Some scholars have divided congenital vaginal atresia into two types: type I refers to lower vaginal atresia with normal upper vaginal segment and uterus; type II refers to complete vaginal atresia, mostly combined with cervical dysplasia, normal or malformed uterine body, and normal endometrial secretion function. Among the 29 cases of congenital cervical atresia admitted to our hospital from March 1984 to March 2009, 26 cases were combined with complete vaginal atresia, 1 with superior vaginal atresia, and 2 with apical vaginal atresia; 2 of the patients admitted with primordial uterus were combined with apical vaginal atresia. In this paper, supravaginal atresia was classified as type III vaginal atresia and apical vaginal atresia was classified as type IV vaginal atresia. Case 1: 19 years old, hospitalization number 9118909, with periodic lower abdominal pain for 2.5 years, abdominal pain with minimal “menstruation” for 4 months, admitted to the hospital on November 3, 1991. The patient began to have vague lower abdominal pain once a month for 2.5 years, lasting 2-3 days each time, and 4 months ago she began to have periodic lower abdominal pain with dripping vaginal bleeding. Last “menstrual period”: November 1, 1991. No other specific medical history. Gynecological examination: normal vulvar development, married and unproductive; vagina is blind, 4-5 M deep, 2 fingers wide, with a small hole in the middle of the tip that can only accommodate a uterine probe, with a small amount of dark purple blood at the orifice, and 2M deep in this hole; tricuspid uterine body is posterior, large and painful to palpation. Pelvic ultrasound: uterine body 5,6M×4,0M, a small amount of liquid dark area in the uterine body cavity, multiple sieve-like hypoechoic areas at the cervix, and disappearance of the cervical line. Under epidural anesthesia, a transabdominal hysterectomy + vaginoplasty with wall peritoneal graft was performed: the blind hole along the top of the vagina was bluntly + sharply enlarged to accommodate 2 fingers of pine, and then deeper to the tougher cervical tissue; the dissection revealed a slightly larger uterine body with multiple adhesions on the surface and a dark purple blood collection of about 100 ml in the peritoneal cavity. Endometrium with a small amount of blood overflow, explore the uterine body cavity down to the blind end, the upper part of the cervix is about 2, 5M long, from the top down gradually thin, the end diameter of less than 1M, and then down to the diameter of about 3M, about 2M long hard tissue, because the expanded tissue and surrounding tissue relationship is unclear for fear of causing collateral damage, the uterus was removed from the cervix thin; separation and excision of the peritoneum of the wall at the incision of the dissection about 8M × 2M, the smooth side of the peritoneum is covered with a small amount of blood. The vaginal model was wrapped in petroleum jelly gauze and several small incisions of 0.5-1M in length were made and sutured with 0/3 intestinal sutures to form a complete tube and transplanted to the mucosal defect in the upper vagina. The cervical cavity was dissected downward along the uterine body incision without a canal, and there were several punctate dark purple cystic cavities with blood accumulation. Postoperative diagnosis: 1. cervical atresia combined with incomplete atresia of the upper vaginal segment; 2. adenomyosis of the cervix. Postoperative periodic abdominal reduction, a little blood still in the panties during the abdominal pain period, clean in 1 to 2 days, and satisfactory sexual life. Case 2: 15 years old, hospitalization number 0209312, periodic lower abdominal pain for six months, pelvic mass found to be gradually increasing in size for one month, admitted on June 28, 2002. The patient had no menstrual period and had abdominal pain once every 30 days for 4 to 5 days. One month ago, an egg-sized mass was found in the lower abdomen during the abdominal pain period, which was painful to touch. She was admitted to the hospital for physical examination: body temperature of 36.2℃, female physique, normal vulva development, unmarried type, no blood in her underwear and vaginal opening, a mixed cystic mass of about 12M×12M×6M was palpated in the pelvic cavity on anal examination, with poor motility and obvious tenderness. After hospitalization, the abdominal pain gradually worsened, and