131. Vaginal Dryness in Complete Androgen Insensitivity Syndrome (CAIS)

Abstract

Background: Complete Androgen Insensitivity Syndrome (CAIS) can impact sexual function although little is understood regarding factors that contribute to this. Vaginal dryness is a common symptom in patients requiring oestrogen replacement treatment, and yet there is a paucity of data regarding its prevalence in patients with CAIS. This study therefore aimed to describe the prevalence and management of symptoms of vaginal dryness in CAIS. Method(s): A retrospective review of medical records from consultations of patients with CAIS seen in a dedicated multidisciplinary Difference of Sex Development tertiary service. Data on age, genetic diagnosis, clinical findings, reported symptoms and management was extracted from medical records of all patients with CAIS seen between 2018-2024. Only patients with genetic diagnosis of CAIS were included. The data was collected and analysed on Excel. Result(s): In this time frame, 43 patients were identified with a median age of 29 years (16-76). Of these, 36/43 (84%) had undergone gonadectomy and 7/43 (16%) had gonads in situ. Mean age at gonadectomy was 14.1 (0 - 40) years. At the time of review, mean age of patients who had gonadectomy was 33.9 (18-76) years and mean age of patients with gonads in situ was 23.2 (16-31) years. A vaginal dilator program was followed by 11/43 (26%) patients. One patient had had a Vacchietti procedure. The remaining 32/43 did not require or had not yet explored vaginal dilation. 1 patient (age 76 years) did not have records extending back to initial discussion of vaginal dilation. Vaginal dryness was reported by 10/43 (23%) patients; these ten were were post- gonadectomy. At the time of reporting vaginal dryness, 8/10 (80%) were taking HRT. After reporting vaginal dryness, 8/10 (80%) were recommended vaginal oestrogen (alongside systemic HRT for those for whom it was clinically indicated), whereas 2/10 (20%) found symptoms manageable with general vulval care and vaginal lubricants. Dryness improved in 6/10 with 1/10 switched to vaginal oestrogen gel, and 3/10 yet to have follow up review. Conclusion(s): Vaginal dryness is described by patients with CAIS although in our cohort was only observed in those post-gonadectomy. Prospective data is required to understand whether vaginal dryness represents hypoestrogenism alone, in order to improve management of vaginal symptoms in CAIS. Copyright © 2025