Vaginal Abnormalities: Congenital Vaginal Obstruction

Vaginal blockages at birth are rare but must be surgically corrected. Here is what you need to know if your daughter is diagnosed with this condition.

What are congenital vaginal obstructions?

Female infants are normally born with a thin membrane (hymen) that surrounds the vaginal opening. In rare instances, a congenital vaginal blockage occurs that results in the absence of an external vaginal opening. The most common reason for this medical abnormality is an imperforate hymen-a layer of connective tissue that forms the hymen has no opening and thus the vaginal opening remains covered. Less commonly, obstruction is due to a high transverse septum. A high transverse septum is usually due to incomplete canalization of the vagina during development.

Either of these can result in hydrocolpos, an abnormal swelling of the vagina, or hydrometrocolpos, abnormal swelling of both the vagina and uterus.

How are congenital vaginal obstructions diagnosed?

Congenital vaginal obstructions are typically diagnosed in a newborn. Usually the physician finds an abdominal swelling, which is the vagina filled by secretions from the cervical glands in response to the mother's hormones. Typically, an ultrasound will confirm the lump. Additionally, a needle may be inserted into the mass to inject dye for an X-ray examination or to withdraw fluids for analysis.

If no abdominal lump or urinary symptoms are present, this condition may not be identified until puberty. At that time, the girl will fail to pass blood during her period, despite regular ovulation. She may also experience cyclical abdominal pain as well as a lump created by a buildup of menstrual blood behind the blockage.

How are congenital vaginal obstructions treated?

Treatment depends on the cause of the vaginal blockage. If the patient has an imperforate hymen, her urologist will make a simple incision that does not require anesthesia. Once drainage occurs, the anatomy should be examined for other abnormalities.

If the patient has a high transverse septum, treatment will depend on its thickness and location. If this partition is in the lower third of the vagina, the surgeon can cut upwards to remove it, reconnecting the upper and lower vagina. If it is located more to the interior, the patient may require an approach in which either skin or part of the intestine is used to bridge the gap between the upper and lower vagina.

Frequently asked questions:

Will our daughter be able to have children?

Fertility should not be affected if the reproductive tract is otherwise normal. A cesarean section may be recommended if the abnormality is a high transverse septum, which requires extensive surgical repair.

When she's older, will her sex life be affected?

No. Once corrected, she should have a normal, enjoyable sex life.