Click here to view next page of this article Vaginal AnomaliesThe genital tubercle becomes the clitoris, the genital swellings form the posterior fourchette and labia major, and the labia minor arise from the vaginal obstruction, absent vagina, double vagina, or double uterus. ABSENT VAGINACongenital vaginal agenesis, also known as the Mayer-Rokitansky syndrome, develops when the vaginal plate fails to canalize. These patients are normal genetic female patients (46,XX) and present at puberty with primary amenorrhea and normal external female genitalia. Many of these patients have renal anomalies also. VAGINAL OBSTRUCTIONObstruction of the vagina most likely results from an incomplete formation of the vaginal canal during gestation. Hydrocolpos is defined as vaginal obstruction only, whereas hydrometrocolpos refers to blockage and distension of the vagina and uterus. Imperforate hymen, vaginal septum, or vaginal atresia may be among the more common anatomic problems. In newborn infants, an abdominal or introital mass may be noted on physical examination. In some cases, urinary tract obstruction may result from extrinsic compression of the bladder or ureters. At puberty, amenorrhea may be the initial presentation. Obstruction of menstrual flow with distension of the vagina. VAGINAL OR UTERINE DUPLICATIONDisruption of the fusion process of the mullerian structures can result in a variety of duplication anomalies. A result of partial fusion can lead to a bicornuate uterus with a single vagina or complete duplication with uterus didelphys. Evaluation and ManagementDetection of vaginal anomalies depends on the time of presentation, varying from an abdominal mass to bulging introitus in newborn infants to cyclical abdominal pain and amenorrhea at puberty. Obvious findings of an absent or blind-ending vagina lead to the diagnosis of vaginal agenesis. Rectal examination with bimanual palpation in older patients may help to detect masses or asymmetry of the internal genital structures. As noted earlier, sonography, computed tomography, and MR imaging may be helpful in determining the anatomic relationships of the internal structures and, when present, the area of obstruction. Surgical treatment is tailored to specific abnormalities. In cases of vaginal segment obstruction by a transverse web, simple incision may be the only procedure required. In cases of vaginal agenesis, extensive reconstruction, including the use of isolated bowel segments and split thickness skin grafts, may be required. These procedures may require consultation from practioners of various specialties. |