Mayer-Rokitansky-Kuster-Hauser or MRKH is a condition that affects 1/4000 – 1/5000 women.  The patient is usually born with a small or absent uterus, cervix and vagina.  Obviously without a uterus and cervix, the patient cannot get pregnant, but initially even more concerning is the patient is unable to engage in vaginal intercourse due to a lack of a vaginal canal.  Though there are several surgical options for this condition, the least invasive surgery with the highest success rate is the laparoscopic Davydov Neovagina surgery.  The surgery is also known as the peritoneal pull-through technique.  Below are immediate before and after photos of the vaginal canal.

Before: Vaginal Length = 1.5 cm

After: Vaginal length = 13 cm

Dr Miklos has performed more than 600 laparoscopic Davydov neovagina surgeries since learning the technique in Moscow Russia in 1998.  The surgical procedure has a 99.9 % surgical success rate where surgical success is defined as restoring a vaginal length of greater than 10 cm. The functional success rate (which is defined as the ability to have sex without pain) is 96%.    Dr Miklos is the most experienced laparoscopic Davydov Neovagina surgeon in the USA is considered by many of his colleagues as the foremost expert on this technique in North America.  Dr Miklos has performed the laparoscopic Davydov neovagina on patients from: USA, Canada, South America, Mexico, Australia, Cypress, Dubai and Turkey.

More about MRKH, including surgical videos, testimonials and patient support.

Short vaginas are usually the result of a previous surgery, specifically and most commonly with hysterectomy or removal of the uterus.  This surgical complication can happen even with a surgeon with the very best reputation and surgical skills. Other vaginal surgeries can result in a shortened vaginas including but not limited to uterine and vaginal prolapse as well as female urologic, gastrointestinal or gynecologic cancers.

How does a patient know if they have a shortened vagina? Usually, the patient will experience pain with deep thrusting, or the patient or patient’s partner will complain that there seems to be something in the way and deep penetration during intercourse is not possible.  This diagnosis can and must be confirmed by Dr Miklos prior to vaginal lengthening surgery.   Below are medical illustrations of a shortened vagina after a hysterectomy and then after the lengthening surgery:

Before: Short Vagina

After: Vaginal Lengthening

Dr Miklos uses the same surgical technique for vaginal lengthening that he uses in patients with MRKH or Mayer Rokitansky Küster Hauser syndrome patients. The surgical procedure usually takes less than 2 hours and has greater than a 96% success rate (success defined as having intercourse without pain after the surgery).

According to the worldwide scientific literature, Dr. John Miklos is the most experienced robotic / laparoscopic vesicovaginal (bladder) fistula (VVF) surgeon in the world. (Exhibit #1)
Please note all of Dr Miklos’ patients are without cancer or radiation therapy.  Dr Miklos’ vesicovaginal fistula cure rate with one surgery is 98% (Exhibit #2)

Exhibit 1

Exhibit 2

and he has successfully surgically cured patients with as many 2, 3 and 4 previous failed VVF repair surgeries with and without omental flaps.  (Exhibit #3 and #4).

These patients have failed surgeries at some of the most prestigious medical universities and institutions in the world.

Exhibit 3

Exhibit 4

Dr Miklos has earned a strong reputation both nationally and internationally as a trusted expert in laparoscopic Vesicovaginal Fistula surgery as he was the 2nd person in the world to describe the laparoscopic approach to VVF repair and the first surgeon to describes a laparoscopic repair of a VVF after a failed surgery (1999). (Exhibit #5)

Exhibit 5

If you are suffering from VVF, call Dr. Miklos, he is specialized in treating pelvic floor disorders like fistulas. Need a second opinion? Dr. Miklos will ensure you understand your diagnosis, treatment options, recovery and expected outcome. Schedule an in person or telephone consult for your VVF condition with Dr. Miklos in Atlanta, Charleston, Dubai, Miami and Boston.

QUESTIONS AND ANSWERS:

What is a VesicoVaginal Fistula (VVF)?

