THE SURGICAL creation of an artificial vagina still intrigues the medical profession. In the past 135 years, countless and tedious methods have been devised only to be discarded because of the magnitude of the procedure and/or the inability to cope with the serious complications.
Dupuytren in 1817, Villaume in 1829, and Amussat in 1832,1 made a simple opening between the bladder and rectum but could not satisfactorily maintain its caliber. Eventually, methods and materials for lining the pouch were outlined. Free skin flaps, strips of vaginal mucosa from other patients, intestinal wall from both the small and large bowel, hernial sac lining, guinea-pig intestine, peritoneum, fetal membranes, and, lately, Thiersch grafts have been utilized. Heppner, Gersung, Baldwin, Schubert, Graves, Wharton, Falls, Counsellor, and Frank contributed techniques to this end.
While all these methods were initiated by the dissection of the area between the bladder and rectum, their greatest differences