Disorders of Sexual Differentiation: Surgical Challenges of Vaginal Reconstruction in Complete Androgen Insensitivity Syndrome (CAIS)

作者：Munoz Jose A^*; Swan Kenneth G

来源：American Surgeon, 2010, 76(2): 188-192.

Disorders of sexual differentiation have proven difficult to treat not only because of physicians' lack of understanding regarding the determinants of sexual orientation, but also because of the psychological impact associated with sexual dysfunction. Patients with complete androgen insensitivity syndrome not only must undergo gonadectomy after puberty, requiring post-gonadectomy hormonal replacement, but also can suffer from underdeveloped, blind vaginal pouches. As a result, sexual intercourse is compromised. Many attempts have been made throughout medical history to correct the vaginal defect, including surgical and nonsurgical approaches, each with its own technical difficulties and complications. Presently, consensus regarding the optimal time for intervention is when the patient is ready to begin sexual life. However, the optimal surgical approach has not been established. In general, nonsurgical vaginal dilatation, like the Frank and Ingram methods, should be followed by surgical interventions, such as described by McIndoe, Vecchietti, and intestinal transplantation, in case of failure of the more conservative procedures.

• 出版日期2010-2