Congenital vaginal obstruction occurs when the hymen (a membrane that surrounds the vaginal opening) has not formed properly and instead of surrounding the vagina, it completely covers it. This is known as an imperforate hymen.
Congenital vaginal obstruction can also occur when the vaginal canal has failed to develop properly during gestation. This is called a high transverse septum.
Both of these anomalies can cause symptoms for your baby. These are:
Swelling of the vagina
Swelling of the uterus
Swelling of the abdomen due to secretions from the cervical glands filling up the vagina with fluid
Urinary difficulties or obstruction can occur.
Diagnosis
Ideally the condition will be diagnosed at birth or shortly afterwards, however, some patients are missed and the problem is not noticed until puberty. Affected girls will be unable to have a menstrual bleed.
Although they will ovulate normally, there is no exit for the menstrual flow to leave their body. They may experience monthly abdominal pain and swelling due to blocked menstrual blood backing up and having nowhere to go.
Undiagnosed congenital vaginal obstruction can be dangerous and even fatal. The Journal of Pediatric and Adolescent Gynecology reported that one patient died when her condition was undiscovered and she developed an overwhelming infection.
Occasionally, the malformation is not detected until adulthood when the adult presents to the doctor, unable to have intercourse. Some people with congenital vaginal obstruction also have infertility, but many are able to have children once the problem has been fixed. It depends on the extent of the malformation.
Diagnosis is carried out by:
Examination
The doctor may find a swollen abdomen.
Ultrasound Scan
The cause of the abdominal mass can be confirmed on ultrasound.
Fine Needle Aspiration
A needle can be inserted into the abdomen to drain off fluid for analysis or to add dye so that an X-ray examination can be performed.
Some children present with minimal symptoms and may not have any swelling or urinary retention. If this is the case, their condition may be missed. Older girls may also be diagnosed by giving a family history and having a vaginal examination. Lack of a period and abdominal pains are a sign that they may have this condition (although lots of other things can cause the same symptoms).
Treatment
If the problem is caused by an imperforate hymen, then an incision is made into the hymen to uncover the vaginal opening and the fluid is drained out. This is a simple procedure and this type of congenital obstruction is usually easy to correct.
If the problem is caused by high transverse septum (a malformation of the vaginal canal) there is a membrane across the vagina, separating the lower and upper segment. If the membrane is lower down, the surgeon can cut it to rejoin the two segments together. If it is higher up, a more complicated surgery will have to be done using skin or part of the intestine to bridge the gap between the lower and upper segments.
Other abnormalities of the reproductive tract will be checked for. If no additional problems are detected, the patient should be able to have children when older. She should also be able to have periods and have a sexual relationship.
Sources:
Vaginal Anomalies: Congenital Vaginal Obstruction, AUA Foundation. Web. 14 March 2012.
http://www.urologyhealth.org/urology/index.cfm?article=49
Congenital Vaginal Obstruction in Neonates and Infants: Recognition and Management. J Pediatr Adolesc Gynecol. 2011 Apr;24(2):74-8. Epub 2011 Jan 22. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/21256779
Congenital vaginal obstructions: varied presentation and outcome, Pediatr Surg Int. 2006 Sep;22(9):749-53. Epub 2006 Jul 27. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/16871398
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/
She is author of the book, "Breast Milk: A Natural Immunisation", and co-author of an educational resource on disabled parenting.
Reviewed March 14, 2012
by Michele Blacksberg RN
Edited by Jody Smnith