Treatment of congenital absence of vagina

What are the treatments for congenital absence of vagina in vulva? Clinical manifestations include primary amenorrhea, periodic lower abdominal pain, and inability to have sexual intercourse after marriage. Check the female phenotype, the vulva is normal, there is only a shallow pit in the hymen without vagina; there is no uterus or primordial uterus malformation, and there may be urinary system or bone malformations. Ovarian function tests are within the normal range.

Diagnosis and differential diagnosis: The diagnosis is confirmed based on the patient's medical history, gynecological examination, H-ultrasound scan of the pelvic cavity and kidney area, endocrine determination, chromosome karyotype analysis or PCR technology detection of sexual genes. At the same time, X-ray urography should be performed to determine whether there is any deformity, and bone radiography should be performed to determine whether there is any deformity. It should be differentiated from secondary vaginal stenosis or atresia.

Treatment: The timing and method of treatment will be determined based on the patient's uterine development.

1. Timing of treatment

If the patient has a nearly normal uterus and normal ovarian function after a detailed examination, the surgery should be performed after the menstrual period to facilitate menstrual blood drainage and sexual intercourse. After treatment, there is hope for intrauterine pregnancy. If the patient has no uterus or a rudimentary uterus and is not likely to have children, it is best to perform artificial vaginoplasty before or after marriage to mainly solve the problem of sexual life.

2. Methods

(1) Vaginoplasty: There are many types of vaginoplasty, such as labia minora flap vaginoplasty, inner thigh flap vaginoplasty, sigmoid colon vaginoplasty, peritoneal vaginoplasty, etc. For specific methods, please refer to gynecological surgery. If pregnancy occurs after surgery, the patient should be closely monitored, and a cesarean section should be selected if the due date is close.

(2) Top-pressure method: For those who are infertile and have a partially sac-like vagina, local top-pressure method can be tried according to the patient's wishes. A round and blunt mold like the bottom of a test tube can be used for long-term self-pressure. Sexual intercourse can also be gradually deepened. If the patient is not satisfied, it also creates better conditions for surgery.