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Vaginal Abnormalities: Vaginal Agenesis

Vaginal agenesis is a birth defect that affects few women. But unless corrected, it can make a sexual life, not to mention childbearing, impossible. The following information should explain this condition and how it can be fixed.

What is vaginal agenesis?

Vaginal agenesis is a congenital disorder of the reproductive system affecting one in 5,000 females. It occurs when the vagina, the muscular canal connecting the cervix of the uterus to the vulva, stops developing because the vaginal plate fails to form the channel.

Some patients may have a shorter vagina, a remnant of one or lack of one all together (Mayer-von Rokitansky-Kuster-Hauser's syndrome). With vaginal agenesis, it is not uncommon to have other malformations in the reproductive tract, such as an absent or small uterus.

In addition, 30 percent of patients with vaginal agenesis will have kidney abnormalities, the most common of which is the absence of one kidney or the dislocation of one or both organs. The two kidneys may also be fused together, forming a horseshoe-like shape. Approximately 12 percent of patients also have skeletal abnormalities, with two-thirds of this group experiencing problems affecting the spine, ribs or limbs.

How is vaginal agenesis diagnosed?

Because external genitalia appear normal, vaginal agenesis is typically not diagnosed until puberty (around age 15); when a young girl notices that she has not had her menstrual period and seeks medical attention. The diagnosis is made by physical examination and diagnostic imaging. They may include an ultrasound to check if the uterus and ovaries are both present and entirely intact. The patient may even be asked to undergo a MRI that will show a more detailed picture of her reproductive tract.

While most vaginal agenesis sufferers are not aware of their condition until their teen years, a subgroup of these patients will be diagnosed during infancy. In this case, the abnormality is usually detected during an examination or test for unrelated problems.

How is vaginal agenesis treated?

Self-dilation: Some women can have their vagina reconstructed without having an operation. Pressure is applied over the area where the vagina should be with a very small tube, called a dilator. The dilator is held against the skin and pressure is applied for about 15 to 20 minutes a day. Usually, this is more comfortable after the patient has taken a bath because the skin is soft and stretches more easily.

Vaginoplasty: Most young women, however, will require surgical reconstruction. Techniques vary widely, but the vagina can be constructed using a graft either of skin or a buccal mucosa (inner lining of the cheek) or using a segment of large bowel. In the first procedure, the surgeon creates a vagina by harvesting a thin piece of skin from the patient's buttocks (artificial skin has been recently recommended to reduce the morbidity from the skin donor site) and placing it over a mold to create a vagina. He or she then makes a small incision where a normal vagina would be located and inserts the mold so the graft will attach naturally to make the inside of a vagina. After the surgery, the patient is usually on bed rest for a week, during which time a catheter is placed into the bladder for drainage. The mold is removed after seven days. With a bowel vaginoplasty, a portion of the lower colon is removed through an abdominal incision. One end of the bowel is then closed, while the other remains open, functioning as a vaginal opening. The colon is sewn into the vaginal remnant. The night before surgery, patients undergoing this vaginoplasty must empty their bowels to remove stool and bacteria. Following the surgery, a mold will be inserted into the new vagina for three days. During this period a catheter is placed into the bladder through the urethra so that urine can drain.

What can be expected after treatment for vaginal agenesis?

Patients undergoing a skin graft usually wear a vaginal dilator for three months after surgery. It is removed for urination, bowel movements, showering and sexual intercourse. After three months, the patient usually wears the dilator only at night for approximately six months. Vaginal stenosis, or a tightening of the vagina, is the major complication of this procedure.

Only one operation is needed with bowel vaginoplasty. The patient will be seen three weeks after the surgery and again in three months. Some women will experience a tightening of the vagina. If this occurs, dilation will be performed under anesthesia. Home dilation is not necessary.

Frequently asked questions:

At what age should my daughter consider having a vagina created?

When she starts is up to her. Most girls begin the process in their teens, but she may want to wait until sometime in the future when she is ready to become sexually active.

After surgery, when can she begin to have sexual intercourse?

Although patients should consult their physician before having sexual intercourse, it is usually acceptable to begin four to six weeks after the procedure. The patient will probably need lubrication since the skin will not produce the same substances as normal vaginal tissue. Lubrication after a bowel vaginoplasty is less of a problem.

Will she be able to lead a normal sex life?

Since much of sexual pleasure comes from stimulation of the clitoris, the female erectile structure, and not the vagina, she should enjoy normal sensations and a good sex life. Since reconstruction is internal, no one will be able to tell that a patient has undergone the procedure.

Will my daughter be able to have children?

Your daughter's individual anatomy will be the biggest factor in whether or not she will be able to have children. It is very likely she will be able to become pregnant if her uterus, ovaries and fallopian tubes are normal. It is unlikely that she will be capable of going through pregnancy by herself if her uterus is tiny or absent. However, since the ovaries usually remain normal, fertility specialists will be able to harvest an egg, fertilize it with her partner's sperm, and implant it into a surrogate mother who would carry it to term. Adoption is another option.

Do doctors know the cause of vaginal agenesis?

There are no known risk factors for vaginal agenesis.

Links for additional information:

The Center for Young Women's Health (CYWH)


Reviewed: January 2011

Last updated:June 2014

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Vaginal Abnormalities: Vaginal Agenesis Glossary
  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • abnormality: A variation from a normal structure or function of the body.

  • anatomy: The physical structure of an internal structure of an organism or any of its parts.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • bacteria: Single-celled microorganisms that can exist independently (free-living) or dependently upon another organism for life (parasite). They can cause infection and are usually treated with antibiotics.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bowel: Another word for intestines or colon.

  • bowel movement: The act of passing feces (stool) through the anus.

  • bowel vaginoplasty: Surgical repair or reconstruction of the vagina using portions of the intestines.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • cervix: The lower, narrow part of the uterus (womb).

  • clitoris: Sensitive female sex organ, which is visible at the front of the vagina.

  • colon: Large intestine.

  • congenital: Present at birth.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • dilation: The stretching or enlargement of a hollow organ or body cavity.

  • dilator: An instrument to stretch body tis-sues and enlarge an opening, passage or canal.

  • dilator: An instrument to stretch body tissues and enlarge an opening, passage or canal.

  • erectile: Capable of filling with blood under pressure, swelling and becoming stiff.

  • fallopian tubes: There are two fallopian tubes, one on each side of the uterus. They transport an egg from the ovary to the uterus.

  • fertility: The ability to conceive and have children.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • genitalia: External sexual organs.

  • graft: Healthy skin, bone or tissue taken from one part of the body to replace diseased or injured tissue removed from another part of the body.

  • incision: Surgical cut for entering the body to perform an operation.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • MRI: Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • ovaries: Female reproductive organs that produce eggs and also produce the sex hormones estrogen and progesterone.

  • pregnancy: The condition of being pregnant.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • stool: Waste material (feces) discharged from the body.

  • tissue: Group of cells in an organism that are similar in form and function.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • uterus: A hallow, muscular organ in the pelvis cavity of females in which the embryo is nourished and develops before birth.

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

  • vaginal plate: The tissue within an embryo that hallows out and becomes the vagina in a female.

  • vaginoplasty: An operation in which a concealed vagina is brought out onto the surface or its existing opening is widened.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vulva: The external female genitals. These include two pairs of fleshy folds that surround the opening of the vagina and clitoris.

Vaginal Abnormalities: Vaginal Agenesis Anatomical Drawings

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