Vaginoplasty Easier at Puberty?

Going against conventional wisdom that vaginoplasty in infants is technically easier, a new case study suggests that surgery at puberty may not be all that more difficult due to anatomical changes in the pelvis as the child grows.  The surgeons report the the case of a girl with CAH on whom they chose not to do vaginoplasty in the neonatal period because of what they described as her “short vagina and long urogenital sinus,” which would have made an already difficult surgery even more complex. When she began puberty at age 9 they did a magnetic resonance scan of her pelvis and found that her vaginal size had increased and her vagina and urogenital sinus had descended toward the perineum—changes that would make surgery less difficult than if it had been performed earlier in her life. This is despite the greater difficulty “mobilizing” tissue in an older child. They conclude:

We therefore presently recommend that, since the vagina is not an organ that is essential in early life, for most children with CAH there is no urgency for vaginal reconstruction. Indeed the natural vaginal growth and development that occurs at puberty may have significant advantages in reducing the extent of surgery, which can then be done with fully vascularized, innervated, and lubricated local vaginal tissue.