To understand variations and experiences of vaginal lengthening internationally in individuals with congenital underdevelopment of the uterus, cervix, and upper vagina—or Müllerian agenesis.

Cross-sectional mixed methods design incorporating quantitative and qualitative questionnaires. Adults with Müllerian agenesis completed questionnaires with quantitative and open-ended qualitative questions about their vaginal lengthening experiences. Data were analyzed using descriptive statistics and inductive thematic analysis.

Of 616 respondents meeting inclusion criteria (representing 40 countries), 46% (n=284) reported no vaginal lengthening intervention. Vaginal lengthening was commonly reported by participants from North America and Europe (59%), and less commonly by participants from Africa, Asia, and South America (16%). Of those who had undergone vaginal lengthening, 72% reported dilator use, 34% coital dilation, and 39% surgery. Four major themes were identified in response to the open-ended vaginal lengthening experience question: (1) Difficult Physical Symptoms, (2) Practical and Psychosocial Challenges, (3) Intimate Relationships and Sexual Satisfaction, and (4) Impact of Experiences with Healthcare Providers.

This study highlights vaginal lengthening practices internationally and shared themes related to significant challenges and positive experiences. Findings show room for improvement in the counseling and care surrounding vaginal lengthening. Future research should investigate factors that influence decision-making about vaginal lengthening and work toward international consensus on best care practices in Müllerian agenesis.