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By SUSHIL KUTTY

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t was unusual. Not everyday does a female without a

vagina walk into a hospital. And not everyday do doctors labour to construct one for a J I I iii

Dr Sanjay Saraf, Dr Praveena Saraf

damsel in such a type of distress. The NMC Speciality Hospital had one such visitor in recent days, and shortly thereafter, without much ado, she walked out a 'woman' in every sense of that term, perfect to behold to her own eyes!

That also was 'unusual'. "It is surgery to make an artificial vagina from the patient's own tissue," says Dr Sanjay Saraf, Specialist Plastic Surgeon, NMC Speciality Hospital. "Congential anomalies of the female genital tract may include an absence of the vagina (vaginal atresia or agenesis), either as an isolated developmental defect or within a complex of more extensive anomalies. Vaginal atresia is

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associated most commonly with Rokintansky - Mayer - KusterHauser (RMKH)syndrome, in which the principal association is with the absent/non-developed uterus despite the presence of normal external genitalia." Wikipedia, the free encyclopedia, explains vaginoplasty as a surgical operation with the aim of correcting structural defects in the vagina or even to construct or reconstruct it. "When used to produce a new vagina when one is lacking (a neovagina) it is called neo-vaginoplasty." When the 27-year-old woman - for want of a name let us call her IV' - walked into NMC Speciality Hospital she was assessed by a gynaecologist and was found to be a fit candidate for neo-vaginoplasty. "She came to the hospital's Gyn/Obs Department with complaints of absent vaginal orifice and

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absence of periods. The patient was investigated and was found to be suffering from Congenital Vaginal Agenesis (MRKH Syndrome)," says specialist gynaecologist Dr Praveena Saraf.

Counselling "Vaginal atresia is estimated to occur in 1 in 5000-7000 live female births and is a significant threat to the mental health and well-being of an otherwise norma" healthy young woman/, says Dr Praveena Saraf. "Such cases are seldom diagnosed at an early age, and diagnosis is frequently not made until adolescence when the patients present with absence of menstrual periods." Dr Praveena Saraf says vaginal agenesis involves iSSL"eS of physical abnormality, bodimage, sexual identity, aNi

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'Now, I'm a complete woman' 'Y' wouldn't meet us, any of us though she was gracious enough to talk over the telephone. Dr Sanjay ~araf fixed the call in such a way that not even the telephone number wa~ conveyed to the 'other party' i.e., 'We'. That suited us just fine. From the round ot her voice, 'Y appeared to be quite in control of the situation, her situation, and she spoke just the right words to make that feeling felt. "One woman out of every 5000 to 10,000 is diagnosed with this disorder. That's what I was told. But that, however, advancement in science has ensured that post-surgery it is possible for women to lead normal, healthy lives. "It was at the age of 19 that we finally visited a doctor. In the beginning, doctors in India thought I had some problem with the ovaries but after a visit to the endocrinologist, we found that the problem was something else, altogether. Of course, I did not undergo the surgery in India, despite the fact that it was much cheaper to get myself operated there. I came to Dubai two years ago and decided to undergo the operation here. "Doctors assure me that I can now lead a normal life. In fact, I'll be getting married in a few months' time. Earlier, I thought it would not be possible at all. Now, I feel like a complete woman. I am not sure if I can have a baby, for I have some other complications as well, but women who have undergone this surgery before could have children. My future in-laws are aware of this fact and so is my husband to be, who I will be meeting for the first time in September. Yes, I'm definitely glad to have had this makeover. I am normal, and I'm feeling just great. Isn't that great?" It is!

sexual/reproductive functioning that require long-term medical and psychological management. "Counselling both for the patient as well as for parents, regarding the disease process, the management options available and the need for long-term follow-up is one issue that is very important. In addition to the surgical and non-surgical options, the discussion should include future fertility, capacity for future physical relations and genital appearance."

The last required the expert hands of a plastic surgeon. And Dr Sanjay Saraf took charge of 'Y' with a confidence born of 1O0s of surgeries where he repaired, reconstructed and constructed most every human body part from cut off fingers to hands at the wrists and nose and the jaw. "The surgical management of absence of the vagina constitutes a significant technical challenge, the outcome of which affects both the physical and psychological health of the patient," says Dr Saraf. "The ideal reconstructive procedure should provide a vagina that has an appropriate length, adequate caliber and should be cosmetically acceptable. Neo-vaginoplasty fits the bill. It is a reconstructive surgical procedure used the reconstruct the vaginal tube." But Dr Sanjay Saraf says the patient should also fit the bill for neo-vaginoplasty. "There is some debate as to when such patients should be treated. My advice is that such treatment should be deferred until the patient attains full growth, is psychologically prepared and is socially and sexually mature." The husband-wife of team Dr Sanjay and Dr Praveena found 'Y" fit all these criteria for a made-to-specifications 'V'. And just so that every thing fell into its right place, a multidisciplinary approach was recommended to best meet the challenge of providing good cosmetic and optimal functional outcomes.

Good news It was an involved procedure. The construction of a vagina where none existed took time -

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Dr Sanjay Saraf, Specialist Plastic Surgeon, NMC Speciality Hospital.

a four-hour long procedure and it needed sure hands, much manipulation of skin and tissue. Dr Saraf took graft skin from 'Y's' thigh and buttocks to construct the vagina, which when made had an 11-12 cm length and a 4.5 cm diameter. The vagina in place, a mould with a condom for cover was made and inserted into the vagina, to be retained there for at least three months, to ensure that the cavity did not collapse into itself. "Over a period of time, nature and bodily reactions would see to it that the skin inside the vagina took on the same characteristics of any normal vagina, have the same feeV' says Dr Saraf. "It assumes the characteristics of a normal vagina, secretes and lubricates on its own." The vagina will allow 'Y' to

be as woman as possible with the exception of conceiving because it's not possible to "transplant a uterus". Says Dr '. Praveena Saraf: "In terms of fertility a number of options are available. Many such women choose to adopt children. One mother of such a patient asked if her own uterus could be transplanted and attached 0 her daughter's ovaries. This is not medically possible now but it is possible to harvest the patient's eggs, inseminate them with her partner's sperm, and implant them into another woman's uterus." The best news as far as 'Y' is concerned is that she is all set to tie the knot, and the man in her life is aware of what she underwent, and knows what he can expect. That, again, is quite the unusual.

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