(40) Feasibility of Nurse Practitioner Led Vaginal Dilation Therapy: A Retrospective Cohort Study

Background: Vaginal dilator therapy is the recommended first line management in patients with vaginal agenesis to increase vaginal length and improve sexual function and has been demonstrated to be highly effective with minimal risks. A barrier to successful vaginal dilator therapy is the long-term nature of treatment and the requirement for extended follow up over multiple visits. Nurse practitioner led clinics have been shown to have positive clinical outcomes in other disciplines, and use of a multidisciplinary clinic has been shown have an 88% functional success rate in patients undergoing vaginal dilator therapy. Our objective was to assess if nurse practitioner led vaginal dilator therapy is a feasible alternative to pediatric gynecologist led therapy and create an evidence-based model of care.

Methods: This is a retrospective cohort study. Electronic medical records were searched using the ICD codes for vaginal agenesis and uterine agenesis. Patients were included who had participated in vaginal dilator therapy led by a pediatric gynecologist or by a nurse practitioner at our institution's Women’s Health Clinic. The primary outcomes were patient satisfaction, change in vaginal length, and sexual function throughout treatment. We also collected visit details including number and timing of visits, prescribed dilation schedule. This study was approved by the Research Ethics Board.

Results: Thirteen patients were included ranging from 15 to 33 years of age. The most common diagnosis was MRKH (92%). 92% of patients were recorded as unsatisfied with their sexual activity and vaginal length before treatment. Among patients who were seen by a nurse practitioner in association with pediatric gynecology, 80% reported normal sexual function, normal vaginal length, or overall satisfaction with vaginal dilator therapy at time of discharge. This is comparable to 84.6% of patients who were followed by either a nurse practitioner or pediatric gynecology alone. Patients were followed for a mean of 15.6 months and required a mean of 4.7 visits prior to discharge. Optimal spacing between visits was monthly with a prescribed dilation schedule of one to two times per day for 10 minutes at a time.

Conclusions: Nurse practitioner led vaginal dilator therapy is a comparable alternative to pediatric gynecology led therapy with similar outcomes as previously reported in the literature. This is a reasonable option to increase access to care for patients with vaginal agenesis without requiring routine specialist involvement.