If you’re seeking more information on the condition of MRKH, you’ve come to the right place. Miklos & Moore Urogynecology is a world leader in neovagina creation and restoring functionality and quality of life to patients diagnosed with MRKH. They have been featured with one of their patients on the hit TV show – THE DOCTORS
The diagnosis of MRHK (Mayer-Rokitansky-Kuster-Hauser) syndrome or AIS (Androgen Insensitivity Syndrome) may be difficult for many young women as they are born without an internal vaginal canal. The good news is Drs. Miklos & Moore offer the latest, greatest and most minimally invasive operation known to achieve full vaginal length and a normal sexual life.
MRKH is a condition where the uterus and the vaginal canal do not form properly, resulting in a very short vaginal canal or no vagina at all in the developing female. However, the patient usually still has ovaries and normal external female anatomy. This condition, which is also called Vaginal Agenesis, affects 1 in 5,000 females. It is a randomly occurring event, i.e. it is not known to be a genetic condition nor caused by anything that the mother was exposed to during pregnancy.
Miklos & Moore Urogynecology is considered one of THE WORLD’S LEADING CENTERS in the laparoscopic creation of the a new vagina for patients who are born without one or for women who have had their vaginas shortened through surgery or trauma. Drs. Miklos & Moore have performed more of this procedure than any other center in the United States have a greater than 90% success rate. Surgeons throughout the United States and World have send their patients to Drs. Miklos & Moore for this minimally invasive outpatient surgical procedure.
A MRKH patient is a genetic female with normal female chromosomes and ovaries, and therefore develops typical external female characteristics – including breasts and external vulva and vagina. The patient looks and appears like a women, because she is 100% female, however the vaginal canal and the uterus just do not fully develop inside her body. The ovaries are normal and still produce estrogen and hormones, which results in the female characteristics. Diagnosis of MRKH is usually made during adolescence when menstruation is delayed, or it may be discovered with the first attempts at having sex.
The most conservative and least invasive treatments for vaginal agenesis (short vagina) is vaginal dilation. This is accomplished by using sequentially larger dilators in the vagina over the course of months to years. Many patients have been successful using this method of treatment however most patients require surgery to acquire a full-length vagina (7-12 cm).
While there are multiple surgical procedures described for the creation of a new vagina in women with this condition, the laparoscopic Davydov procedure is considered by far the least invasive procedure to create a full-length functioning vagina. Procedures such as the McIndoe procedure utilize external skin and require the patient to wear a surgical mold in the vagina for as long as 4-6 weeks. The McIndoe also requires lifelong dilation and has high rates of scarring down and becoming non-functional. Other approaches such as utilizing a segment of bowel or skin grafts from the inside of the cheek have been described, but again are much more invasive and carry much higher risks of complications compared to the Davydov.
Dr. Miklos and Dr. Moore are considered world leaders in this laparoscopic approach to create a neovagina and complete more of these procedures than any other center in the United States on an annual basis. They also utilize the procedure in patients with failed previous neovagina procedures, such as the McIndoe.
Drs. Moore and Miklos utilize a laparoscopic modification of the Davydov procedure. The doctors travelled to Russia and were trained by Dr. L.V. Adamyan, who developed this original technique. They have used their laparoscopic expertise and suturing skills to modify the procedure, making it less invasive than most of the alternative surgical options. Studies have shown the Davydov to result in the development of normal vaginal tissue and normal sexual function including lubrication, sensation and potentially orgasm
The quickest way to attain a full-length vagina is to have surgery and the least invasive surgery is known as the Laparoscopic Davydov procedure that is depicted below. The surgery is accomplished through both a vaginal and laparoscopic approach usually in about 1.5 hours.
The Davydov procedure utilizes the patient’s own peritoneum (the cellular layer that lines the walls of the pelvis and the abdominal cavity) as the new vaginal canal. The procedure usually takes between 1-2 hours and is completed in an outpatient surgical setting. The procedure is completed with both a vaginal and laparoscopic approach. Tiny incisions are made in the belly to allow access to the abdominal cavity.
Patients will spend the night in the outpatient center or a recovery center with nursing support for 24 hours and then are discharged to go home or to the hotel. Packing is left in place for 48 hours and then removed. Dilators are passed for the first few months or until the patient becomes sexually active. (Patients do not have to become sexually active after the procedure, they can wait as long as they would like). Pain is typically minimal and is controlled by pain medications for the first few days. Usually after a couple days the patient is up and moving around and by 1 week, doing most of her normal daily activities. Vigorous activities such as sports or hard exercise are limited for the first few months after the procedure. Patients can start walking for exercise in as early as 2 weeks following the procedure. Patients usually stay for about one week and see the doctors several times throughout their stay. Drs. Moore and Miklos will communicate with the patients’ doctor at home and the follow-up visits can be completed with a home gynecologist. After healing, the patient should see her gynecologist on an annual basis for normal female care including pap smears, however there is no special care needed after healing.
Since women with MRKH typically have normal ovaries, they CAN have their own biologic children through in-vitro-fertilization and a surrogate carrier. They would see a specialist in Reproductive Endocrinology for this type treatment. There are studies currently being completed in Sweden on Uterine transplant surgery, and there have been successful pregnancies reported, however these studies are still very early in the investigative phase.
Finding out that you or your daughter has MRKH can be very difficult for a family. Finding a physician that can answer all your questions regarding this rare syndrome can be difficult. At Miklos and Moore, we’re available to help guide you during this journey. But if you would like to reach out and connect with other women with MRKH, there are support groups available all over the United States and internationally. Below are some communities that Dr. Moore and Dr. Miklos have connected other patients with. Some of these groups are open to the public and some are private. Finding the right one is up to you.
• www.mrkhconnect.org – MRKH Connect is a registered charity in England and Wales that aims to connect women with MRKH worldwide. It provides members with an online support system, allowing you to receive and offer support to women in similar situations.
• www.mid-atlanticmrkh.org – Mid-Atlantic MRKH Foundation provides opportunities for women with MRKH in the Mid-Atlantic region to meet and make connections face to face