Aplasia of the vagina

Aplasia of the vagina is a deviation from the norm of development of the female genitalia, which includes the complete or partial absence of the vagina. For the first time this anomaly was revealed by the German scientist Meyer, supplemented the diagnosis of Rokitansky and Muller, discovering in parallel with this vice the absence of the uterus.

[1],

Epidemiology

Aplasia of the vagina is rare. According to statistics on 10tys. Born girls account for one or two such cases. In 60% of women with this diagnosis, an abnormality of the urinary tract is developed, and in 35% - defects of the musculoskeletal system.

[2], [3], [4]

Causes of the aplasia of the vagina

The cause of vaginal aplasia is congenital malformation, often accompanied by defects or absence of anatomically adjacent organs: uterus, kidney. What provokes the development of such an anomaly, there is no definite answer. Most often, the occurrence of such cases is single and does not involve heredity. There are also precedents of the existence of this dysfunction in several generations of women of the same family, which gives rise to talk about the genetic predisposition. At the genetic level, they have a common set of 46 chromosomes with a standard view of the last XX. The formation of the uterus occurs at the embryonic stage at the end of the second month of intrauterine development of the fetus, beginning with the Mullerian ducts. Of these, the uterus, the fallopian tubes and the vagina are formed. It is assumed that various infectious diseases, especially sexually transmitted diseases (trichomoniasis, papillomavirus infection, genital herpes, etc.), strong and prolonged exposure to chemicals, incorrect douching can lead to a defect in the reproductive system of the infant.

[5]

Risk factors

Proceeding from the expected causes of uterine aplasia, risk factors can be classified as:

• chronic inflammation of the genital organs of a future mother;
• any diseases, including viral infections, which entailed long-term treatment with antibiotics and other medications;
• hormonal failures;
• neuropsychiatric disorders.

[6], [7]

Pathogenesis

The pathogenesis of the disease has not been fully established to date, but it is obvious that the biological inferiority of the cells participating in the formation of the future sexual organ results in this defect. The complete absence or lack of estrogen receptors in the Müllerian tubules leads to their partial fusion or non-fusion, as a result of which an anomaly arises. Often the fusion of the walls of the Mullerian ducts is hampered by defects in the urinary and musculoskeletal systems.

[8], [9], [10], [11], [12], [13]

Symptoms of the aplasia of the vagina

Aplasia of the vagina does not affect the appearance of the woman. All secondary sexual characteristics are age-appropriate. Symptoms occur when puberty occurs. Often, they signal themselves with pelvic pain, weight in the abdomen, lack of menstruation. With partial aplasia, excessive bleeding is possible with the inability to insert a tampon. Sometimes urination is accompanied by painful sensations, defecation is broken. In some cases, vomiting occurs, the temperature rises.

Often the first sign that there is a defect in the development of the reproductive system is the absence of menstruation when the age of puberty is reached. Some girls encounter an unsuccessful attempt at first sexual contact, others are troubled by severe bouts of periodic pain that do not pass after taking pain medications.

[14], [15]

Forms

Aplasia of the vagina is divided into full and partial. In the partial absence of the vagina, the transverse septum is complete or incomplete, its walls may have different thicknesses and are located in different parts of the upper third of the vagina.

By the form of complete aplasia happens:

• with a full-fledged uterus;
• with aplasia of the uterus;
• with aplasia of the cervix and a channel connecting the internal and external genital organs.

[16], [17]

Aplasia of the uterus and vagina

Aplasia of the uterus and vagina still carries the name of the syndrome Rokitansky-Küster-Mayer. With this disease, the uterus is completely absent, but there are normally functioning ovaries. Secondary sexual characteristics are formed without abnormalities, there is no painful periodic syndrome.

[18], [19]

Complications and consequences

The consequences of aplasia of the vagina - infertility and the impossibility of a full intimate life without eliminating the anomaly in an operative way. At the same time, this is a great psychological blow for every girl who needs to overcome it. Complications can occur when trying to have a first sexual encounter. Not knowing his own vice, a girl can get a rupture of the perineum, the urethra.

