How to treat congenital absence of vagina

How to treat congenital absence of vagina? Congenital absence of vagina is caused by internal or external factors that hinder the development of the embryo, or it may be caused by abnormal development of the paramesonephric duct due to gene mutation. The main causes of its occurrence are: chromosomal abnormalities; androgen insensitivity syndrome; mother's use of male hormones, anticancer drugs, thalidomide, etc. in early pregnancy; infection with certain viruses or toxoplasma in early pregnancy.

Infertility experts say: The principle of treating congenital absence of vagina is to reconstruct the vagina. There are many methods of artificial vaginal formation:

1. Non-surgical treatment, that is, using the method of top pressure, 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 has been basically abandoned and rarely used.

Second, surgical treatment mainly involves separating the urethra, bladder and rectum to form an artificial cavity, and using different methods to find an appropriate cavity wound covering material to reconstruct the vagina. (1) The most common method is to use the patient's own medium-thickness free skin graft, but after the operation, 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 grafted skin graft from contracting, which increases the patient's pain and brings great inconvenience to work and life. In addition, the characteristics of skin and mucosal tissues are too different, and they do not meet physiological requirements, which is their biggest disadvantage. (2) Vaginoplasty using labia skin flaps destroys the normal vulva morphology and is often rejected by patients. (3) Reconstruction using sigmoid colon or ileum segments increases the complexity of the operation. Covering with amniotic membrane or pelvic peritoneum 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 local vulvar 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 pros and cons need to be promoted before a conclusion can be drawn.

When the paramesonephric duct is seriously dysplastic, there is often incomplete renal rotation, low migration of the kidney, or migration to the pelvic cavity, forming pelvic kidney, horseshoe kidney, transboundary renal ectopia (two kidneys are located on the same side of the body), renal agenesis, renal insufficiency and other urinary tract malformations. Literature reports that in RKH syndrome, renal malformations account for more than 30%. Therefore, when vaginoplasty is performed on cases of congenital absence of vagina, intravenous pyelography should be performed before the operation to be alert to the presence of the above malformations and avoid surgical injuries. In addition, patients with this disease also have skeletal deformities, accounting for about 10%, including spina bifida, sacral occult fracture, vertebral fusion and spinal non-segmentation.

The vast majority of patients with congenital absence of 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 deformities, 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, and there is no menstruation or it is not until after marriage that it is discovered through medical examination due to sexual intercourse difficulties. As for the treatment of congenital absence of vagina, surgical treatment is currently more common. Infertility experts recommend that you must choose a regular professional hospital for treatment.