A vesicovaginal fistula can best be defined by deconstructing each of the 3 terms.  Vesico means bladder, vaginal means vagina and fistula means an abnormal communication or passage between two independent organs or anatomical structures.  Specifically, VVF means an abnormal passage between the bladder and the vagina usually resulting in continuous uncontrollable urine leakage from the vagina.

What are the causes of Vesicovaginal Fistulas?

Vesicovaginal fistulas can be caused by a number of things including surgery, trauma, injury, inflammation, infection, cancer or radiation. In underdeveloped countries the most common cause of VVF is birth trauma but in developed countries such as the USA, Canada and Mexico the most common cause is surgery specifically hysterectomy.

What are the symptoms of Vesicovaginal Fistulas?

Symptoms commonly associated with VVF include continuous urine leakage, urine leakage without sensation, frequency of urination, foul smelling vaginal discharge, and painful intercourse.

How is a Vesicovaginal Fistula Diagnosed?

There are many ways to make the diagnosis of a VVF including: direct visualization of the fistula during a vaginal exam, direct visualization of the fistula on cystoscopy (looking inside the bladder with a small scope), dye tests, and imaging studies such as X-ray, Ultrasound or CT scans.

Can Vesicovaginal Fistulas be treated or repaired?

There are many ways to attempt to treat non-cancerous and non-radiation VVF.  Surgery remains the most common way with the highest cure rate.  It is possible that a newly acquired fistula can heal on its own by placing a catheter through the urethra and allowing the bladder to remain drained while the fistula heals. Other ways include electrocautery also known as fulguration, glues, and antibiotics.

What can i expect from Dr Miklos performing my vesicovaginal fistula surgery?

1)Surgical Time: The length of the surgery usually takes 1-2 hours
2) Laparoscopic Approach: The surgery is performed using a laparoscopic approach and consists of 2 incisions of 3/4 of an inch and 2 incisions of 1/3 of an inch
3) Surgical Pain:  Post operative pain is usually short lived and easily managed with anti-inflammatory and narcotic medications

How long is the recovery after vesicovaginal fistula repair surgery?

The recovery after a vesicovaginal fistula repair is dependent upon many different factors two of the more prominent ones being the surgical approach as well as the amount of pain encountered after the surgery.

• Catheter: A suprapubic catheter is usually required for 2- 3 weeks to allow for the VVF repair to heal.  The suprapubic catheter is more comfortable than a urethral catheter and creates less bladder infection then a catheter placed through the urethra.
• Pain: Pain is usually short-lived and easily managed. You can take anti-inflammatories to treat abdominal cramps and shoulder discomfort caused by the carbon dioxide gas used during surgery.
• Work: Depending upon the patients type of work and her motivation some can return to work in as little as 48 hours.  Most patients can return to work within 1-2 weeks, but a few take off as much 4-6 weeks.
• Sex: Dr Miklos recommends avoiding sexual intercourse for 6 weeks.
• Driving:  One can resume driving as soon as they are off narcotics which is usually less than one week.

Why choose Dr. John Miklos for vesicovaginal fistula surgery?

Experience:  Dr Miklos has operated on patients from 50 states and 55 countries and has 35 years of surgery. He is internationally renowned, and his reputation has led him to operate on 6 different continents including: North America, South America, Asia, Australia, Europe, and Africa.  Even more importantly he has 30 years of surgical experience has been involved with more than 12,000 surgical patients.

Expertise:  Dr Miklos is an internationally renowned expert in vesicovaginal fistula repairs, and he performed laparoscopic VVF repairs than anyone in Canada, Mexico, or South America.  He has a cure rate above 98% and is a master surgeon when it comes to repairing failed VVF repairs. In 2024 he repaired a patient with a VVF with one laparoscopic surgery after she suffered for 5 years of continuous urine leakage.  She had failed 3 VVF repair surgeries at the Medical University of /South Caroline and one at the Mayo Clinic. She found Dr Miklos in January 2024, and he is privileged and ecstatic that her repaired her fistula in a 2-hour surgery.

Dr Miklos is also the first surgeon in the world to publish a paper on laparoscopic vesico uterine fistula repair. Exhibit #6   A vesico uterine fistula is an abnormal communication between the bladder and the uterus.  This is usually caused by trauma due to childbirth or a Cesarean Section (C-section).

