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Vaginal Implants Could Finally Kill Our Tottering Civilisation

This is an excellent story about a medical advance that is likely to make life considerably better for a significant number of people. It's to be applauded as it is: but it's possible to worry more than a little about what will happen if the technique becomes widespread.

The basic background is that there's a genetic or developmental abnormality called Mayer-Rokiansky-Kuster-Hauser syndrome that leaves the vagina or uterus either underdeveloped or even absent in some unfortunate women. This happens to as many as one in 4,500 women, meaning that there might be 30,000 or so sufferers in the US at any one time. there have been treatments for this but they've not been very effective, have high complication rates and are, if we're honest about it, little more than surgical butchery trying to make some small difference.

And then along comes part of the new wave of entirely new treatments. Whereby a small piece of tissue is taken from the patient (clearly, for transplant rejection reasons it is better done this way) and then the necessary cells are grown on a structural lattice. This is then implanted where the missing parts should be and the condition is thereby cured. Not for the uterus as yet, but for the vagina it has been successfully done:

Follow-up tests showed that the engineered tissue was indistinguishable from the women's native tissue. "We now show up to an 8-year follow-up with those organs showing functionality," Atala said. By "functionality," he means that the women are now able to experience sexual desire, pain-free sex, and can even reach orgasm. This operation, however, will not allow them to bear children.

The full paper is here in The Lancet.

Findings We noted no long-term postoperative surgical complications. Yearly serial biopsies showed a tri-layered structure, consisting of an epithelial cell-lined lumen surrounded by matrix and muscle, with expected components of vaginal tissue present. Immunohistochemical analysis confirmed the presence of phenotypically normal smooth muscle and epithelia. The MRIs, which showed the extent of the vaginal aplasia before surgery, showed the engineered organs and the absence of abnormalities after surgery, which was confirmed with yearly vaginoscopy. A validated self-administered Female Sexual Function Index questionnaire showed variables in the normal range in all areas tested, such as desire, arousal, lubrication, orgasm, satisfaction, and painless intercourse. Interpretation Vaginal organs, engineered from the patient's own cells and implanted, showed normal structural and functional variables with a follow-up of up to 8 years. These technologies could be useful in patients requiring vaginal reconstruction.

This is a great result for those tens of thousands of women (and, in cases where it is appropriate, their partners too one would assume).

However, there's something that slightly worries about the longer term of such surgery, which is the war between the sexes. Without being too crude about it it really is the fact that sex is great fun that drives a goodly portion of the dating game. And that dance between the two sexes (OK, add more as you please to suit your view of gender) is what leads to the way in which humans cooperate with each other. If we were to turn into a society where that cooperation were no longer necessary in order to gain access to sex then whether it would be a better or worse society is arguable, but it would most certainly be a very different one.

And if we can implant vaginas into women who do not have one then how long is it going to be before someone decides to try implanting them into men who do not have one but would like to? No, I don't mean as part of gender reassignment surgery: rather, how long before it is marketed as a way to get boys through their difficult teenage years? No need to chase the girls, here's one of your own to play with?

If you think that's unlikely then you've not been paying attention to the major driving force of hormonally challenged young men.

Yes, OK, it's easy enough to giggle at this extreme position. But it really would be a major change if teenage boys were able to have their own pleasure palaces. And one perhaps not for the better.

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