Vaginal transplantation

Vaginal transplantation is procedure whereby donated or laboratory-grown vagina tissue is used to create a 'neovagina'. It is most often used in women who have vaginal aplasia (the congential absence of a vagina).

Background[]

Vaginal aplasia is a rare medical condition in which the vagina does not form properly before birth. Sufferers of the condition may have a partially formed vagina, or none at all. The condition is typically treated by reconstructive surgery. First a space is surgically created where the vagina would typically exist. Then tissue from another part of the body is harvested, molded into the shape of a vagina, and grafted into the vagina cavity. This technique has significant drawbacks. Typically, the implanted tissue does not function normally as a muscle, which can lead to low enjoyment of sexual intercourse. Additionally, stenosis (narrowing of the cavity) can occur over time.^[1] Most women require multiple surgeries before a satisfactory result is achieved.^[2] An alternative to traditional reconstructive surgery is transplantation.

Donor technique[]

In a handful of cases, a woman with vaginal aplasia has received a successful vagina transplant donated by her mother.^[3] The first such case is believed to have occurred in 1970, with no signs of rejection taking place after three years.^[4] In at least one case, a woman who received such a transplant was able to conceive and give birth.^[5] In 1981, a 12-year-old girl with vaginal aplasia received a vaginal wall implant from her mother. She became sexually active seven years later, without incident. At age 24, she conceived and carried a child to term. The child was born via cesarean section.^[6]

Laboratory-grown technique[]

In April 2014, a team of scientists led by Anthony Atala reported that they had successfully transplanted laboratory-grown vaginas into four female teenaged girls with a rare medical condition called Mayer-Rokitansky-Küster-Hauser syndrome that causes the vagina to develop improperly, or sometimes not at all.^[7] Between 1 of 1,500 to 4,000 females are born with this condition.^[1]

The four patients began treatment between May 2005 and August 2008.^[1] In each case, the medical research team began by taking a small sample of genital tissue from the teenager's vulva.^[8] The sample was used as a seed to grow additional tissue in the lab which was then placed in a vaginal shaped, biodegradable mold.^[7] Vaginal-lining cells were placed on the inside of the tube, while muscle cells were attached to the outside.^[8] Five to six weeks later, the structure was implanted into the patients, where the tissue continued to grow and connected with the girls' circulatory and other bodily systems.^[1][7] After about eight years, all four patients reported normal function and pleasure levels during sexual intercourse according to the Female Sexual Function Index questionnaire, a validated self-report tool. No adverse results or complications were reported.^[1]

In two of the four women, the vagina was attached to the uterus, making pregnancy possible. No pregnancies were reported, however, during the study period. , who works on tissue engineering, but was not involved in the study, said it "addressed some of the most important questions facing translation of tissue engineering technologies."^[8] Commentary published by the National Health Service (NHS) called the study "an important proof of concept" and said it showed that tissue engineering had "a great deal of potential."^[1] However, the NHS also cautioned that the sample size was very small and further research was necessary to determine the general viability of the technique.^[1]

The laboratory-grown autologous transplant technique could also be used on women who want reconstructive surgery due to cancer or other disease once the technique is perfected.^[7] However, more studies will need to be conducted and the techniques further developed before commercial production can begin.^[8]

References[]