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By SUSHIL KUTTY
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t was unusual. Not everyday That also was 'unusual'.

does a female without a
I vagina walk into a hospital.
And not everyday do doctors
labour to construct one for a
damsel in such a type of distress.
J The NMC Speciality Hospital
had one such visitor in recent
I days, and shortly thereafter,
I
iii without much ado, she walked
out a 'woman' in every sense of
Dr Sanjay Saraf,
Dr Praveena Saraf that term, perfect to behold to
her own eyes!
"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

September I 55 ~~
2006,UAEDIGEST
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Dr Praveena Saraf

associated most commonly with absence of periods. The patient

Rokintansky - Mayer - Kuster-
Hauser (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
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, bod-
image, sexual identity, aNi

56 IUAE DIGEST,September 2006

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ill

The last required the expert

hands of a plastic surgeon. And
'Now, I'm a complete woman' Dr Sanjay Saraf took charge of
'Y' with a confidence born of
'Y' wouldn't meet us, any of us though 1O0s of surgeries where he
she was gracious enough to talk over repaired, reconstructed and
the telephone. Dr Sanjay ~araf fixed constructed most every human
the call in such a way that not even body part from cut off fingers to
the telephone number wa~ conveyed hands at the wrists and nose and
to the 'other party' i.e., 'We'. That the jaw. "The surgical
suited us just fine. From the round ot management of absence of the
her voice, 'Y appeared to be quite in control of the vagina constitutes a significant
situation, her situation, and she spoke just the right words to technical challenge, the
make that feeling felt. outcome of which affects both
"One woman out of every 5000 to 10,000 is diagnosed with this the physical and psychological
disorder. That's what I was told. But that, however, advancement health of the patient," says Dr
in science has ensured that post-surgery it is possible for women Saraf.
to lead normal, healthy lives. "The ideal reconstructive
"It was at the age of 19 that we finally visited a doctor. In the procedure should provide a
beginning, doctors in India thought I had some problem with vagina that has an appropriate
the ovaries but after a visit to the endocrinologist, we found that length, adequate caliber and
the problem was something else, altogether. Of course, I did not should be cosmetically
undergo the surgery in India, despite the fact that it was much acceptable. Neo-vaginoplasty fits
cheaper to get myself operated there. I came to Dubai two years the bill. It is a reconstructive
ago and decided to undergo the operation here. surgical procedure used the
"Doctors assure me that I can now lead a normal life. In fact, I'll reconstruct the vaginal tube."
be getting married in a few months' time. Earlier, I thought it But Dr Sanjay Saraf says the
would not be possible at all. Now, I feel like a complete patient should also fit the bill for
woman. I am not sure if I can have a baby, for I have some neo-vaginoplasty. "There is some
other complications as well, but women who have undergone debate as to when such patients
this surgery before could have children. My future in-laws are should be treated. My advice is
aware of this fact and so is my husband to be, who I will be that such treatment should be
meeting for the first time in September. Yes, I'm definitely glad deferred until the patient attains
to have had this makeover. I am normal, and I'm feeling just full growth, is psychologically
great. Isn't that great?" prepared and is socially and
It is! sexually mature."
The husband-wife of team Dr
Sanjay and Dr Praveena found
sexual/reproductive functioning 'Y" fit all these criteria for a
that require long-term medical made-to-specifications 'V'. And
and psychological management. just so that every thing fell into
"Counselling both for the patient its right place, a multi-
as well as for parents, regarding disciplinary approach was
the disease process, the recommended to best meet the
management options available challenge of providing good
and the need for long-term cosmetic and optimal functional
follow-up is one issue that is outcomes.
very important. In addition to the
surgical and non-surgical Good news
options, the discussion should
include future fertility, capacity It was an involved procedure.
for future physical relations and The construction of a vagina
genital appearance." where none existed took time -

September 2006, UAE DIGEST157 ~~ ~


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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
I
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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.
September2006, UAE DIGEST!59 ~~
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