During the formation and differentiation of the female reproductive organs, various developmental abnormalities can result from the influence of certain endogenous or exogenous factors. Since the female genital organs and the urinary organs are the same in origin, it is important to consider whether there are abnormalities of the urinary organs (kidneys) when diagnosing genital organ abnormalities.
I. Hymenal Atresia
Also known as hymenesis imperforate. Because the hymen is not perforated, the vagina is isolated from the outside world, so vaginal secretions or menstrual blood from the first menstrual flow is blocked and accumulates in the vagina. Sometimes menstrual blood may flow backwards through the fallopian tube into the abdominal cavity. If incision is not made in time, the repeated menstrual flow will increase the accumulation of blood and develop into blood accumulation in the uterine cavity. The fallopian tube may become atretic at the umbilical end due to the accumulation of blood and the reflux of menstrual blood to the pelvic cavity may lead to endometriosis.
Presentation: Periodic lower abdominal cramps occur in patients until puberty, with progressive increase. Severe cases may cause anal or vaginal distension and frequent urination. On examination, the hymen is seen to be bulging with a purplish-blue surface; pelvic ultrasonography reveals fluid in both the uterine cavity and vagina.
Treatment: timely surgical excision of the excess hymen.
Congenital absence of vagina
The incidence of congenital anovagina is about 1/4000~1/5000. Almost all congenital anovaginas are combined with no uterus or only a primordial uterus and normal ovarian function.
Presentation: primary amenorrhea without periodic lower abdominal pain. On examination, the patient has normal physical and secondary sexual characteristics and vulva development, but there is no vaginal opening or only a shallow concavity in the posterior vestibule. Uterine hypoplasia (absence of uterus or primordial uterus) is often present. Some patients have abnormal development of the urinary tract and some have spinal abnormalities.
Treatment: surgical and non-surgical (parietal compression) treatment.
Vaginal atresia can be divided into two types.
(1) lower vaginal atresia with normal upper vaginal segment, cervix and uterine body.
(2) complete vaginal atresia, combined with cervical dysplasia, uterine body dysplasia or uterine malformation.
(2) complete vaginal atresia, combined with cervical dysplasia, uterine body dysplasia or uterine malformation. In complete vaginal atresia, most of them are combined with cervical dysplasia, uterine body dysplasia or uterine malformation, endometrial secretion function is not normal, symptoms appear later, menstrual blood easily flows back to the pelvis, and endometriosis often occurs.
Treatment: Once the diagnosis is clear, the vaginal obstruction should be removed by surgery as soon as possible so that the menstrual blood can be drained smoothly.
Transverse vaginal septum is classified according to whether there is a hole in the septum: complete septum (no hole); incomplete septum (small hole in the septum). The septum can be located in any part of the vagina, but the upper and middle junctions are the most common.
The incomplete septum is asymptomatic if it is located in the upper part of the vagina, but it can affect sexual life if it is low. Complete septum has primary amenorrhea with periodic abdominal pain that is progressively worse.
Treatment: Excision of the septum and suturing to stop bleeding.
V. Longitudinal vaginal septum
There are complete and incomplete longitudinal septum. Complete mediastinum is characterized by symmetry. It is often associated with double uterus, double cervix, and ipsilateral renal dysplasia.
Presentation: Complete vaginal mediastinum is asymptomatic, while incomplete mediastinum may be associated with sexual difficulties or discomfort.
Treatment: If the vaginal mediastinum interferes with sexual life or vaginal delivery, the mediastinum should be removed.
Oblique vaginal septum syndrome
Double uterine body, double cervix, vaginal oblique septum and renal agenesis on the side of the oblique septum are divided into perforated and nonperforated septum. Due to the presence of vaginal oblique septum, the menstrual blood in that side of the uterus cannot be discharged or is not discharged smoothly.
Presentation: younger age of onset, normal menstrual cycle, dysmenorrhea and pain in one side of the lower abdomen, some patients present with a small amount of brown vaginal discharge or old blood dripping between menstruation, purulent discharge with odor.
Treatment: oblique septal excision surgery.