Non-surgical treatment of vaginal agenesis using a simplified version of Ingram's method

Abstract

Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator.

Fig. 1

Pelvic MR image shows complete agenesis of the vagina (short arrow) and suggests the presence of a rudimentary uterus (2-cm diameter) (long arrow).

Fig. 2

The acrylic dilators. Among the three sets of dilators, the first two sets (diameters of 1.5 cm and 2.5 cm) were used in this patient.

Fig. 3

A bicycle seat stool (A) and an ordinary chair (B). The photo of the ordinary chair is shown as an example, but was not the chair used in our study.