on June 30, she underwent an emergency abdominal dissection and saw extensive pelvic adhesions. A cystic mass of approximately 7M×6M×6M in size with high tension, thick muscular tissue in the wall of the mass, and the lower pole of the mass reaching deep into the pelvic floor. The diagnosis of atresia of the cervix was considered. After obtaining the consent of the patient’s parents, a vaginal exploration was performed and the vagina was found to be a blind end with a capacity of 2 fingers and a depth of about 8 M. The tip was slightly dilated and palpated as the lower pole of the pelvic cystic mass. Saline was injected into the left uterine cavity first, and the colorless saline then flowed out of the vaginal apical incision. After closing the abdomen, vaginal and cervicoplasty is performed vaginally, i.e., the mucosa around the apical vaginal incision is trimmed and the vaginal mucosal incision is intermittently sutured to the ectropion of the cervical mucosa and some of the underlying muscular tissue. The cervical canal is smooth and can accommodate 1 index finger. He was discharged after 7 days of hospitalization without further dysmenorrhea. Case 3: 22 years old, hospitalization number 0715761, after marriage, her abdominal pain gradually increased and left lower abdominal mass for 4 months, she was treated as “pelvic abscess” at local hospital by repeated vaginal puncture and aspiration, and was admitted to our hospital on July 11, 2007. She was discharged with 150 ml, 150 ml and 80 ml of pus on three occasions. He was discharged from the hospital for 39 d. He was readmitted on August 27, 2007 after 7 d of worsening abdominal pain and recurrence of left lower abdominal mass. Follow-up history: When she was 14 years old, she had a “mass” removed by caesarean section due to “menstrual blood retention”, and she had no more menstrual pain after the operation until her marriage. On examination, the body temperature was normal, a smaller cervix was seen on the right side of the vaginal apex, the left vault was dilated and a pinhole-shaped atresia scar was seen, the uterus was right-sided on double diagnosis, normal size, and a cystic painful mass of about 8cm×7cm×6cm protruded into the left vaginal vault immediately below the left side of the uterus, with poor motility. Ultrasound showed that the uterus was left-sided, normal in size, and a 6,3 cm×6,6 cm cystic predominant mass could be detected in the left adnexal region. The proposed diagnosis: pelvic abscess; genital tract abnormality was not excluded. In the third day of hospitalization, an exploratory dissection was performed: the uterine body was seen to the right, about 5 cm × 3, 5 cm × 2, 5 cm, the left angle was smooth, and there was a cystic mass of about 8 cm × 7 cm × 6 cm in the lower left part of the uterus, with thick walls and fused with the right cervix, which could not be separated. The cystic cavity was as deep as the vaginal vault and the inner wall was as light as a thin blanket, the cystic wall was muscular tissue, the upper end of the incision was about 1 cm long and the wall was about 1 or 2 cm thick, and downward it thinned to 0.6-0.7 cm thick muscular tissue. The blue liquid then flowed out from the right cervical opening, and there was no blue staining of the gauze built into the cystic cavity on the left side of the uterus. The biopsy of the thin wall of the cystic cavity reported that the smooth muscle tissue was separated by proliferating blood vessels and fibrous tissue with a small amount of lymphocytic infiltration, and the cervical mucosa and endometrial tissue were locally covered. The cystic cavity was considered to be an enlarged terminal atresia of the isthmus. Treatment: The pelvic cystic mass was opened from the left side of the scar at the top of the vagina, the incision could accommodate 2 fingers, the vaginal wall around the incision was trimmed, the incision margin of the vaginal wall was intermittently sutured to the mucosal layer of the isthmus incision, and the upper incision of the cystic cavity was closed with sutures from the abdomen, and one skin strip was placed to drain the peritoneal cavity and one cystic cavity from the abdominal wall and vagina respectively, which was removed after 48h. One month after surgery, ultrasound showed that the cystic cavity of the left uterine isthmus had shrunk to 3,8M×2,1M, and gynecological examination showed that the left uterine cervical canal was patent and smooth and could accommodate 1 finger loose. 