Vaginal atresia is a pathology of the female body that develops on the basis of the Mayer-Rokitansky syndrome. The disease is congenital and one case of morbidity is detected per 5,000 women.
The content of the article:
Causes of vaginal atresia
Symptoms of vaginal atresia
Diagnosis of vaginal atresia
Complications of the disease
Treatment of vaginal atresia
Vaginal atresia
Sometimes the disease can be acquired, and the lower, middle and upper parts of the vagina are completely or partially overgrown. The form of localization of overgrowth depends on this. So, the fistulous form of atresia implies an opening on the septum of the vaginal department.
The vagina with atresia is overgrown with fibrous tissue, the uterus, its neck and body, and the tubes also perform the correct function. With vaginal atresia, the outflow of blood for menstruation is disrupted and sexual life is difficult.
With vaginal atresia, the vagina and uterus are missing. This phenomenon is caused by the underdevelopment of the female genital organs. At the same time, the girls look absolutely normal, since the development and work of the ovaries occurs like in all other patients, that is, the hormonal background is completely normal. The sign that leads to an appointment with a specialist for the appointment of an examination and treatment is the complete absence of menstruation.
All these similar diseases are noticed by a woman at the beginning of puberty, when it is necessary to come to an appointment with a gynecologist, or they are alarmed by the absence of a menstrual cycle. In some cases, patients with such a pathology even live a sexual life. For sexual intercourse in this case, the urethra comes to the rescue. And, as a consequence, inflammation of the bladder (cystitis), urinary incontinence and a visit to a urologist.
Causes of vaginal atresia
Vaginal atresia has a multifactorial etiology.
In the congenital form of the disease, it is necessary to talk about the consequence of pathological formations of the Muller duct in the womb, which did not merge with the urogenital sinus. This is affected by unfavorable factors, such as the presence of sexually transmitted diseases in the mother (mycoplasmosis, trichomoniasis, genital herpes, ureaplasmosis, papillomavirus infection and many others).
With the acquired form (secondary), surgical and birth injuries of the vagina, frequent inflammation (colpitis), douching with concentrated solutions, complications during medical manipulations can cause the development of vaginal atresia. The transferred infectious disease in some cases provokes such a disease.
Symptoms of vaginal atresia
In girls, in the presence of the primary form of atresia, with the onset of the first phase of menstruation, sharp cramping pains in the lower abdomen are observed, but there is no menstrual bleeding. Depending on where the blood is localized, it accumulates and stretches the muscles and walls of the vagina (hematocolpos), as well as the uterus (hematometer) and fallopian tubes (hematosalpinx).
With hematocolpos, aching pains are observed, with a hematometer — spastic, which are accompanied by loss of consciousness.
Vaginal atresia can also be detected in infants. When maternal estrogen stimulates the cervical and vaginal glands, it causes mucocolpos, in which the vagina is filled and overgrown with mucous secretions. Mucocolpos is detected when a child complains of painful urination and the detection of volumetric formations in the abdominal cavity. With atresia, a strong stretching of the vagina will lead to a hydronephrotic rearrangement of the upper urinary tract.
Vaginal atresia is accompanied by false amenorrhea, vaginal itching, which occurs due to the absence of secret fluid outflows to the outside, dysbiosis and colpitis.
Women who have sex, depending on what level of atresia is observed, experience severe pain during sexual contact, so it is difficult or impossible at all. The onset of pregnancy in such patients is absent due to the disease, since physiological labor is impossible (against the background of atresia during pregnancy).
With fistulous atresia of the vagina, an ascending infection develops, which is complicated by pyokolpos, periodic purulent discharge. Rectoabdomial examination is a process of anti—inflammatory therapy, provoking emptying of the piokolpos.
In cases where there is no drainage hole in the vaginal septum of a woman, pyometra, pyosalpinx and reflux of pus into an empty area of the abdominal cavity develop rapidly. The rapidly increasing character is manifested by febrility, the phenomenon of “acute abdomen”, deterioration of well-being. Sometimes an ascending infection has such a rapid effect that during an emergency colpotomy it is impossible to avoid pelvioperitonitis and peritonitis.
Diagnosis of vaginal atresia
Recto-abdominal examination diagnoses vaginal atresia, as well as ultrasound (MRI) of the pelvis, probing of the vagina (it is necessary to determine the level of atresia).
Hematocolpos is detected during gynecological examination on the chair, when it is visible as a dome that has come out in the genital slit. With recto-abdominal examination, it is possible to identify the uterus and tubes located in a highly located place, enlarged or very painful. The depth of the vagina, the level of atresia, which will be needed in the future during vaginal plastic surgery, can be determined by probing.
Adequate antibacterial therapy can be prescribed with bacteriological and microscopic studies of a smear from the vagina and genital tract.
Hematometer (pyometer) and hematosalpinx (pyosalpinx), the size and level of their localization are detected by ultrasound method. MRI of the pelvic organs can be prescribed with a small hematocolpose. Diagnostic laparoscopy is also prescribed for vaginal atresia when it is above obstruction.
The consultation of a urologist and urological examination should be resorted to in case of acute urinary retention, pyuria, fistulous piokolpos.
Complications of the disease
It is possible to develop peritonitis with the discharge of infected blood into the abdominal cavity. Rare cases of rupture of the uterus with obstruction of the tubes, and the expiration of the contents.
A frequent complication is excessive scarring, repeated vaginal atresia may follow.
Treatment of vaginal atresia
With vaginal atresia, the fusion of the vaginal tube is surgically eliminated, its patency is restored — vaginoplasty.
During surgical intervention, the vaginal septum is opened, the piokolpos (hematocolpos, hematometer) is emptied with the help of the cervical canal. Then, when the vagina is freed from the accumulated blood, washed with antiseptic, the septum is carefully excised with scissors to the vaginal wall. All the edges of the wound are sutured circularly with a catgut, provide patency, forming the capacity and volume of the vagina. A sterile swab with vaseline oil is inserted into the vagina formed by the surgeon.
Abdominal ventriloquism and removal of the hematosalpinx begins surgery when blood accumulation is detected in the fallopian tubes. The hematocolpos begins to empty through the vaginal pathway. Antibacterial therapy is prescribed in the postoperative period.
After atresia is eliminated, a woman should be regularly monitored by a gynecologist and have a regular sex life. Vaginal augmentation (colpoelongation) is prescribed if the disease is likely to occur again.
