What is Vaginal Abnormalities: Congenital Vaginal Obstruction?

Vaginal blockages at birth are rare but must be fixed with surgery. Most female infants are born with a thin layer of issue (hymen) that surrounds the vaginal opening. In rare cases this space can be blocked.

The most common cause is an imperforate hymen. This means the tissue that makes the hymen fails to split and leave a hole. In this case the area stays covered.

Less often (1 in 70,000) it is from a high transverse septum. This is when the vagina does not develop fully.

Either of these issues can lead to swelling of the vagina and uterus.

Symptoms depend on the level of obstruction. If the baby is born with imperforate hymen, the retained mucus secretions will cause a bulge visible in the genital area. If the obstruction is higher (transverse vaginal septum), a belly swelling is usually noted.

It is most often found in a newborn. The doctor finds abdominal or genital swelling because the vagina is filled with fluid.

An ultrasound or MRI can confirm the cause of the swelling. Or, a needle would be inserted into the area (or mass if there) to inject dye for an X-ray, or to withdraw fluid for testing.

If there is no mass or urinary signs, it might not be found until puberty. At that time, the girl will not pass blood during her period even with normal ovulation. She may also have pain and swelling that comes and goes from the buildup of menstrual blood behind the block.

The doctor will decide on treatment based on the cause.

If the patient has an imperforate hymen, the urologist will make a simple cut. No anesthesia is needed with this method. Once drainage occurs, the patient will be checked for other issues.

If the patient has a high transverse septum, treatment will depend on its thickness and location. Depending on where it is, the surgeon can cut upwards to remove it, reconnecting the upper and lower vagina. Or, it may call for surgical excision. Certain methods are used to prevent vaginal narrowing.

The patient's own skin or part of the intestine can be used to bridge the gap between the upper and lower vagina. A mold can be placed in the vagina after surgery with a hollow center to allow menstrual flow.

Many parents have questions about their daughter’s future quality of life and fertility. Once this blockage is fixed, a normal, enjoyable sex life is usually possible.

Fertility should not be affected if the reproductive tract is normal. A C-section may be recommended if a high transverse septum was the problem.

• How long will recovery take?
• How will we know that the surgery was successful?
• Are there any additional tests we should take to make sure my daughter is fertile?