Made available in DSpace on 2015-07-22T20:50:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-27. Added 1 bitstream(s) on 2015-08-11T03:07:21Z : No. of bitstreams: 1 Publico-12807.pdf: 1925667 bytes, checksum: 40f94a2382fcb5e9e0c7155532f0079a (MD5) / Objetivo: Apresentar e avaliar os resultados histológicos, anatômicos e funcionais do procedimento de McIndoe modificado, utilizando a celulose oxidada (Surgicel®). Métodos: Onze mulheres com agenesia vaginal se submeteram à neovaginoplastia com ou sem canalização útero-vaginal utilizando um molde revestido com celulose oxidada. As cirurgias foram realizadas entre janeiro de 2009 e dezembro de 2010. Oito dessas pacientes tiveram o diagnóstico de Síndrome de Mayer-Rokitansky-Kuster-Hauser (MRKH), e as outras três tiveram o diagnóstico de Agenesia Cervico-vaginal (CVA). O tempo médio de seguimento foi 14 meses (variando de 6 a 24 meses), e incluiu exame físico e avaliação do questionário sexual (Female Sexual Function Index-FSFI). Amostras teciduais foram obtidas no momento da cirurgia e 1 a 12 meses após o procedimento. Biópsias vaginais para controle foram obtidas de um grupo de pacientes com doenças ginecológicas benignas. Avaliou-se a epitelização escamosa do tecido da neovagina, e a quantidade total de colágeno das neovaginas, e comparou-se com o grupo controle. Para análise estatística utilizou-se o teste ANOVA e o t-test. Resultados: Seis meses após a cirurgia, o sucesso anatômico foi encontrado em 100% das pacientes com síndrome MRKH (comprimento vaginal > 6 cm), e sucesso funcional em todas as pacientes que iniciaram atividade sexual (Score FSFI > 30). As biópsias mostraram epitelização da neovagina após 6 meses em todas as amostras, e o conteúdo total de colágeno foi comparável ao de uma vagina normal. Uma complicação maior ocorreu em uma paciente com CVA, que culminou em morte. O procedimento de canalização útero vaginal não foi bem sucedido em criar um pertuito para menstruações regulares mensais em nenhum dos casos. Nenhuma das pacientes com CVA obtiveram sucesso anatômico ou funcional. Conclusão: A neovaginoplastia com a técnica de McIndoe modificada, utilizando a celulose oxidada (Surgicel®), procedimento simples e de baixo custo, permite a formação de canal vaginal com epitelização e conteúdo de colágeno similar ao de uma vagina normal. É uma potencial alternativa terapêutica para síndrome de MRKH. / Objective: To present and evaluate the histological, anatomical and functional results of the McIndoe procedure, as modified by the application of oxidized cellulose (SurgicelTM) in women with vaginal agenesis. Study design: Eleven patients with vaginal agenesis underwent vaginoplasty with or without uterovaginal cannulation using a mold that had been wrapped with oxidized cellulose. The surgeries were performed between January 2009 and January 2010. Eight of the patients had been diagnosed with Mayer-Rokitansky- Kuster-Hauser (MRKH) syndrome, and the remaining three had been diagnosed with cervicovaginal agenesis (CVA). The mean follow-up time was 14 months (range, 6-24 months), and it included clinical examinations and evaluation of the Female Sexual Function Index (FSFI). Neovaginal biopsies were taken from the patients with MRKH syndrome at the time of surgery and 1-12 months after surgery. Control tissues were taken from a group of patients without vaginal disease. The histology of the samples was evaluated to determine squamous epithelialization of the neovaginal tissue over time, and the total collagen content of the neovaginas were compared with normal control subjects. For statistical analysis we employed the ANOVA test and the t-test. Results: At 6 months, anatomical success was achieved in 100% of the MRKH syndrome patients (neovaginal length . 6 cm), and functional success was achieved in 100% of the patients who started their sexual life (FSFI score . 30). Biopsy results showed complete epithelialization of the neovagina after 5 monthsin all samples, and the amount of collagen content in the neovaginas progressively increased. After 6 months, the collagen content was comparable to that of a normal vagina. One major postoperative complication occurred in a patient with CVA, which culminated in death. The uterovaginal canalization procedure was unsuccessful at creating an outflow tract for regular menses in all cases. None of patients with CVA achieved anatomical or functional success. Conclusions: The procedure described here offers patients a functional vagina by means of a simple and low-cost procedure that elicits squamous epithelialization of the neovaginal vault, with total collagen content similar to that of normal vaginal tissue. It is a potential alternative therapeutic approach for MRKH syndrome but not applicable to cases of CVA. / TEDE

