First vaginal transplant carried out successfully

By Arpana Adhikari, Kathmandu, Jan. 17: Nepal has made a tremendous progress in healthcare service in recent years as doctors in the country have, of late, succeeded in conducting very rare and complex health organ transplants like bone marrow and liver transplants. 

A recent achievement made in this field was a vaginal transplant carried out by a team of pediatric surgeons and gynecologists at Ishan Children and Women Hospital, Maharajgunj.

A 26-year-old woman of Pokhara became the first person in Nepal to have a piece of tissue incised from the cavity of her large intestine turned it into her vagina.

A team led by Dr. RP Chaudhary, pediatric surgeon and Dr. Asha Singh, gynecologist, had carried out the six-and-half-hour vaginal transplant surgery successfully implanting a vagina into the woman.

“This was one of the complicated transplants because as the vagina lies between the urethra and the rectum, in such cases even a minor mistake in the surgery could damage the urinary tract or rectum of the patient,” Dr. Chaudhary told The Rising Nepal.

Dr. Chaudhary said the woman was born without vagina, a rare condition called ‘Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome’.

Furthermore, she had Bicornuate uterus, which means her uterus was separated into two parts and was not properly developed. But her ovaries were functioning.

More than half a million women worldwide were said to be affected by the MRKH syndrome, according to Dr. Chaudhary.

“Her condition is a congenital malformation characterised by a failure of the Mullerian duct to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. However, she is genetically a female and have normally functioning ovaries,” said Dr. Asha Singh.

The patient had first visited her some three years ago, complaining that she was not having her periods, said Dr. Singh, adding, she was completely shattered after knowing her condition.

“After three years, she visited me again because like other girls, she wanted to get married with a guy she was in love and live a normal marital life. So, I decided to have consultation with Dr. Chaudhary about her rare condition, and he suggested me that we could implant her vagina,” Singh said.

Dr. Chaudhary said, “Implanting vagina that can work as vagina was very challenging. We used the tissue from her large intestine, which is basically a cavity of loose tissue and which will also secrete fluid like vagina.”

After the vaginal implant, she can now enjoy her sexual life. But as the implanted tissue might get shrink, she needs regular vaginal dilation therapy until she gets sexually active.

“We have removed her uterus with her consent because her uterus was not developed and in the long run this could develop cancer, “ said Dr. Singh.

Quoting the girl, Dr. Chaudhary said getting the surgery helped her feel more normal and have the right body parts as any other girl.

“During my 30 year long experience, only four people have visited me with the similar condition,” Dr. Singh said.

It was estimated that one in every 5,000 women have this rare complication, she added.

She asked the parents to visit a doctor if their daughter doesn’t get their menstrual period even after reaching 15.

When asked if similar surgery could help trans-woman (a male to female transsexual) to implant vagina, Dr. Singh said, “Even the trans-women can have this surgery but that will be a more complex process, because they are not biologically woman.”

Vaginal implant was also possible for trans-woman, said Dr. Chaudhary, adding that the surgery cost would vary from Rs. 150,000 to Rs. 300,000, based on the age and biological condition of the person.

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