team. Those with suspected or confirmed MRKH work with a gynecologist, psychologist, social worker and pelvic health physical therapist. The team first helps patients with dilation, if desired. Then, for patients who require surgery, they discuss all options, including Vecchietti vaginoplasty.

Before the procedure, patients meet with their care team. This meeting is called a pre-op consult. Patients also have a pre-op consult with their anesthesia team, who help manage pain while they’re in the hospital. During consults, patients go over expectations and can ask any questions.

When preparing for vaginoplasty surgery, several screenings are done to make sure surgery is safe. Some conditions, such as a pelvic kidney, can mean a patient is not an ideal candidate for Vecchietti vaginoplasty. Patients may have a kidney screening, spine screening and heart screening with an echocardiogram.

Before thinking about surgery, it’s important that a patient is comfortable with their body. They will need to place and remove a dilator on their own after the surgery.

If patients have a parent or partner involved, a social worker will help them understand what surgery might be like for the patient. They can also help with accommodations, travel and other needs. The clinical psychologist will spend time with the patient. They provide mental health and counseling support.

Recovery and Aftercare

It usually takes about six to 12 weeks for the vaginal canal to heal after surgery. During Vecchietti vaginoplasty recovery, patients must do dilation therapy. How long and how often patients wear a dilator depends on their specific needs.

Patients also see their gynecologist for frequent follow-up visits in the two months after surgery. The gynecologist looks at their vaginal canal with a device called a speculum. Some patients can have a yellow discharge associated with healing (granulation tissue). During the speculum exam, the gynecologist may apply silver nitrate medication to treat this granulation tissue. It can allow healing and reduced vaginal discharge.

Though most patients can walk after they first leave the hospital, they need time to heal. Many return to school or work but cannot do any heavy lifting or intense physical activity for two weeks after the operation. They should also avoid sex until their gynecologist says it is safe.

Recovery can be an adjustment for patients, so it’s important for them to receive support and care. It can take time to get used to the space in the body. Wearing a dilator is often a new sensation.

Long-Term Outcomes and Quality of Life

Most patients have positive Vecchietti vaginoplasty results. But maintaining the length of the vagina requires long-term care. If a person does not regularly have sex, they may need to place and remove a dilator at least once a week. Using a dilator can prevent shortening or narrowing of the vaginal canal.

Sexual health is part of a person’s quality of life. This procedure can improve a person’s ability to have penetrative sex. While the Vecchietti vaginoplasty surgery helps to lengthen the vagina, patients still will not have a period or be able to carry a pregnancy after surgery. More complete support for their diagnosis is important for overall well-being.

Patients continue to see their pediatric gynecologist until they have healed and can have painless sex without bleeding. Later, they often transition to an adult OBGYN provider for gynecologic care into adulthood.

Emotional Support for Teens and Families

People with MRKH syndrome can still live a full life. The diagnosis and treatment, though, can be an emotional experience. Psychosocial support is a key aspect of MRKH care.

It’s important to support a teen’s body image and self-esteem and help them communicate with trusted adults or partners. At Cincinnati Children’s, our social workers and psychologists provide counseling and offer peer support resources.