Vaginal prevalence of HPV infections in uterovaginal aplasia patients before and after laparoscopically assisted creation of a neovagina: a prospective epidemiological observational study

Objective:

The aim of the present study was to study vaginal (as opposed to cervical) HPV acquisition with regard to true prevalence, HPV types, and the role of co-factors in virgins and after their sexual debut.

Materials and methods:

This is a prospective epidemiological observational study conducted at a university hospital specialized in genital malformations.

The study included 186 MRKH patients undergoing neovaginoplasty between November 2011 and July 2017 before and after sexual debut.

Conventional vaginal cytology and different HPV tests were performed at surgery and during routine gynecological follow-up 1, 3, 6 and ≥11 months after surgery and risk factors were documented. The study was approved by the local Ethics Committee.

Results:

The mean age of all patients at surgery was 20.1 years. In 83 vaginal samples from 41 different patients at least one of the HPV tests was positive. 33 different HPV types were detected. The prevalence of 41/186 = 22.0% as well as type distribution is comparable to that of a young German female population. The overall rate of acquisition was clearly associated with sexual activity and smoking habits. Out of 367 Pap smears only 6 were abnormal with Pap IIID (MN II) and no obvious vaginal lesion was detected.

Conclusions:

Vaginal HPV prevalence and HPV types in previously virgin patients after creation of a neovagina is not different from the acquisition of cervical infections in the general population and is clearly associated with sexual activity and with smoking habits. Abnormal Pap smears are however rarely seen.