Expert opinion: vaginal aplasia: creation of a neovagina following the Creatsas vaginoplasty

Vaginal aplasia is an uncommon congenital anomaly which is usually diagnosed as part of the Mayer-Rokitansky-Kuster-Hauser syndrome. The appropriate management of the anomaly includes the creation of a neovagina, and various surgical or non-surgical techniques have been described. Among them the Creatsas modification of Williams vaginoplasty is an operative technique which involves the following surgical steps: Under general anesthesia, and after cutting the hymen with the use of diathermy, a U-shaped incision is made in the vulva extending across the perineum and up to the medial side of the labia to the level of the external urethral meatus, being 4cm lateral to it. The tissues are mobilized and a first layer of interrupted sutures is put between the inner skin margins using absorbable material with the knots lying inside the creating neovagina. A second layer of the same material is used to approximate the subcutaneous fat and the perineal muscles and finally, the external skin is sutured with absorbable interrupted stitches. The Creatsas vaginoplasty is simple, safe and highly effective, as its application in a large number of patients has been followed by excellent results, with the creation of a satisfactory neovagina (length 10-12 cm, width 5 cm) in 98% of patients.