Vaginal atresia, a congenital absence of the vaginal canal, is commonly seen in Mullerian agenesis and is primarily treated by vaginal dilation therapy or surgical vaginoplasty. In a previous study, our vaginal expansion sleeve (VES) device exhibited significant lengthening of vaginal tissue over time using a single static implanted device. This study aims to evaluate the impact of progressive serial expansion of the vaginal canal and vaginal length retention utilizing VES.

Initial vaginal lengths of Sprague-Dowley rats were measured by sounding the vaginal canals. The VES, a spring-like woven cylinder with biocompatible flat resin caps, was custom fabricated to measure 1.3x the vaginal canal length. Each VES was maintained within the vaginal canal for one week to expand the vaginal tissue, then removed, and a serially larger VES was re-implanted. Removal and reinsertion were performed weekly for three weeks, with each VES measuring 1.3x the remeasured vaginal canal length. Upon completion of the serial expansion, two weeks of recovery were allotted to assess tissue contraction before final measurements were recorded. Vaginal tissue was harvested and stained for histologic analysis.

Utilizing the VES serial expansion technique, the mean vaginal canal length increased from 24.5 ± 0.577 mm to a retained 35.5 ± 0.577 mm 2 weeks post-removal (n= 4, p < 0.001), a 45% increase in vaginal length. Histologic examination of lengthened vaginal tissue exhibited minimal submucosal chronic inflammation, impaired squamous maturation/regenerative change, and muscularis disruption with interspersed fibrosis.

Serial vaginal expansion utilizing the VES device demonstrated significant lengthening that was retained post-removal. The histologic changes were minimal and suggest an appropriate reparative/regenerative response. Retention of the expanded vaginal length indicates there is potential for this technique to treat vaginal length disorders.