Vaginal Anomalies: 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.

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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.

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.

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.

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.

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

Reviewed October, 2009

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Glossary Terms

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.
cervical:
	Relating to the neck or any part of the body that resembles a neck. In the context of reproduction, it refers to the neck of the uterus (the cervix) in the female.
cervical glands:
	Glands in the mucosa of the cervix within the uterus.
congenital:
	Present at birth.
gland:
	A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.
high transverse septum:
	A thin membrane up high in an organism that lies crosswise.
hormone:
	A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.
hymen:
	A thin mucous membrane that completely or partially covers the opening of the vagina.
imperforate hymen:
	No opening through the hymen, which covers the opening of the vagina.
incision:
	Surgical cut for entering the body to perform an operation.
intestine:
	The part of the digestive system between the stomach and the anus that digests and absorbs food and water.
ions:
	Electrically charged atoms.
membrane:
	A thin sheet or layer of tissue that lines a cavity or separates two parts of the body. A membrane can act as a filter, allowing some particles to pass from one part of the body to another while keeping others where they are.
ovulation:
	Ripening and discharge of an egg from the ovary for possible fertilization.
septum:
	Thin membrane dividing something into two or more cavities.
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.
urologist:
	A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)
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.

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