What Are Vaginal Anomalies?
Vaginal anomalies are a category of disorders occurring before birth and involving abnormally formed or absent vaginas (the closed muscular canals that extend from the outside of the female genital area to the cervix, the neck of the uterus.) These occur in about 5% of females with an anorectal malformation/imperforate anus.
Vaginal anomalies include:
- Vaginal agenesis/atresia is a disorder present before birth in which the vagina stops developing. Some patients may have a shorter vagina, a part of a vagina or no vagina at all. This affects one in 5,000 females. Patients with vaginal agenesis sometimes have other abnormally formed parts of their reproductive tract, such as no uterus or a small one in addition to kidney abnormalities or problems affecting the spine, ribs or limbs.
- Transverse vaginal septum is a wall of tissue that blocks the vagina (the closed muscular canals that extend from the outside of the female genital area to the cervix, the neck of the uterus) and is formed while a fetus is developing in the womb. Sometimes there is a small hole in the transverse vaginal septum that causes women to have regular menstrual periods, but the periods may last longer than the typical four to seven days. If there is no hole in the transverse vaginal septum, blood may be collect in the upper vagina instead of completely flowing out of the vagina. A transverse vaginal septum will most likely require a surgical procedure to remove the fibrous tissue blocking the vagina.
- Longitudinal vaginal septum is a condition where there is a wall of fibrous tissue that divides the vagina into two halves. Menstrual blood can exit the vagina normally, but patients may have difficulty with tampon insertion or vaginal intercourse.
Additional types include:
- Imperforate hymen is a condition present before birth in which the hymen (a thin membrane that surrounds the opening to the vagina) fails to open up and therefore completely covers the opening to the vagina, blocking menstrual blood from flowing out. Typically adolescent girls with imperforate hymens don't have their periods and suffer pelvic pain, and some may also have pain with bowel movements and difficulty passing urine. A patient with an imperforate hymen can be treated with a surgery in which the hymen is cut to create a normal size vagina so that blood can flow out of it. An imperforate hymen is most often diagnosed after puberty in girls with otherwise normal development.
- Septate hymen is a septate hymen occurs when the thin membrane of the hymen (a thin membrane that surrounds the opening to the vagina) has a band of extra tissue in the middle that causes two small vaginal openings instead of one. Teens with a septate hymen may have trouble getting a tampon in or out. The treatment for a septate hymen is minor surgery to remove the extra band of tissue and create a normal sized vaginal opening.
- Microperforate hymen is a microperforate hymen is a thin membrane that almost completely covers the opening to a young women’s vagina. Menstrual blood is usually able to flow out of the vagina but the opening is very small. A teen with a microperforate hymen may not realize that she has a very tiny opening. If she is able to place a tampon into her vagina, she may not be able to remove it when it becomes filled with blood. The treatment for this condition is minor surgery to remove the extra tissue at the opening of the vagina to create a normal sized opening for menstrual blood to flow out.
What Are the Signs and Symptoms of Vaginal Anomalies?
With vaginal agenesis/atresia or a transverse vaginal septum, the most common symptom is a lack of a menstrual period. Typically, patients progress through puberty normally but never have a menstrual period. If there is menstrual blood collecting in the upper vagina, the patient may present with abdominal or pelvic pain. If the upper vagina is quite distended with menstrual blood, the patient may also have urinary symptoms — such as urinary frequency, urinary urgency, or feelings of incomplete voiding.
In cases of a longitudinal vaginal septum, patients will menstruate normally, but may have difficulty with tampon insertion or vaginal intercourse. They may also report that they can insert a tampon, continue to notice menstrual blood leaking around the tampon. This happens because the tampon is inserted on one side of the longitudinal vaginal septum and menstrual blood is continuing to flow out on the other side of the septum.
What Causes Vaginal Anomalies?
Vaginal anomalies are congenital anomalies — this means the condition is acquired during development and is present at birth.
How Are Vaginal Anomalies Treated?
- Vaginal Agenesis/Atresia: Treatment of this condition depends upon the amount of vaginal tissue present. If there is a very small amount of vaginal tissue present, this tissue can be stretched using vaginal dilators. This is quite successful. There are some cases where an upper vagina is present, but it does not reach down to the perineum. This may require a surgical procedure to either pull the vagina down to the perineum (“distal vaginal pull through”), or bridge the gap using a tissue graft (bowel or buccal mucosa). An exam in the office combined with imaging (pelvic ultrasound and/or pelvic MRI) is helpful to determine the amount of vaginal tissue present and the correct treatment plan.
- Transverse Vaginal Septum: A transverse vaginal septum can be removed via a surgical procedure that removes the fibrous tissue blocking the vagina. Once removed, the tissue will not grow back.
- Longitudinal Vaginal Septum: A longitudinal vaginal septum can be removed via a surgical procedure that removes the fibrous tissue. Once removed the tissue will not grow back.
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Hymen is a thin piece of tissue located at the opening of the vagina. The hymen needs to be open to allow menstrual blood and normal secretions to exit the vagina. Hymens come in different shapes including imperforate hymen, microperforate hymen, cribiform hymen and septate hymen.