Vaginal transplantation

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Vaginal transplantation is procedure whereby donated or laboratory-grown vagina tissue is used to create a 'neovagina'. It is most often used in women who have vaginal aplasia (the congenital absence of a vagina).

Contents

Background

Vaginal aplasia is a rare medical condition in which the vagina does not form properly before birth. Those with the condition may have a partially formed vagina, or none at all. The condition is typically treated by reconstructive surgery. First a space is surgically created where the vagina would typically exist. Then tissue from another part of the body is harvested, molded into the shape of a vagina, and grafted into the vagina cavity. This technique has significant drawbacks. Typically, the implanted tissue does not function normally as a muscle, which can lead to low enjoyment of sexual intercourse. Additionally, stenosis (narrowing of the cavity) can occur over time. [1] Most women require multiple surgeries before a satisfactory result is achieved. [2] An alternative to traditional reconstructive surgery is transplantation.

Donor technique

In a handful of cases, a woman with vaginal aplasia has received a successful vagina transplant donated by her mother. [3] The first such case is believed to have occurred in 1970, with no signs of rejection taking place after three years. [4] In at least one case, a woman who received such a transplant was able to conceive and give birth. [5] In 1981, a 12-year-old girl with vaginal aplasia received a vaginal wall implant from her mother. She became sexually active seven years later, without incident. At age 24, she conceived and carried a child to term. The child was born via cesarean section. [6]

Laboratory-grown technique

In April 2014, a team of scientists led by Anthony Atala reported that they had successfully transplanted laboratory-grown vaginas into four female teenaged girls with a rare medical condition called Mayer-Rokitansky-Küster-Hauser syndrome that causes the vagina to develop improperly, or sometimes not at all. [7] Between 1 of 1,500 to 4,000 females are born with this condition. [1]

The four patients began treatment between May 2005 and August 2008. [1] In each case, the medical research team began by taking a small sample of genital tissue from the teenager's vulva. [8] The sample was used as a seed to grow additional tissue in the lab which was then placed in a vaginal shaped, biodegradable mold. [7] Vaginal-lining cells were placed on the inside of the tube, while muscle cells were attached to the outside. [8] Five to six weeks later, the structure was implanted into the patients, where the tissue continued to grow and connected with the girls' circulatory and other bodily systems. [1] [7] After about eight years, all four patients reported normal function and pleasure levels during sexual intercourse according to the Female Sexual Function Index questionnaire, a validated self-report tool. No adverse results or complications were reported. [1]

In two of the four women, the vagina was attached to the uterus, making pregnancy possible. No pregnancies were reported, however, during the study period. Martin Birchall, who works on tissue engineering, but was not involved in the study, said it "addressed some of the most important questions facing translation of tissue engineering technologies." [8] Commentary published by the National Health Service (NHS) called the study "an important proof of concept" and said it showed that tissue engineering had "a great deal of potential." [1] However, the NHS also cautioned that the sample size was very small and further research was necessary to determine the general viability of the technique. [1]

The laboratory-grown autologous transplant technique could also be used on women who want reconstructive surgery due to cancer or other disease once the technique is perfected. [7] However, more studies will need to be conducted and the techniques further developed before commercial production can begin. [8]

Related Research Articles

In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the partial or total surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. Partial hysterectomies allow for hormone regulation while total hysterectomies do not.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of human females

The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. In humans, the female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo which develops into the fetus. The uterus also produces secretions which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

Gender-affirming surgery for male-to-female transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

<span class="mw-page-title-main">Vaginoplasty</span> Surgical procedure

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury. Labiaplasty, which alters the appearance of the vulva, can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.

