The clinical, structural, and biological features of neovaginas: a comparison of the Frank and the McIndoe techniques

Abstract

Objective: To compare two methods of neovagina construction, the Frank and McIndoe techniques, in terms of structural and biological aspects. Study design: A total of 55 subjects were included in this retrospective study: 43 underwent the Frank technique (FT) and 12 underwent the McIndoe technique (MT). A clinical evaluation and a comparison of the structural (color, shine, presence of hair, and histology) and biological (bacteriological, pH, and hormonal determinations) features were performed. Statistical analysis was performed using the Fisher and Mann-Whitney tests. Results: The time to achieve a functional neovagina using the FT was longer than when using the MT (9.8 +/- 5.3 versus 5.8 +/- 2.9 months) (p = 0.01). The neovaginal wall of the MT skin grafts was more rigid and drier, and it did not exhibit a shine in the way that the FT skin grafts did. The lining of the cavity formed by the FT in all subjects was similar to that of vaginal mucosa, whereas the lining formed by the MT persisted as a skin graft in 83.3% of the cases. The pH was lower for the FT (p < 0.01), and Doderlein bacilli were present in 90% of the FT neovaginas but absent from the MT neovaginas. In the latter, flora with anaerobic bacteria was present. Hormonal cytology showed estrogen activity in 100% of the FT neovaginas, but there was no such activity in the MT neovaginas. Conclusions: Our data suggest that the FT may be clinically, structurally, and biologically superior to the MT for the creation of neovaginas and is also less costly.