Against a backdrop of feminist and social scientific research on sex, female embodiment, and normality this thesis aims to discern how young women, who in adolescence have learned that their bodies are developing in ways considered ‘atypical’ for the female sex, make sense of their bodies and their situation. In focus are the ways in which the women make sense of and negotiate female embodiment; how they, particularly in stories about their interactions with others, position their embodied selves; and how norms and beliefs about sexed embodiment, heterosexual practice, and in/fertility are strengthened and challenged in the interviewees’ sense-making. The data comprise 23 in-depth interviews with women who in adolescence have learned that they do not have a uterus and a vagina, or who have learned that they do not have two X chromosomes and have no, or non-functioning, ovaries. Through narrative and thematic analysis the thesis shows how the women’s sense-making can be obstructed by norms about female embodiment, heterosexual practice, and in/fertility, expressed through medical terminology and practice and in interaction with family, friends, and peers, as described by the interviewees. Concomitantly, as the thesis demonstrates, medical terminology can be experienced and function as a resource in the women’s sense-making. Diagnostic categories enable them to put the specificities of sex development into words and raise awareness about bodily variation. Furthermore, in their stories about others’ reactions to their bodies and about their experience and management of certain medical treatments, the women question norms about female embodiment, heterosexual practice, and in/fertility that were previously taken for granted. The complexity of the women’s sense-making is demonstrated through the ways in which the interviewees, on the one hand, align with norms about female embodiment, heterosexual practice, and in/fertility, and in which they, on the other hand, succeed in challenging the same. In this ‘juggling’ of reinforcement and resistance, the thesis argues, the women are found to expand rather than dismiss beliefs about female embodiment.  Thus, the thesis contributes with deepened knowledge about what it can be like to live with these specific conditions and with problematizations of how norms about female embodiment can be enacted and questioned. / Mot bakgrund av feministisk och samhällsvetenskaplig forskning kring kön, kvinnlig kroppslighet och normalitet syftar avhandlingen till att undersöka hur unga kvinnor, som i tonåren fått reda på att deras kropp utvecklas på ett sätt som anses ”otypiskt” för det kvinnliga könet söker förstå och skapa mening kring sin kropp och situation. Framförallt undersöks dessa kvinnors meningsskapande, hur de i sina berättelser positionerar sig i relation till andra, och hur normer och föreställningar om kvinnlig kroppslighet, heterosexuell praktik och in/fertilitet förstås, förhandlas, stärks och ifrågasätts i berättelserna. Materialet som undersöks utgörs av 23 djupintervjuer med kvinnor som i tonåren fått reda på att de antingen inte har någon livmoder och vagina eller att de inte har två X kromosomer och inga eller  icke-fungerade äggstockar. Genom narrativa och tematiska analyser visar avhandlingen hur kvinnornas meningskapande formas av normer kring kvinnlig kroppslighet, heterosexuell praktik och in/fertilitet, då de uttrycks i kvinnornas berättelser om sin situation i möten med andra och i relation till medicinsk praktik. Samtidigt, visar avhandlingen, kan medicinsk terminologi, specifikt diagnoser, och praktik utgöra resurser i kvinnornas meningsskapande som möjliggör för dem att sätta ord på och sprida kunskap om kroppslig variation. I kvinnornas berättelser om andras reaktioner på deras kroppar och om deras erfarenhet och hantering av specifika medicinska behandlingar utmanas vidare normer som kvinnorna tidigare har tagit för givet. Genom analysen framträder således komplexiteten i kvinnornas meningskapande då de å ena sidan anammar förgivettagna normer om kvinnlig kroppslighet, heterosexuell praktik och infertilitet och å andra sidan utmanar de samma. I detta ”jonglerande” av anpassning till normer och motstånd mot desammasyns kvinnorna expandera snarare än avfärda föreställningar om kvinnlig kroppslighet. Avhandlingen fördjupar därmed kunskapen om hur det kan vara att leva med dess specifika tillstånd och till att problematisera hur normer om kvinnlig kroppslighet kan ta sig uttryck och ifrågasättas.