Müllerian agenesis, also known as Müllerian aplasia, vaginal agenesis, or Mayer–Rokitansky–Küster–Hauser syndrome, is a congenital malformation characterized by a failure of the Müllerian ducts to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. Müllerian agenesis is the cause in 15% of cases of primary amenorrhoea. Because most of the vagina does not develop from the Müllerian duct, instead developing from the urogenital sinus, along with the bladder and urethra, it is present even when the Müllerian duct is completely absent. Because ovaries do not develop from the Müllerian ducts, affected people might have normal secondary sexual characteristics but are infertile due to the lack of a functional uterus. However, biological motherhood is possible through uterus transplantation or use of gestational surrogates.

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

<span class="mw-page-title-main">Labiaplasty</span> Plastic surgery procedure for altering the labia minora

Labiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range.

Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal septum. It results in uterovaginal outflow tract obstruction. This condition does not usually occur by itself within an individual, but coupled with other developmental disorders within the female. The disorders that are usually coupled with a female who has vaginal atresia are Mayer-Rokitansky-Küster-Hauser syndrome, Bardet-Biedl syndrome, or Fraser syndrome. One out of every 5,000 women have this abnormality.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

Vaginal hypoplasia is the underdevelopment or incomplete development of the vagina. It is a birth defect or congenital abnormality of the female genitourinary system.

<span class="mw-page-title-main">Pelvic examination</span> Physical medical examination

A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used to assess a woman's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Postcoital bleeding is bleeding from the vagina after sexual intercourse and may or may not be associated with pain. The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. Postcoital bleeding can be one of the first indications of cervical cancer. There are other reasons why vaginal bleeding may occur after intercourse. Some people will bleed after intercourse for the first time but others will not. The hymen may bleed if it is stretched since it is thin tissue. Other activities may have an effect on the vagina such as sports and tampon use. Postcoital bleeding may stop without treatment. In some instances, postcoital bleeding may resemble menstrual irregularities. Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged. Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.

Müllerian duct anomalies are those structural anomalies caused by errors in müllerian duct development during embryonic morphogenesis. Factors that precipitate include genetics, and maternal exposure to teratogens.

A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. Urogenital fistulas vary in etiology. Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

Transvaginal mesh, also known as vaginal mesh implant, is a net-like surgical tool that is used to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI) among female patients. The surgical mesh is placed transvaginally to reconstruct weakened pelvic muscle walls and to support the urethra or bladder.

References

  1. 1 2 3 4 5 6 7 Bazian (April 11, 2014). "Lab-grown vaginas successfully implanted". NHS (UK). Retrieved May 17, 2014.
  2. ↑ Melissa C. Davies; Sarah M. Creighton; Christopher R.J. Woodhouse (June 2005). "The pitfalls of vaginal construction". BJU International. 95 (9): 1293–98. doi:10.1111/j.1464-410x.2005.05522.x. PMID   15892820.
  3. ↑ G Belleannée; J L Brun; H Trouette; J P Mompart; J F Goussot; G Brun; A de Mascarel (July–August 1998). "Cytologic Findings in a Neovagina Created with Vecchietti's Technique for Treating Vaginal Aplasia". Acta Cytol. 42 (4): 945–8. doi:10.1159/000331973. PMID   9684582. S2CID   3352490.
  4. ↑ Dennis Sanders (1982). The First of Everything. p. 117. ISBN   9780440524229.
  5. ↑ Atef M.M. Darwish (June 2010). "Fine needle vaginoplasty: a simplified novel approach for correction of vaginal aplasia". Fertility and Sterility. 94 (1): 309–312. doi: 10.1016/j.fertnstert.2009.02.006 . PMID   19344896.
  6. ↑ Prapas; Papanicolaou; Prapas; Goutzioulis; Papanicolaou (1993). "Term pregnancy after vaginal transplantation in a case of vaginal agenesis with a functional uterus". Acta Europaea Fertilitatis. 24 (2): 77–78. PMID   8171927.
  7. 1 2 3 4 Kim Painter (April 11, 2014). "Lab-grown vaginas and nostrils work, doctors report". USA Today. Retrieved April 12, 2014.
  8. 1 2 3 4 James Gallagher (April 10, 2014). "Doctors implant lab-grown vagina". BBC. Retrieved April 12, 2014.
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