On November 23, at the 8th Pujiang International Forum on Gynecologic Oncology and Minimally Invasive Surgery, the Obstetrics and Gynecology Channel of Medical World had the privilege of interviewing Professor Luo Guangnan, Honorary Lifetime Director of Obstetrics and Gynecology and Reproductive Medicine at Luohu Hospital. Let's learn about his thoughts on medicine and doctor-patient relationships.
When a girl starts menstruating, it also means that she is entering another stage of life and gradually moving towards becoming a mature woman.
Xiao Yan (pseudonym), a 14-year-old girl from Australia, is a lively and lovely girl and the apple of her family's eye.
One day, Xiao Yan suddenly told her mother that her stomach was upset.
At first, the mother didn't think much of it, assuming it was just a minor ailment, so she took Xiaoyan to the local hospital. After a series of tests, the mother was stunned by the diagnosis—
Xiao Yan has no cervix! Nor does she have a vagina! But her ovaries and uterus are developing normally…
So what exactly is wrong with Xiaoyan?
The Australian doctors diagnosed Xiaoyan with congenital vaginal atresia, meaning she has ovaries and a uterus, but no vagina. Her normal menstrual flow was unable to be released, causing Xiaoyan severe abdominal pain.
Many hospitals in Australia have suggested vaginoplasty as a treatment option, but because Xiaoyan's cervix is also underdeveloped, the surgical plan mentions that the uterus needs to be removed.
Xiaoyan's parents felt it was a truly tragic thing for their 14-year-old daughter to have her uterus removed. Xiaoyan was finding it difficult to accept psychologically, and the couple didn't want their daughter to be "deprived" of her reproductive rights by illness at such a young age.
Afterwards, Xiaoyan's parents went to several major hospitals in Hong Kong for treatment, but the recommended treatment was still to remove her uterus.
Xiao Yan's parents were unwilling to accept this, so they went north to seek medical treatment. However, the experts in Beijing still advised that their daughter's uterus should be removed.
Seeing Xiao Yan's abdominal pain getting worse and worse, Xiao Yan's mother's heart was breaking.
But is this the truth about Xiaoyan's condition? Is there really no other way besides "hysterectomy"?
Unwilling to give up, Xiaoyan's mother inquired everywhere, hoping to find a hospital that could help her daughter recover her health and preserve her uterus. Finally, they came to Shenzhen University Affiliated Luohu Hospital after hearing about its reputation.
“When Xiaoyan’s parents came to our hospital, they were basically in despair but still had a glimmer of hope. After examining her, I basically determined her condition; she had a type of ‘imperforate hymen’. We performed surgery on her, but we had to preserve her uterus.”
The person who told this patient's story is Professor Luo Guangnan, a doctor with over 50 years of medical experience, well-known to women with imperforate hymens—the Honorary Lifetime Director of the Department of Obstetrics and Gynecology at Shenzhen University Affiliated Luohu Hospital.
What is a "stone woman"?
Girls like Xiaoyan are colloquially known as "stone women," and this is precisely Professor Luo Guangnan's area of expertise.
A woman with a "stone-like" genital tract deformity, as the name suggests, is like a woman made of stone, who does not menstruate from a young age. Modern medicine refers to this as a "congenital reproductive tract malformation."
Female reproductive tract malformations are a congenital disease. Similar diseases have been recorded in ancient documents from the 4th century AD. The incidence rate is between 1/4,500 and 1/5,000, making it a rare disease. However, due to my country's huge population, the number of people with this disease is not small.
Women with "imperforate ovaries" generally have healthy ovaries that can secrete estrogen to maintain normal female secondary sexual characteristics and ovulation. Therefore, from both a physiological and social gender perspective, these women are women in the true sense.
According to Professor Luo Guangnan, female congenital reproductive tract malformations are divided into several categories. One type is the absence of a uterus and vagina, which only requires a vaginoplasty.
Another type is Xiaoyan, which is a bit more complicated. Her uterus is normal, but her cervix is underdeveloped and she has no vagina.
Before the "Luohu procedure" appeared, most doctors had no other options but to remove the uterus and perform a vaginal reconstruction based on their old experience.
"This is a huge blow to both the family and the girl herself," Professor Luo sighed helplessly.
He overcame the challenges of surgical treatment.
On March 17, 2015, a surgical team led by Professor Luo Guangnan performed laparoscopic peritoneal vaginoplasty, cervical atresia resection, and uterine-to-artificial vagina anastomosis on Xiao Yan at the Affiliated Luohu Hospital of Shenzhen University.
The entire surgery was performed laparoscopically and went very smoothly with minimal bleeding. Shortly after the surgery, Xiaoyan was finally able to menstruate naturally, just like a normal girl, without the backflow causing severe abdominal pain.
"The reason why this congenital disease is difficult to treat is mainly because patients usually have multiple congenital malformations, making the surgery extremely difficult. Moreover, after the surgery opens the passage between the uterus and the outside, because it is impossible to form a continuously effective smooth surface, the passage contracts and is very easy to close again, eventually necessitating the removal of the functional uterus."
Professor Luo Guangnan said that Luohu People's Hospital has many years of advanced experience in treating congenital vaginal agenesis, and its laparoscopic surgery skills are quite proficient. After creating an artificial vagina with a smooth wound using laparoscopic peritoneal vaginoplasty (Luohu Type II), the reconstructed functional uterus was anastomosed to the top of the vagina, and the surgery was successfully completed for 14-year-old Xiaoyan.