2. Discussion: (1) The occurrence of vaginal atresia malformation: 37 days after fertilization of the human egg, the dorsal side of the epithelium of the corpora cavernosa curls and folds laterally in the noon-non-canal to form the Mullerian canal, and a pair of Mullerian canals continue to grow downward to the middle across the ventral side of the noon-non-canal, finally fusing to form the urogenital septum, and the septum between the two Mullerian canals gradually disappears to form the uterovaginal cavity. The vagina develops from the caudal end of the utero-vaginal cavity, which is formed by the mullerian ducts and the urogenital sinuses, the junction of which is Miller’s node. The cells at the caudal end of the fused Müllerian ducts differentiate to form the vaginal cords. The vaginal cord gradually lengthens and merges with the ectodermal part of the endoderm from behind the genitourinary sinus (vaginal sinus bulb) on both sides. The vaginal sinus bulb extends headward, fuses with the caudal part of the vaginal cord, and divides and proliferates at the same time to form a parenchymal column called the vaginal plate, which penetrates from above and downward to form the vaginal cavity, which is then penetrated by the vaginal cord and covered by the epithelium from the genitourinary sinus. It has also been suggested that the epithelium of the upper 1/3 to 4/5 of the vaginal canal lumen is formed by the vaginal uterine primordium, while the epithelium of the lower 2/3 to 1/5 is differentiated from the vaginal sinus bulb. The site of Miller’s node in the vagina determines the proportion of the müllerian duct and the genitourinary sinus in the formation of the vagina, with the upper 1/3 of most vaginas coming from the müllerian duct and the lower 2/3 developing from the vaginal plate of the genitourinary sinus, with very few variants. Therefore, it can be considered that: type I vaginal atresia is due to the non-involvement of the urogenital sinus in the formation of the vagina, and is mostly a lower or middle vaginal atresia; type II vaginal atresia is due to the involvement of both the Mullerian duct and the urogenital sinus during vaginal formation and presents as a complete vaginal atresia; upper or upper middle vaginal atresia occurs when the Mullerian duct is involved during vaginal formation and the urogenital sinus is still normally involved in the formation of the lower or middle vaginal segment Atresia of the apical vagina occurs when the open vaginal cavity does not pass through the vaginal cord or when the fusion of the urogenital ducts stops shortly afterwards. (2) Diagnostic criteria of vaginal atresia: To facilitate the diagnosis and treatment of congenital vaginal atresia, this article suggests that: (1) congenital atresia of the upper or upper-middle vaginal segment should be collectively referred to as “upper vaginal atresia”, and atresia of the lower or lower-middle vaginal segment should be collectively referred to as “lower vaginal atresia “(2), upper vaginal atresia and apical vaginal atresia are listed as III vaginal atresia and IV vaginal atresia after type I and II vaginal atresia, respectively. Therefore, the diagnostic criteria of vaginal atresia are: Type I (lower vaginal atresia type): refers to lower or lower middle vaginal atresia, above which the vagina and uterus develop normally; Type II (complete vaginal atresia type): refers to complete vaginal atresia, combined with combined uterine malformation; Type III (upper vaginal atresia type): refers to upper or middle upper vaginal atresia, combined with uterine malformation; Type IV (apical vaginal atresia type): refers to apical vaginal atresia Type IV (apical vaginal atresia): refers to apical vaginal atresia combined with uterine malformation. (3) Diagnosis and differential diagnosis: A study of 29 cases of congenital cervical atresia in our hospital found that cervical atresia can be divided into four types, and the diagnostic criteria are: Type I (incomplete cervical atresia): atresia at the endometrium, normal development of the uterus above it, and absence of the cervical canal; Type II (atresia at the isthmus): atresia of the uterine cervix above the endometrium, and absence of the cervix below the atretic segment Type III (complete atresia of the cervix): atresia of the isthmus and