What women should know about vaginal agenesis
Vaginal agenesis is a birth defect that affects 1 out of 5,000 women. But unless it is fixed, it can make sex and having a baby impossible. It occurs when the vagina does not develop fully.
Some girls may have a shorter vagina, a remnant of one, or lack one altogether. It is not uncommon to have other issues in the reproductive tract, such as an absent or small uterus.
Also, 30 out of 100 girls with vaginal agenesis will have kidney abnormalities. The most common is missing 1 kidney or the dislocation of 1 or both organs.
The 2 kidneys may also be joined, forming a horseshoe-like shape. About 12 out of 100 females also have atypical skeletons, and 2 of 3 in this group have problems with the spine, ribs or limbs.
The symptoms of vaginal agenesis are related to a condition known as amenorrhea. Amenorrhea is the lack of menstrual period after puberty has started.
Girls with amenorrhea because of vaginal agenesis can grow normally. However, they may experience painful amenorrhea, a condition happens to girls with a uterus.
They may also experience painless amenorrhea, condition happens to girls who do not have a uterus and do not have a menstrual cycle.
They may also experience monthly cramping and abdominal pain. The pain is due to buildup of menstrual flow from the obstruction caused by the missing vagina.
The cause of vaginal agenesis is not entirely known. Some scientists believe the condition is caused by the failure of certain organs (mullerian ducts) forming during fetal development.
Because the outer sex organs appear normal, it is often not found until around age 15, when a young girl notes that she has not had her period and seeks medical care. The diagnosis is made by physical exam and imaging.
An ultrasound may be used to check the womb and ovaries. If needed, MRI can show a fuller picture of the reproductive tract.
Most girls do not know about this issue until their teen years. But some cases will be found during infancy, often during an exam or test for other problems.
Many ask at what point a girl should think about having a vagina created. But when she starts this process is up to her. Most girls start treatment in their teens, but some may want to wait until they are ready to become sexually active.
Some young women can have a vagina made without having surgery. A very small tube, called a dilator, is pressed against the skin where the vagina should be for about 15 to 20 minutes a day. This is easier after a bath because the skin is soft and stretches well. This works best for girls who have a dimple in the area.
Most young women will need surgery, and how this is done can vary. The vagina can be made with a graft of skin or buccal mucosa (inner lining of the cheek), or with part of the large bowel.
Skin Graft Method
The surgeon takes a thin piece of skin from the patient’s buttocks and places it over a mold to make a vagina. Artificial skin has also recently been recommended. The surgeon then makes a small cut where a vagina would normally be, between the rectum and the urethra, and places the mold so the graft will attach to make the inside of a vagina. After surgery, you are likely on bed rest for a week. A catheter is placed into the bladder so urine can drain. The mold is removed after 7 days.
This method is more complex. The night before surgery, you must empty your bowels to remove stool and bacteria. During surgery, part of the lower colon is removed through a cut in the belly.
One end of the bowel is then closed while the other stays open. The colon is sewn onto the vaginal remnant, acting as a vaginal opening. After the surgery, a mold is placed in the new vagina for 3 days. A catheter is placed in the bladder through the urethra so that urine can drain.