Exhibit 6

Extraordinary Results:  As stated above Dr Miklos surgical success rate on non-radiated and non-cancerous patients is greater than 98% and 100% in patients who have already failed at least VVF repair with without an omental flap.

The clitoropexy surgery is a surgical procedure for patients who suffer from an enlarged and protruding clitoris.  The clitoropexy elevates the clitoris and reduces the clitoris in length and from sticking out.  Most often patients seek this surgery when they feel their clitoris is enlarged and sticking out too far from their body. The protruding clitoris can be an aesthetic issue for the patient as they do not like the way the clitoris looks, or a functional issue (i.e. the patient has irritation, rubbing, or enhanced and unwanted sensitivity).   The clitoropexy is not just a reduction of the prepuce or clitoral hood, but an actual reduction of the protruding clitoris.

Dr Miklos has been performing clitoropexy surgery for approximately 20 years and has never had complaints of nerve damage, loss of clitoral orgasm or permanent pain after the surgery.  Below is one of Dr Miklos’ patients who underwent a clitoropexy procedure.

Dr. Miklos can usually achieve approximately a 66% reduction in clitoral length with this surgery.

Read more on what causes an enlarged clitoris and how clitoropexy surgery may help.

Labiaplasty is a plastic surgical procedure of either the labia minora or labia majora.  This surgical procedure is performed for a variety of reasons but most commonly for either aesthetic or functional issues.  Patients sometimes do not like appearance of the labia (aesthetic) or they don’t like the feeling, irritation, and or pain (functional issues) often associated with protruding labia minora.

Dr Miklos and his partner Dr Moore have been performing labiaplasties routinely since 1998 and estimate they have performed more than 2500 labiaplasties.   This can be supported by their scientific publication which consisted of 550 patients who came to their office for labiaplasties over a 3.5-year period:

This is the largest single practice series of patients considering labiaplasties in the scientific literature. Patients should really consider a surgeon’s experience, expertise and results before choosing a cosmetic vaginal surgeon. All too often patients will REGRET choosing a surgeon based upon location or price instead of experience and results. Please choose your surgeon carefully and wisely. Please review your surgeon’s number and quality of their before and after labiaplasty photos.

Watch videos, see before and after photos and learn more about labiaplasty.

Vaginal tightening surgery also known as vaginal rejuvenation surgery is performed to enhance a woman’s feeling during vaginal penetration.  This surgery should only be performed at the patients request and never at the surgeon’s discretion or suggestion.  Patient’s often feel less friction during intercourse because of nerve damage due to the carrying and delivery of their child.  Every patient is different and only the patient should determine if they feel less friction with intercourse.

This surgical procedure is not a simple posterior repair or is it tightening just the opening of the vagina, but instead a tightening of approximately 2/3 the length of the vagina as well as the vaginal opening.  Here we see a medical illustration of a patient who has vaginal relaxation due to nerve damage and muscle relaxation resulting in an enlarged vaginal caliber as well as post-surgical vaginal tightening.

Hysteropexy or uterine suspension surgery can be performed when a patient has uterine vaginal prolapse.  Uterine prolapse simply means the uterus is falling. The uterus falls towards the opening of the vagina and if given enough time can fall out of the vaginal opening.  This is usually the result of pelvic floor damage which occurred during the pregnancy and delivery of a woman’s baby.  Uterine prolapse usually results in symptoms of a bulge and pressure at the opening of the vagina, lower back pain as the day progresses, the feeling that something is being hit during deep thrusting with intercourse and a general sensation of pelvic heaviness.

Most surgeons will not offer a hysteropexy (i.e. Uterine suspension), instead they will most commonly offer the patient or tell the patient she needs a hysterectomy.  Dr Miklos gives the patient the choice and most of the time the patient will ask to keep her uterus.  Dr Miklos believes the benefits of keeping the uterus far outweigh the risks of performing the hysterectomy.  Benefits include less surgery, less pain, less potential complications of doing an extra surgical procedure, less chance of shortening the vagina, less blood loss and faster recovery but keeping the uterus.  The choice is yours!!!