What is Vaginal Agenesis?
Vaginal Agenesis is a congenital (by birth) defect where in the baby will have an under developed vagina and in rare case, the baby may not have vagina at all. In such babies, other problems may also be found such as absence of a kidney or both or the kidneys may be joined together. In some cases of Vaginal Agenesis, problems related to skeleton, spine, ribs and limbs may also be found. They may also not have the uterus which will make it impossible to conceive when they grow up.
Vaginal Agenesis is also known as ‘Mullerian Aplasia’ or ‘Mayer – Rokintansky – Kuster – Hauser (MRKH) Syndrome’. Vaginal Agenesis can be treated surgically or non-surgically, depending on the case. Women with no uterus can never get pregnant. However, if they have healthy and functioning ovaries, surrogacy may be an option by extracting the egg from the ovaries.
Symptoms of Vaginal Agenesis
Amenorrhea – absence of menstrual cycle even after the girl reaches the age of 15. With the presence or absence of uterus, following can happen in the girl:
- If the uterus is present – the lining of the uterus will start shedding like in normal girls but because of the under development or absence of vagina, there is no way for the menstrual blood to flow out and it causes painful amenorrhea.
- If the uterus is absent – a case where there is no uterus and no pain. This is called Painless Amenorrhea.
- If there are periods but the girl has a under developed vagina or missing vagina, that obstructs the flow, this can result in painful abdominal cramps and pain.
In a nutshell – If your girl child is not menstruating even by the age of 15, you must see your gynecologist without any delay.
What causes Vaginal Agenesis?
The exact answer for what causes vaginal agenesis is not known but our medical experts only know that if the ‘Mullerian’ ducts don’t develop during the first 20 weeks of pregnancy, it can lead to Vaginal Agenesis. Typically, in normal girl babies, one Mullerian duct develops into vagina and uterus and the other grows into fallopian tubes.
What causes the Mullerian ducts not to form – answer is still not known.
Diagnosing Vaginal Agenesis
The problem may not be found until the girl reaches the age of 15 if she doesn’t start menstruating. In some cases, the problem may be figured when a doctor is examining for other problems.
Physical exam, imaging, ultrasound scans and in some cases, MRIs will be used to diagnose the issue.
Treatment options for Vaginal Agenesis
Surgical and non surgical options are available to create or make the vaginal opening depending on the condition of the patient. When this can be done depends on the individual and their family’s discretion. Some may get it done when they are around 15 and some may get it done once they become sexually active.
Following are the treatment options for Vaginal Agenesis:
1. Self Dilation
This is a non surgical process of creating the vagina. This is done for women who have a small dimple in the place of vagina. A small tube called ‘dilator’ is pressed in the area for about 20 minutes every day. It is advised to do this after bath when the skin is soft and has more elasticity.
2. Vaginoplasty
This is a surgical procedure where the vagina is created. The vagina is made with a graft of skin or from the inner lining of the cheek called ‘buccal mucosa’ in medical terms. Sometimes, vagina is made with part of the large bowel.
3. Skin graft method
Initially a mold is taken, that resembles the vagina. Skin from buttocks is taken and put on the mold. A cut is made in the area where the actual vagina should be and the mold will be placed inside the opening. The mold is placed there for about a week so that the grafted skin gets attached to the body and forms the vagina. Once it attaches and forms the vaginal opening, the mold is removed.
During this period a catheter is placed inside the urethra to drain the urine.
4. Bowel Vaginoplasty
This is a more complex process. A part of lower colon is removed by making an incision in the belly area. The colon is then sewed into the vaginal remnant (in girls where the vagina has not formed fully) and that acts as vaginal opening. A mold is placed into the new vagina for 3 days.
The patient will be advised to empty her bowels by passing stools the night before the surgery because one of the bowel will be cut during the surgery keeping it open.
Post operative care for Vaginal Agenesis
Patients treated with skin grafting method will be advised to wear the dilator for 3 months after the surgery. It can be removed when having sex or during bowel movements. After first 3 months, patient will be advised to wear the dilator for 6 months but only during the nights. In cases of bowel vaginoplasty, dilator may not be necessary unless vagina becomes too tight.
The patient will need to talk to the doctor about when she can start having sex. Usually it would be ok to start after 2 months after the surgery. One thing to note in this case is, since the vagina doesn’t make the lubricant by itself (like in normal women), the person may have to use artificial lubes throughout her life before having sex.
What are the chances of a woman becoming pregnant who was treated for Vaginal Agenesis?
This depends on what parts of the reproductive system were formed completely at birth. In treatment for Vaginal Agenesis, only the vagina will be constructed but not the internal parts of the reproductive system. If the fallopian tubes, uterus and ovaries are fully formed, the chances of getting pregnant will be high. If the uterus is not well formed, your body can only produce eggs in the ovaries and you may have to opt for surrogacy.