Compared to similar surgeries both domestically and internationally, this procedure (Luohu Method 3) is simpler, has a higher success rate, and causes less surgical trauma, making it a boon for patients with cervical dysplasia.
"The 'Luohu Three Techniques' can preserve the patient's normal uterus. This allows the girl to menstruate normally, conceive, and give birth to children. This is a world-first treatment method that overcomes the challenges of vaginal and cervical atresia," Professor Luo explained. "Currently, the Luohu series of procedures is widely recognized both domestically and internationally, by colleagues and patients alike. But we are not content with this; we will continue to explore and provide patients with the best possible treatment."
Caring for patients and helping them regain their confidence
“Girls with reproductive tract malformations already endure immense psychological stress. Due to societal prejudice or limited personal understanding, there are various reasons why they cannot openly seek medical treatment. Most patients (or their guardians) secretly think: they would rather have a tumor, so they could boldly see a doctor and receive treatment,” Professor Luo said. “Therefore, for doctors, in addition to healing the patient’s body, it is even more important to care for their mental well-being.”
To truly connect with patients, managing the doctor-patient relationship is crucial. Professor Luo Guangnan and his team believe that doctors and patients are not adversaries, but rather comrades-in-arms fighting together against illness.
From a doctor's perspective, it's essential to sympathize with the patient, prioritize their best interests, and strive to provide the optimal treatment plan. At the same time, it's crucial to patiently explain the condition, treatment methods, and possible outcomes to the patient and their family.
From the patient's perspective, it's important to fully trust your doctor. If you go to see a doctor and immediately say things like, "That's what the internet says," or "That's what my family says," this attitude is a cruel blow to a doctor who wants to do their best to cure you.
"Of course, as doctors, our first priority is to earn the trust of our patients," Professor Luo said.
The doctor-patient relationship is exceptionally good in the obstetrics and gynecology department of Luohu Hospital. They always put themselves in the patients' shoes and consider their needs.
Professor Luo Guangnan said that when patients come to the hospital for surgery, the cause of their illness must be written on the bedside card. In order to take care of this special group of patients, the hospital initially used English abbreviations instead, but later decided not to write the cause of their illness on the card in order to protect their privacy.
Professor Luo Guangnan explained that because of the special nature of this disease, after a patient is successfully discharged from the hospital, in addition to asking the patient to have regular check-ups, another very important task is to give the patient a psychological lesson before discharge, telling them about precautions in life, including how to communicate with their partner after marriage and having children.
In addition, after patients are discharged from the hospital, Professor Luo Guangnan and his team will continue to keep in touch with them so that they can return to their normal daily lives as women as soon as possible.
“It’s not that we don’t care about patients once they’re discharged,” Professor Luo said. “We need to follow up on their condition and stay informed. This is a disease that is closely related to the patients’ well-being.”
To facilitate better communication among these patients, Professor Luo also organized a "Petroleum Club." Each group of patients who successfully underwent surgery were like classmates in one class, and they all shared a common characteristic: they cried when they entered the hospital, but by the time they were discharged, they were already cheerful and optimistic.
Early diagnosis is key to treating "imperforate hymen".
Congenital genital tract malformations are a very painful condition for those affected. Although they do not affect life, their privacy and the psychological burden they create can be a heavy burden for the individual and their family.
"Especially since these patients are young, we need to detect them as early as possible and treat them promptly."
According to Professor Luo, these patients previously didn't know where to go for treatment. They would go to the endocrinology and adult gynecology departments of general hospitals, but the doctors there knew very little about these rare diseases; they would go to children's hospitals, but there was no gynecology department. This back-and-forth process could easily delay diagnosis and treatment.
As a result, a new subspecialty called "Pediatric and Adolescent Gynecology" has emerged in academia. It is led by Professor Shi Yifu of the Women's Hospital of Zhejiang University School of Medicine and Director Sun Liying of the Department of Pediatric and Adolescent Gynecology of the Children's Hospital of Zhejiang University School of Medicine. The aim is to help these teenage girls get diagnosed as early as possible and receive the best treatment.
In order to help patients with congenital reproductive tract malformations get diagnosed as early as possible, Professor Luo Guangnan also mentioned the role of primary care physicians.
"We hope that primary care physicians will be more vigilant and accurately detect physiological abnormalities in patients as early as possible. For example, if a patient has obvious abnormalities in the external genital tract, we can recommend that they check for chromosomal problems, perform a gynecological panel, and check for gonadal problems. At the same time, we can help the patient's guardians understand when menstruation is normal. If a patient has not started menstruating by the age of 14 or 15, we should remind them to pay attention. This is a very simple question, but most patients do not know it."
Professor Luo explained, "If possible, further diagnostic tests such as ultrasound, CT scans, and MRIs can be used to determine the specific type of reproductive tract malformation. Then, appropriate guidance can be provided, recommending where to receive the most comprehensive treatment. Simultaneously, psychological counseling should be offered to patients to help them overcome their psychological barriers to seeking medical help."
Final words
"Medicine is a compassionate discipline. When dealing with patients with congenital reproductive tract malformations, because they are still young, we must have great compassion for them, care for them, put ourselves in their shoes, and help them solve their problems. At the same time, we must also protect their privacy," Professor Luo said.
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