[20], [21], [22], [23], [24]

Diagnostics of the aplasia of the vagina

The primary physical examination of the genitalia on the armchair does not show any abnormalities in the structure of the external genital organs, it indicates the presence of the scalp on the pubis. With aplasia and the vagina and the uterus are some features of their location. So, the surface of the vestibule vestibule can be smoothed from the urethra to the rectum, the hymen - without a depression in the perineum and have a hole through which the aplasia is detected. Palpation of the abdomen reveals a thorn in place of the uterus. To clarify the diagnosis, laboratory tests of urine, blood, instrumental and differential examination are prescribed.

[25], [26], [27], [28]

Analyzes

If you suspect a vaginal aplasia, the tests are not very informative, but are necessary to determine the background on which the defect develops. For this purpose, a urine test is performed, as well as a general and detailed blood test. Studies will show the hormonal level, its possible imbalance. Bacteriological and bacterioscopic analysis of the smear and biomaterial will determine the microflora of the genital tract, the presence of inflammation, fungi, bacteria, possible venereal diseases.

[29], [30],

Instrumental diagnostics

The most important mechanism for establishing the correct diagnosis in case of vaginal aplasia is instrumental diagnostics. Using the probe during the examination allows you to reveal the vagina behind the hymen, which blindly ends. If such measures are insufficient to establish a diagnosis, laparoscopic diagnostics is used. This is a minimally invasive surgical method of investigation, which enables the optical laparoscope to penetrate into the abdominal cavity through small holes, and to give an image of reproductive organs in an enlarged size to the monitor. Non-surgical methods of diagnosis - ultrasound (ultrasound) and magnetic resonance imaging (MRI) of the abdominal organs will show whether there are defects in other genital or neighboring organs. There may not be a uterus with normal ovaries and fallopian tubes, or it may be underdeveloped, defects in the urinary system are found.

Differential diagnosis

Differential diagnosis is very important for determining the diagnosis and is designed to protect the patient from improper treatment. In girls with aplasia of the uterus at a distance of 2-8 cm from the anus, when viewed on a gynecological chair and palpation of the abdomen, a seal is identified that can be mistaken for a cyst or a tumor. Painful sensations can be mistaken for an attack of acute appendicitis, torsion of the leg of the ovaries or vulvovaginitis.

Treatment of the aplasia of the vagina

Treatment of vaginal aplasia involves the elimination of a congenital anomaly with the help of kolpopoiesis - the creation of an artificial neovaginal. This is not always a plastic surgery. There is a bloodless method with the use of colpelo - a special protector. The essence of this method consists in gradual stretching of the vestibule vestibule by means of a special apparatus. The procedure is carried out under the supervision of medical staff, the pressure on the tissue is regulated, based on the sensations of the woman. The duration of the procedure in the first stages is 20 minutes, gradually increasing to half an hour or forty minutes twice a day. The course of treatment is 15-20 procedures. After 2 months you can repeat. The majority of patients reach stretch tissues up to 10 cm. Drug treatment is not required.

If conservative treatment has not brought results, resort to an operative measure. The history of such operations goes back to the beginning of the nineteenth century. But without endoscopic instruments, operations were accompanied by great traumatism and significant complications. There were their various technologies: using silver or stainless steel prosthesis in the created canal, through the rectum and with the formation of neovagins from skin flaps, etc. The modern method of colpopoiesis involves a combination of an invasive and a laparoscopic method. The operation is carried out simultaneously in two places: one surgeon - through the pelvic peritoneum, others - through the perineum, where a channel is formed between the bladder and rectum. Further, the wall of the peritoneum is sutured to the vestibule of the vagina and its dome is formed.

One month after the operation, a full sexual life can begin. To prevent clumping of the walls of the newly formed vagina, it is necessary to have a regular sexual life, or to carry out artificial bougie. In the future, once every six months, you should undergo a medical examination in order to diagnose cicatricial changes in the vagina in time.

Prevention

Prevention of aplasia of the vagina is not available today. There is it at the recommendation level to pregnant women who want to give birth to healthy offspring - to be very careful in the first trimester of pregnancy, when the sexual organs are formed at the embryonic level. Alcohol, smoking, various chemical influences, harmful production, viral infections are factors that can harm a future girl, her psyche, take away the joy of a full sexual life and the joy of motherhood.

[31], [32]

Forecast

Modern technologies, the invention and use of high-precision diagnostic and surgical equipment give hope to patients and make the prognosis of the disease favorable. In vitro fertilization has made it possible for women with aplasia of the vagina to learn the joy of motherhood with the help of surrogate motherhood.

[33], [34]