Congenital anomalies (or congenital malformation) of the female genital tract are developmental issues that form in the embryo. These formations can occur in the vagina, ovaries, uterus or cervix. Although quite uncommon, some women are born with Congenital Vaginal Abnormalities may go undiscovered for years, and may cause difficulties throughout the lifespan. Vaginal abnormalities may lead to problems having sex and using tampons or may interfere with menstruation and childbirth.
Many vaginal anomalies are not detected at birth because the external genitalia appears to be normal. Other organs of the reproductive system may not be affected by an abnormality of the vagina. The uterus, fallopian tubes, and ovaries can be functional despite the presence of a defect of the vagina and external genitalia. A vaginal anomaly may not affect fertility. Though it depends on the extent of the vaginal defect, it is possible for conception to occur.
Congenital Vaginal Abnormalities typically involve the development of a septum – this is a fleshy piece of tissue that separates an anatomical cavity. The tissue separating your nasal cavity into two nostrils is one example of a septum. However, septums can also grow abnormally inside the vagina. There are two types of vaginal septum abnormalities: transverse and longitudinal.
Symptoms of Congenital Anomalies of the Vagina
While some congenital anomalies of the female genital tract could be asymptomatic, common symptoms include:
- Inability to empty the bladder
- Breasts do not grow
- Menstrual flow that occurs despite the use of a tampon
- Repeated preterm birth, or miscarriages
- Monthly cramping or pain without menstruation
- Pain with intercourse
- Abdominal pain
Diagnosis of Congenital Anomalies of the Vagina
Typically, your women’s health care doctor will be able to identify a congenital anomaly of your genital tract during a complete review of your medical history and physical examination. Other diagnostic procedures may include:
- Hysterosalpingogram (HSG)—An HSG is an X-ray procedure typically used to asses fertility.
- 3D Ultrasound—This imaging technique provides a three-dimensional picture to your healthcare provider, which is helpful for this diagnosis.
- Magnetic resonance imaging (MRI)—An MRI is a diagnostic procedure that utilizes a large magnet, radio frequencies, and a computer to reflect images of structures and organs within your body.
Vaginal agenesis, or absence of the vagina, is a congenital disorder of the female reproductive tract. It affects about 1 in every 5,000 female infants. The cause of vaginal agenesis is unknown. A woman with complete vaginal agenesis may have this abnormality based on the fact that the vagina did not grow during embryologic development and this is called Mayer-Rokitansky-Küster-Hauser syndrome. There are many variations to this syndrome.
Nearly all patients without a vagina have associated anomalies of the urinary tract, including renal agenesis, renal anomalies. ectopic pelvic kidney, and ureteral anomalies.
With vaginal agenesis, a vagina will need to be created to have normal sexual function. There are numerous options for creation of a vagina. It is our recommendation that we initially start with the utilization of vaginal dilators to create a functional vagina.
Alternatively, a vagina can be created with the utilization of a skin graft and this procedure is called a McIndoe procedure. A split-thickness skin graft is taken from the buttock and space is created for the placement of vaginal mold with the skin graft affixed to it.
Lower Vaginal Atresia
This happens when the lower portion of the vagina fails to develop properly and may be replaced by fibrous tissue that causes a blockage.
Transverse Vaginal Septums
When a septum develops “horizontally” across the vaginal canal, this is called a transverse vaginal septum. It divides the vagina into a top-half and a bottom-half; sometimes the division is complete, and sometimes it is partial.
This type of vaginal abnormality is very rare, occurring in only one out of every 3,000-80,000 female infants. Doctors are not entirely certain how many patients this condition affects, because it often goes unnoticed unless it’s causing problems.
A complete or nearly-complete division could cause blockages, trapping menstrual blood inside the vagina at the onset of puberty.
In the case of a complete blockage, there is an increased chance that menstrual blood will flow inward instead of outward, which may cause endometriosis. Endometriosis is a painful condition in which the endometrium (uterine lining normally shed during menstruation) attaches itself to tissue outside of the uterus. Endometriosis can cause painful periods and fertility problems, but there are treatments available.
Symptoms of Transverse Vaginal Septums
Many women go their whole lives without experiencing any problems caused by a septum. However, symptoms typically arise at puberty, due to accumulated menstrual blood that cannot escape, such as:
- Pelvic pain in monthly cycles
- Urinary problems
- Back pain
- Painful or impossible vaginal intercourse
- Difficulty using tampons
- Abdominal swelling (in newborns)
Longitudinal Vaginal Septum
Women with a complete vaginal septum also have duplication of the upper reproductive tract and thus have two uteri and two cervixes. Also known as a “double vagina,” in this condition a septum divides the vagina “vertically” into two separate canals with two vaginal openings, both leading from the vulva to the cervix. Many women with a longitudinal septum also have a double cervix and an abnormality of the uterus, such as a septate uterus or two uteruses.
This type of abnormality occurs during fetal development. During normal development, the vaginal canal is formed from the fusion of two adjacent tubes called the Mullerian ducts. If these ducts fail to merge completely, the infant will be born with a “double vagina.”
This is another condition which many women may not discover until later in life, or never if it doesn’t cause any problems. For this reason, it is difficult to estimate how many women are affected, although it does seem to be more common than transverse septums.
Symptoms of Longitudinal Vaginal Septum
Some symptoms include:
- Painful menstruation (dysmenorrhea)
- Menstrual blood that “leaks out” despite using a tampon
- Abnormal uterine bleeding
- Pain during sex
Pregnancy with Congenital Vaginal Abnormalities
Vaginal septums can cause some problems getting pregnant and during pregnancy, but most women with vaginal septums are able to carry healthy pregnancies. Some areas where you may run into problems include:
- Conceiving naturally with a complete vaginal blockage may be difficult.
- Miscarriage and early pregnancy loss. Incidence is slightly higher for women with vaginal septums.
- Risk of premature birth and preterm labor
- Possible congenital abnormalities in the fetus
- Difficulty during labor, especially if the mother has a previously undiscovered septum
Talk to your doctor about your concerns. A vaginal septum can be surgically removed if it causes you discomfort, or if your gynecologist suspects it will cause complications to your fertility. This type of procedure is known as a septoplasty.