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Vaginal agenesis is a birth defect in which a baby girl is born with total or partial absence of vagina. These patients also have either no uterus or an underdeveloped uterus.
Vaginal agenesis is a Mullerian anomaly. Normally embryological structures callled Mullerian ducts form the uterus and vagina utero.
But in some female babies, during the first 20 weeks of pregnancy, the lower portion of Mullerian ducts do not develop normally and this results in an absent or partially closed vagina, absent or partially formed uterus or both.
If a baby girl with vaginal agenesis is examined by a doctor at birth, the condition can be diagnosed. Later on during adolescence when a girl fails to have menstruation, gynecological examination may reveal that she was born without a vagina.
Additional blood tests for hormones and chromosomes may be ordered. Radiological imaging by ultrasound and MRI can show whether the uterus and ovaries are present and whether there are additional abnormalities related to the kidneys.
Patients with vaginal agenesis may have additional birth defects related to the kidneys and the skeletal system.
It is a rare congenital disorder in which the uterus and vagina are underdeveloped of absent. They have normal ovaries and normal external female genitalia and normal female chromosomes (46 XX).
The external genital organs look normal as female genitelia in patients with vaginal agenesis.
A woman with vaginal agenesis can have a normal sexual life, because her clitoris and labia are normally formed. These structures are sufficient for female sexual satisfaction however, for penetrative vagina intercourse, they may need treatment. After treatment they can have a functional vagina and normal penetrative intercourse.
A woman without a uterus cannot conceive naturally. There are two options for her to have a child. One of the options is to go through an in vitro fertilization cycle because they have normal ovaries and once the embryo is formed, it can be transferred to a host uterus (surrogate mother) who will carry and deliver the baby for her.
The other option is to have a uterine transplantation surgery, the pregnancy needs to be through an in vitro fertilization cycle. She needs to take immune suppressant medications until the pregnancy is complete. After birth the transplanted uterus needs to be taken out.
If a woman is willing to have penetrative sexual intercourse, vaginal agenesis needs to be treated.
There are mainly two treatment options for vaginal agenesis:
The patients can use dilators to gradually enlarge and elongate a vaginal canal. They need to press vaginal dilators, which are similar to a firm tampon to the closed vaginal entrance everyday a few times for about 30 minutes. As the vagina enlarges, they can use bigger size dilators. It may take a few months to get the desired vaginal length.
It is a surgical technique used to create a new vagina. An incision is made at the vaginal dimple. Then a skin graft is taken from the thighs, buttocks or abdomen. The skin graft is folded over a mold which is inserted into the newly formed vagina. The mold needs to stay in for a few months or until regular vaginal intercourse starts.
It is one of the most successful and minimally invasive techniques to create a new vagina.
It is a laparoscopic surgery, which means a camera is inserted through a 1 cm incision on the navel. Several other small incisions are made on the abdominal wall for laporoscopic instruments. Then the peritoneal tissue is dissected, freed from the pelvic organ surfaces and replaced to line the walls of the newly created vaginal canal. A mold is inserted and it needs to stay in the neovagina for a few months or until regular vaginal intercourse starts.
It is a laporoscopic surgery which uses a traction device. An olive shaped object is placed on the traction device and the patient increases the tension of the device every day so that the olive moves inward to create a new vagina.
It is the most advanced surgical technique to create a neovagina, however it is the technique with the highest risk of complications. A segment of the bowel is taken out and replaced into the incision made to form a new vaginal canal.
It uses microsurgery techniques because it is a form of free tissue transfer, the vessels of the bowel segment need to be anastomosed (attached) to the vessels of the tissues in the recepient vaginal canal. There is a risk that the vessels are occluded so that the bowel segment does not survive. If the surgery is successful, there is no need to use a mold or dilator after surgery.
The recovery period after surgery is easier for laparoscopic techniques compared to bowel vaginoplasty which is an open surgery. After laparoscopic surgery, most patients can be discharged on the next day unless there is a complication. They can go home walking and go back to normal daily routines on the first week after surgery. The healing period may be longer with bowel vaginoplasty.
Patients need to use a dilator after surgery for vaginoplasty. The dilator can be taken out everyday, washed, covered with prescription creams and reinserted into the neovagina. The dilator is necessary to keep the vaginal space long and wide. The dilator use is recommended until frequent vaginal penetrative intercourse starts. The healing period before intercourse is about 6-8 weeks.
It is not possible for a sexual partner to understand that a woman had prior surgery for vaginal agenesis. Some patients may need to use lubricants for more comfortable intercourse.
Vaginoplasty Clinic TurkeyMd. Burcu Saygan Karamursel