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Vaginal dilator pressure treatment is a nonsurgical treatment method to extend or create a vagina for patients with vaginal agenesis. In this chapter, the term dilation is used to describe the extension of width and length of the vaginal pit (dilatation). The dilator is a cylindrical instrument of moulded plastic, which is repeatedly applied with pressure. Treatment to develop a short or absent vagina is offered to women who desire the capacity for sexual activity that includes sexual intercourse or other vaginal penetration. Dilation treatment relies upon patient adherence and, therefore, requires a scrupulous patient-centred approach by the multidisciplinary team.
History of dilation
Since the first descriptions of congenital absence of the vagina, physicians have described and performed various techniques for the creation of a neovagina in order that women can achieve sexual function including vaginal penetration. Frank was the first to describe treating young women with vaginal agenesis using a vaginal pressure dilation technique (Frank, 1938). He reported the treatment of six patients using vaginal dilators. Dilation treatment occurred two to three times per day and dilators were placed in the vagina throughout the night. Frank reported that five of his patients achieved a vaginal length of 6.5–7 cm within six to eight weeks of treatment and three of the women had sexual intercourse after treatment.
Since Frank detailed his method, there have been variations of his pressure dilation technique.
Psychosocial functioning and quality of life are of increasing emphasis in consideration of outcome for people with chronic health conditions. The World Health Organization's assessment of quality of life has six domains, three of which refer to psychosocial outcomes (WHOQOL group, 1995). While few will experience clinically significant psychopathology, children with chronic illness are more likely to have psychosocial problems and a child's illness can impact on the whole family (Drotar and Crawford 1985; Eiser, 1990; Wallander et al., 1989).
Healthcare services for children and adolescents with disorders of sexual differentiation and determination (DSDD) are in part aimed at the prevention of psychopathological responses to diagnosis and treatment. Medical and nursing staff aim to provide healthcare that is designed to be sensitive to patients' psychological needs, but it is acknowledged that specialist psychosocial care should also be available and integrated with the medical care. A clinical psychologist or other applied psychologist in a health setting with experience of DSDD generally provides this service.
The psychologist has a dual role of supporting the family and working with the wider team to ensure that individual child or family needs are incorporated into treatment from the outset. Recognition of the psychological components of healthcare does not represent a presumption of psychological disorder, rather an acknowledgement of the possible impact on the child's psychological development and the wider family adaptation.
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