Vaginal agenesis

Diagnosis

The diagnosis of vaginal agenesis involves doing a physical examination of the vaginal and anal area and performing several tests.

This condition can be found earlier when healthcare providers check for other issues or if parents notice that a baby does not have a vaginal opening. However, in most cases, the diagnosis occurs during teenage years, especially when a girl has not started menstruating by age 15.

Tests that may be required include:

• Blood tests: This can help identify any chromosomal abnormalities or genetic conditions, such as MRKH syndrome, that could be linked to vaginal agenesis. The tests can rule out other problems and measure hormone levels.
• Imaging tests: An ultrasound is a test that uses sound waves to create images, while MRI uses magnetic fields to create detailed pictures of the reproductive system and kidneys.
• Other tests: To assess the skeleton, heart, and hearing, more tests may be required.

Treatment

Treatment for vaginal agenesis is available, but the timing for starting it can vary depending on personal factors. Some people might start treatment during childhood, while others may wait until they are older or are considering sexual activity.

Treatment options include:

• Self-dilation: Self-dilation is a technique used to create or lengthen a vagina without surgery, often recommended for individuals seeking a non-invasive way to enhance vaginal size for comfort during sexual intercourse. Consistent self-dilation or regular sexual intercourse is required to maintain vaginal length over time. The process involves inserting a small tube to gradually stretch and enlarge the vaginal opening, usually spending about 20 minutes a day. Although it might be uncomfortable, it should not be painful. Increasing the size of the dilator can be easier after a warm bath, as the skin is softer and more flexible. Over time, one may switch to larger dilators to gradually increase the size.

Always consult a healthcare provider to ensure that the safest and most effective method are used for one’s needs.

• Surgery: If one needs to create a vaginal canal, a surgery called vaginoplasty may be suggested. The specific technique depends on one’s body and other factors.
  • Using tissue graft: Tissue grafts used are usually from various parts of the body, like the outer thigh, buttocks, or lower abdomen. During the procedure, an incision is made to create the vaginal opening, then the tissue graft is placed in a mold to form the new vagina. This mold stays in place for about a week. After surgery, one typically need to keep a vaginal mold or dilator in place, except when using the bathroom or during sexual intercourse. After the initial recovery period, dilator may only be needed at night. To maintain a functional vagina, it is helpful to use artificial lubrication during sexual intercourse and continue occasional dilation.
  • Putting medical traction equipment: Your surgeon inserts either an olive-shaped device (Vecchietti procedure) or a balloon device (balloon vaginoplasty) into your vaginal opening. Using a laparoscope for guidance, the surgeon then connects the device to a separate traction device located either on your lower abdomen or through your navel.

After this procedure, one may need to use a mold of varying sizes for about three months to keep the canal open. After this period, a functional vagina can be maintained through further self-dilation or regular sexual intercourse, often requiring artificial lubrication.

• • Bowel vaginoplasty: In a bowel vaginoplasty, the surgeon relocates a section of your colon to create a new vagina in your genital area. Subsequently, the remaining colon is reconnected. Following this surgery, daily use of a vaginal dilator is unnecessary, and the need for artificial lubrication during sexual intercourse is reduced.

Post-surgery, maintenance of a functional vagina requires the use of a mold, dilation, or regular sexual intercourse. Surgical treatments are typically postponed until you feel emotionally and physically prepared to manage self-dilation. Without consistent dilation, the newly formed vaginal canal may narrow and shorten rapidly