Vaginal Agenesis: Causes, Symptoms, Diagnosis, Treatment and Complications

Vaginal agenesis is an uncommon disorder in which the vagina does not develop, but the uterus (womb) may develop partially or not at all. This is a congenital condition that has also been connected to renal or bone problems.

Other names for the ailment include Mayer-Rokitansky-Kuster-Hauser syndrome, Mullerian agenesis, and Mullerian aplasia.

A female is often diagnosed with vaginal agenesis when she does not begin menstruation at puberty. A vaginal dilator is a tube-like device that is commonly used to create a vagina. With repeated use, the device can stretch the vagina. On rare occasions, surgery may be necessary. Having sex vaginally is feasible while undergoing therapy.

Causes Of Vaginal Agenesis

The Mullerian ducts, a tube that connects the uterus, do not form normally during the first 20 weeks of pregnancy; this is the exact cause of vaginal agenesis.

Normally, the fallopian tubes originate from the top of these ducts, while the uterus and vagina grow from the lower part. The underdevelopment of the Mullerian ducts may result in an absent or partially closed vagina, an absent or partially formed uterus, or both.

Symptoms Of Vaginal Agenesis

Many times, a lady with vaginal agenesis who does not menstruate (amenorrhoea) is not diagnosed until she is in her teens. Other signs of puberty often follow typical female growth.

Vaginal agenesis symptoms may include:

• The genitalia are similar to those of an average female.
• The vagina may be nonexistent or have a tiny indentation where a vaginal entrance should be, or it may be shorter and not have a cervix at the end.
• The uterus may be partially formed or absent. Monthly cramps or chronic abdominal pain may be caused by the endometrium, the tissue lining the uterus.
• The ovaries are often fully developed and functional, though occasionally they may be positioned abnormally inside the abdomen. Occasionally, the fallopian tubes which transport eggs from the ovaries to the uterus—may develop improperly or not at all.

Additional issues that could be connected to vaginal agenesis are as follows:

• Abnormalities in the wrist, rib, and spine bones during development that are related to kidney and urinary tract development
• Problems with hearing

Additional congenital conditions impacting the heart, gastrointestinal tract, and limb growth

The embryo may be implanted in the uterus of another person (a gestational carrier) to carry the pregnancy. Discuss your reproductive options with your healthcare provider.

Also Read: Cystocele: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Diagnosis Of Vaginal Agenesis

Your gynaecologist or paediatrician will diagnose vaginal agenesis based on your medical history and physical examination results.Vaginal agenesis is the term used to describe the condition in which menstruation does not start throughout puberty, even after pubic and underarm hair growth and breast development. 

Sometimes vaginal agenesis is detected at an earlier age when a baby's vaginal opening is observed by parents or a physician, or when the condition is assessed for other problems.

The following tests may be recommended by your healthcare provider:

• Blood tests: Blood tests that measure your hormone levels and examine your chromosomes can help you confirm your diagnosis and rule out other conditions.
• Ultrasound: Your physician can examine the kidneys to identify whether or not you have kidney problems. from an ultrasound, which also reveals whether you have an ovary or uterus.
• Magnetic resonance imaging is referred to as MRI: An MRI gives your doctor a good picture of your reproductive system and kidneys.
• Additional examination: To evaluate your heart, hearing, and skeleton, your doctor might also recommend additional testing.

Also Read: Precocious Puberty: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Treatment Of Vaginal Agenesis

While you can wait until you're older and feel ready to begin therapy, vaginal agenesis commonly begins in the late teens or early 20s.

You can talk to your healthcare provider about your treatment options. The absence of any therapy at all, self-dilation, or surgery are possible options for creating a vagina.

Self-dilation is typically recommended as the first line of action. Self-dilation may help you create a vagina without the need for surgery. The idea is to make the vagina longer so that it is appropriate for sexual activity.

When you self-dilate, you use a small, round rod called a dilator which is similar to a firm tampon to apply pressure to your skin at your vaginal entrance or inside your already-existing vagina for ten to thirty minutes, one to three times a day. Gradually, you go up to larger dilators each week. It could take several months to get the desired result.

To ensure you know what to do, your healthcare provider should go over the self-dilation technique with you. To choose the best dilator for you, you need also to talk about the many options available. Over time, you'll need to maintain the length of your vagina by regular sexual activity or utilising self-dilation as directed by your healthcare provider.

Some patients have trouble urinating and experience pain and bleeding in the vagina, especially in the beginning. It might be helpful to experiment with different dilators and artificial lubrication. Your skin extends more easily after a warm bath, so this might be a good time for dilation.

One alternative to self-dilation for women who have interested partners is vaginal dilatation through regular sexual interactions. If you would want to try this method, talk to your healthcare provider about the best course of action.

If self-dilation is unsuccessful, operation vaginoplasty a surgical procedure to create a functioning vagina may be a possibility. The following surgical methods are used in vaginoplasty:

utilising an alternative to tissue. Your surgeon has a variety of autologous tissue grafts to choose from when creating a vagina. The skin of the buttocks, outer thighs, and lower abdomen may be sources.

Making an incision, placing a tissue graft over a mould, and then inserting it into the newly formed canal is how your surgeon creates the vagina. It takes a week or so for the mould to completely grow.

While the vaginal dilator or mould is typically left in place after surgery, you are free to remove it for sexual activity or bathroom breaks. You will only use the dilator at night after the initial advice from your surgeon. Regular dilation and artificial lubrication during intercourse help to maintain a healthy vagina.

Inserting a medical traction device. Either an olive-shaped Vecchietti treatment device or a balloon vaginoplasty will be inserted at your vaginal aperture by your surgeon. Using a small, lit viewing instrument called a laparoscope as a guide, the surgeon links the device to a separate traction device through your navel or on your lower abdomen.

To create a vaginal channel, you gradually drag the traction device inward over the course of roughly a week by tightening it every day. After removal, you will utilise the gadget for around three months using a moulds of various sizes. During the three months that pass, you can continue to use self-dilation or have regular sex to maintain the functionality of your vagina. It's likely that artificial lubrication will be required for sexual activity.

Bowel vaginoplasty: the use of a colon segment. During a bowel vaginoplasty, the surgeon makes a new vagina by moving a portion of your colon to an opening in your vagina. After that, your surgeon reattaches the colon's remnants. Following this operation, there will likely be no need for daily use of a vaginal dilator and artificial lubrication during sexual activity.

Following surgery, regular sex, dilatation, or the use of a mould are necessary to maintain the vagina working. Medical practitioners usually wait to do surgery until you feel comfortable and confident enough to handle self-dilation. Being emotionally mature and ready to adhere to aftercare recommendations is essential since the newly constructed vaginal canal has the potential to shorten and narrow very quickly without regular dilation.

Also Read: Galactorrhea: Causes, Symptoms, Diagnosis, Treatment, Prevention and Complications

Complications Of Vaginal Agenesis

Vaginal agenesis may have an impact on your sexual interactions, but with treatment, your vagina will typically function normally for sexual activity.

A woman cannot conceive if her uterus is nonexistent or only partially developed. On the other side, if your ovaries are in good health, you may be able to use in vitro fertilisation.

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