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Symptoms of vaginal and uterine malformations
Last reviewed: 06.07.2025
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During puberty, malformations of the vagina and uterus appear, in which primary amenorrhea and/or pain syndrome are observed: aplasia of the vagina and uterus, atresia of the hymen, aplasia of all or part of the vagina with a functioning uterus.
Girls with vaginal and uterine aplasia have a characteristic complaint - absence of menstruation, and later - impossibility of sexual activity. In some cases, in the presence of a functioning rudimentary uterus on one or both sides of the small pelvis, cyclical pains in the lower abdomen may occur.
Patients with hymenal atresia in puberty complain of cyclic pain, a feeling of heaviness in the lower abdomen, and sometimes difficulty urinating. The literature provides many examples of dysfunction of adjacent organs in girls with hymenal atresia and the formation of a large hematocolpos. R. Chircop (2003) observed acute urinary retention in a 13-year-old girl with hematocolpos and hematometra that arose with hymenal atresia. A. Kumar (2002) describes urinary retention against the background of intense pain in the lower abdomen in two girls with hymenal atresia. RG Buick (1999) reported on a girl with hymenal atresia complaining of pain in the lumbar region, urinary incontinence, and constipation that lasted for 72 hours.
A typical complaint of patients with aplasia of part of the vagina with a functioning uterus is the presence of cyclical (every 3-4 weeks) pain in the lower abdomen (with hematocolpos - aching, with hematometra - cramping), there may be vomiting, increased body temperature, frequent, painful urination, and bowel movement disorders.
In case of doubling of the vagina and uterus with partial aplasia of one of the vaginas and an additional functioning horn of the uterus, sharply painful menstruations are characteristic. In this defect, the outflow of menstrual blood from one of the vaginas is disrupted, which is partially aplastic (blindly closed) at the level of its upper, middle or lower third. Patients are bothered by monthly recurring severe pain in the lower abdomen, which is not relieved by either analgesics or antispasmodics, leading them to suicidal attempts. When a fistula tract is formed between the vaginas, patients experience constant bloody or purulent discharge from the genital tract.
Such defects as complete duplication of the uterus and vagina, bicornuate uterus, intrauterine septum (complete or incomplete) may not be clinically evident. Sometimes patients report painful and/or heavy menstruation.
Patients with a rudimentary closed horn of the uterus complain of severe pain in the lower abdomen, which occurs soon after menarche, increases with each menstruation, and is not relieved by antispasmodics and analgesics. The intensity of the pain and the ineffectiveness of therapy cause suicidal thoughts and sometimes suicide attempts. The rudimentary uterus (without a cervix) can be adjacent to the main uterus, and also intimately connected with it without communication between the cavities of these uteruses. In this situation, in the presence of a functioning endometrium, there is a violation of the outflow of menstrual blood from the cavity of the rudimentary uterus (horn), which, accumulating in it, leads to the formation of hematometra and hematosalpinx on the side of the rudiment.
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