Vaginal amplification using a posterolateral Y-V plasty.

Problems encountered in attempts to construct a normal vaginal orifice in girls with congenital adrenal hyperplasia have met with great difficulty. Many procedures are complicated by failure to achieve adequate patency at the time of operation and/or by postoperative stenosis. The usual method of direct posterior Y-V vaginoplasty has been altered by bringing the V flap in from the side of the perineum, between the inferior aspect of the labium majus and the median perineal raphe. Thereby, a thicker, large, more pliable and more moveable flap is obtained. The 11 children on whom this method was done are presented. Followup is from 6 months to 5 1/2 years. The importance of teaching the parents or child the use of home vaginal dilation with Hegar dilators is stressed. Th use of this surgical technique plus home dilation will overcome the problems of restenosis in this group of children.