An international consensus statement and clinical decision support tool (CDST) on the timing and considerations of vaginal replacement in patients with anorectal malformations, vaginal agenesis, and identifiable Müllerian structures has been accepted for publication in the Journal of Pediatric Surgery.
The paper is the outcome of the consensus meeting held in Lund, Sweden, in April 2025, which was organised by Dr Pernilla Stenström and colleagues in collaboration with ERN eUROGEN and ARM-Net.
Vaginal replacement has traditionally been performed during childhood, at the same time as anorectal reconstruction. Concerns about long-term outcomes have led to growing debate about whether to defer this surgery until adolescence or adulthood, when the patient can take part in the decision. The published evidence is limited: the literature review behind the paper found 27 studies, all of low evidence level.
To address this, an international multidisciplinary panel of paediatric surgeons, gynaecologists, urologists, psychologists, patients and patient representatives used the Nominal Group Technique, drawing on the literature review, online case discussions and a global survey of 71 experts.
The panel did not reach consensus on whether vaginal replacement should be carried out early or deferred, and the paper sets out the arguments on both sides. Consensus was reached on a number of principles of care, including referral to an interdisciplinary expert team, full and balanced information for families about all options, regular pelvic ultrasound from the onset of breast development to detect menstrual obstruction early, and psychological and sexual health support as part of routine follow-up. The authors highlight the need for long-term outcome studies to guide future practice.
🔗 Access the consensus statement/clinical support tool
🔗 Read about the Lund consensus meeting
The meeting was financially supported by ERN eUROGEN, the European Reference Network for Rare Uro-Recto-Genital Diseases and Complex Conditions, which is funded by the European Union under the EU4Health Programme (Project No. 101156380 — EU4H-2023-ERN2-IBA).
