Feasibility of Nurse Practitioner Led Vaginal Dilation Therapy: A Retrospective Brief Report

STUDY OBJECTIVE: to determine feasibility of nurse practitioner (NP) led vaginal dilator therapy as an alternative to pediatric gynecologist-led therapy and create an evidence-based model of care. METHODS: This is a retrospective, brief report. Electronic medical records were searched using ICD codes for vaginal and uterine agenesis. Patients were included who had participated in vaginal dilator therapy led by a pediatric gynecologist or by an NP in the Access Clinic at BC Women's Hospital. The primary outcomes were patient satisfaction, change in vaginal length, and sexual function throughout treatment. We collected visit details, including number and timing of visits, prescribed dilation schedule. RESULTS: Fourteen patients were included from 15 to 33 years of age. The most common diagnosis was MRKH (93%). 86% of patients were unsatisfied with their sexual activity and vaginal length before treatment. The mean starting vaginal length was 3.4 cm (range 2-5 cm) and the mean vaginal length at completion was 6.75 cm (range 3-10 cm), P < .001. The functional success rate was 85.7% overall, 80% for those followed by pediatric gynecology alone, and 89% for those followed primarily by NPs. Patients were followed for a mean of 15.6 months with a mean of 4.7 visits prior to discharge. Optimal spacing between visits was monthly, with a dilation schedule of one to two times per day for 10 minutes. CONCLUSION: NP led vaginal dilator therapy is a comparable alternative to pediatric gynecology-led therapy. This is a reasonable option to increase access to care for patients with vaginal agenesis.