What are the methods of traditional Chinese medicine for treating congenital absence of vagina?

This disease is caused by the obstruction of the embryo during development by internal or external factors, or by abnormal development of the paramesonephric duct due to gene mutation (may have a family history). The most common patients with Rokitansky-Kustner-Hauser syndrome are characterized by normal female chromosome karyotype, normal systemic growth and development of female secondary sexual characteristics, normal vulva, vaginal absence, uterine development (only remnants of two horns), small fallopian tubes, and normal ovarian development and function. Testicular feminization (androgen insensitivity syndrome) patients are relatively rare. Very few are true hermaphroditism or gonadal dysgenesis.

【diagnosis】

Most patients with congenital angular vagina only have completely closed vaginal vestibule mucosa at the normal vaginal opening, with no vaginal traces. Some patients also have shallow depressions in the vaginal vestibule, and some have blind vaginas shorter than 3 cm. It is often accompanied by no deformity, and only slightly thickened strips of tissue can be seen in the normal uterus, located in the middle of the broad ligament. About 1/10 patients may have partial uterine body development and functional endometrium. After puberty, due to menstrual blood retention, periodic abdominal pain occurs, no menstruation, or it is not discovered until after marriage when they seek medical examination due to sexual intercourse difficulties.

【Treatment measures】

The principle of treatment for congenital absence of vagina is to reconstruct the vagina. There are many methods for artificial vaginal formation, including non-surgical treatment, which is to use the means of top pressure to gradually push the closed vestibular mucosa in the normal vaginal position toward the head end along the vaginal axis to form an artificial cavity. This method requires a long treatment time and the artificial vagina formed is short. If the tissue elasticity is poor, it is difficult to succeed. It is now basically abandoned and rarely used. Surgical treatment mainly separates the urethra, bladder and rectum to form an artificial cavity, and uses different methods to find an appropriate cavity wound covering to reconstruct the vagina. In previous years, the most common method used was the patient's own medium-thickness free skin grafting method, but after surgery, a hard vaginal mold needs to be used for a long time to expand the artificial vagina to prevent the artificial cavity covered by the transplanted skin from contracting, which increases the patient's pain and brings great inconvenience to the work and life. Moreover, the difference in the characteristics of skin and mucosal tissues is too great, and it does not meet physiological requirements, which is its biggest disadvantage. Vaginal formation using labia skin flaps destroys the normal vulva morphology and is often rejected by patients. Reconstruction using sigmoid colon or ileum segments increases the complexity of the operation. Using amniotic membrane or pelvic peritoneum to cover also has its own disadvantages. Therefore, although there are many methods, there is still no very ideal shaping surgery. The choice should be mainly based on the patient's vulvar local anatomy and other specific clinical conditions. In recent years, with the progress of microsurgery, vascularized myocutaneous flaps have been used to cover the cavity, opening up a new way for this operation. Its advantages and disadvantages need to be promoted before a conclusion can be drawn.

When the development of the paramesonephric duct is severe, there is often incomplete renal rotation, low migration of the kidney, or migration to the pelvis, forming urinary tract malformations such as pelvic kidney, horseshoe kidney, transboundary renal ectopia (two kidneys located on the same side of the body), renal agenesis, and renal insufficiency.

【Clinical manifestations】

The vast majority of patients with congenital angular vagina only have completely closed vaginal vestibule mucosa at the normal vaginal opening, with no trace of vagina. Some patients also have shallow depressions in the vaginal vestibule, and some have blind-end vaginas shorter than 3 cm. It is often accompanied by no deformity, and only slightly thickened strips of tissue can be seen in the normal uterus, located in the middle of the broad ligament. About 1/10 of patients may have partial uterine development and functional endometrium. After puberty, due to menstrual blood retention, periodic abdominal pain occurs, and there is no menstruation, or it is not discovered until after marriage when they seek medical examination due to sexual intercourse difficulties.