the cervical canal below the anatomical internal opening of the uterus, with different length, diameter and shape of the atretic cervix, mostly accompanied by hypoplasia of the uterine body; Type IV (absence of the isthmus): the lower end of the uterine body is directly connected to the cervical canal at the blind end, with absence of the isthmus, mostly accompanied by hypoplasia of the uterine body. In patients with cervical atresia, preoperative diagnosis is usually based on the history of periodic lower abdominal pain and pelvic masses without menstrual menarche, combined with gynecologic examination and imaging, and preliminary diagnosis and typing can be made. Type I vaginal atresia should be differentiated from type I cervical atresia: in type I vaginal atresia, preoperative ultrasound reveals the presence of a cystic cavity with the cervical canal line and a cervical ring. In type I cervical atresia, there is a narrow angle between the body and neck of the uterus on preoperative ultrasound that forms a clear demarcation between the cystic cavity and the cystic cavity under the body of the uterus, and the overall figure is like a “frying pan with handles”. In the former case, the wall of the cystic mass under the body of the uterus on the side of cervical atresia was thicker on preoperative ultrasound, and the cystic cavity shrank rapidly after the discharge of blood from the lower blind end of the cystic mass. In the latter case, preoperative ultrasound showed a double uterus with a cystic cavity on the oblique vaginal septum side surrounding part of the cervix downward, with a thin wall and transverse folds and a smooth protruding cervix at the tip, and the wall of the cystic cavity after biopsy of the septum was also compounded with squamous epithelium. Type III vaginal atresia should be differentiated from high and intermediate vaginal transverse septum: in the former, the uterus is combined with cervical atresia, there is no menstrual blood retention above the atretic segment of the vagina, there is no hypoechoic area between the lower cervix and the atretic segment of the vagina on preoperative ultrasound, and the blind end of the vagina is separated from the end of the atretic cervix by a segment of hyperechoic tissue; in the latter, preoperative ultrasound shows a normal uterus with a hypoechoic space surrounding part of the cervix downward, and the vaginal transverse septum divides the vagina into two parts. The transverse vaginal septum divides the vagina into upper and lower parts. It is easy to open the transverse vaginal septum surgically, and there are transverse folds in the posterior wall of the septum. (4) Treatment: The treatment of vaginal atresia is to surgically open the vaginal channel and epithelialize the rough surface of the vagina (apical vaginal atresia in combination with the primordial uterus does not require treatment), while those with cervical atresia should be treated according to the diagnosis of cervical atresia typology. Type IV cervical atresia can be treated by either hysterectomy and vaginoplasty before marriage or transabdominal perineal route of cervical and vaginoplasty according to the request of the affected party. In this case, type III cervical atresia combined with type III vaginal atresia should be performed as total hysterectomy + vaginoplasty. Preoperative ultrasound in this case showed that the end of the uterine cervix was about 2M long and spherically enlarged, with a maximum transverse diameter of about 3M. In case 2, the uterus was completely bicornuate with type I cervical atresia and type IV vaginal atresia, and in case 3, the uterus was bicornuate with type I cervical atresia and type IV vaginal atresia on the left side, and the treatment should be vaginal and cervicoplasty, i.e., transvaginal opening of the tip of the vagina and the isthmus of the atretic cervix, and then anastomosis of the vagina with the cervix. In case 3, the left uterine body was excised at the age of 14 due to menstrual blood retention in the left uterus, while the unresectable left isthmus and a small amount of uterine body tissue above the anatomical internal opening of the uterus were preserved. The diagnosis was confirmed and cured only after vaginal and cervicoplasty was performed. The misdiagnosis and mistreatment of this case show that the correct treatment of the disease depends on the knowledge of the disease.