Vaginal atresia is an isolated primary (congenital) or secondary (acquired) fusion of the vaginal walls. Clinically, vaginal atresia can be manifested by hematocolpos, hematometer, hematosalpinx, mucocolpos, inability to have sex. Vaginal atresia is diagnosed during gynecological examination, vaginal probing, ultrasound and pelvic MRI. The treatment of vaginal atresia is exclusively operative – emptying of the hematocolpos and plastic surgery of a full-fledged vagina. Complications of pathology can be the development of an ascending infection, peritonitis, sepsis, repeated fusion of the vaginal walls.
N89.5 Stricture and atresia of the vagina
With atresia of the vagina, it is overgrown with fibrous tissue, while the external genitalia, uterus (neck and body), tubes and ovaries are formed and function correctly. Vaginal atresia disrupts the outflow of menstrual blood and makes it difficult to have sex. According to the localization of vaginal overgrowth, clinical gynecology distinguishes complete and partial forms in its lower, middle or upper part. If there is a hole in the vaginal septum, they speak of a fistulous form of atresia. The population incidence is 2-4 cases per 10,000 women.
The etiology is multifactorial. Vaginal atresia can be acquired or congenital in nature:
- Congenital vaginal atresia is a consequence of improper intrauterine formation of the Muller ducts that have not merged with the urogenital sinus as a result of various adverse factors (including STDs in the mother – mycoplasmosis, trichomoniasis, genital herpes, ureaplasmosis, papillomavirus infection, etc.).
- Secondary (acquired) atresia can develop after surgical and birth injuries of the vagina, frequent inflammation (colpitis), douching with concentrated solutions, complicated medical manipulations. Often acquired atresia occurs after childhood infectious diseases – mumps, scarlet fever, diphtheria, etc., complicated by adhesive inflammation of the vagina.
With the primary form of vaginal atresia, with the arrival of menarche, the girl has regularly recurring sharp pains in the lower abdomen, but external menstrual bleeding does not occur. Depending on the localization of atresia, blood can accumulate and stretch the walls of the vagina (hematocolpos), uterus (hematometer), fallopian tubes (hematosalpinx). Hematocolpos is characterized by aching pains, and hematometers are spastic, sometimes accompanied by loss of consciousness.
Less often, vaginal atresia can be diagnosed in infants when, due to stimulation of the cervical and vaginal glands by maternal estrogens, mucocolpos develops – filling and overgrowth of the vagina with mucous secretions. Mucokolpos is more often detected accidentally when complaining about the child’s anxiety during urination or when detecting a bulky formation in the abdominal cavity. Significant stretching of the vagina with its atresia can lead to hydronephrotic transformation of the upper urinary tract.
Congenital atresia of the vagina in some cases is combined with fistulous or complete and atresia of the anus and agenesis of the urinary system. In addition to false amenorrhea, vaginal atresia can be accompanied by vaginal itching, which occurs due to the lack of outflow of secretions to the outside, the development of dysbiosis and colpitis. In women who have sex, depending on the level of vaginal atresia, sexual contact is impossible or difficult due to discomfort or severe pain during intercourse. Vaginal atresia prevents the onset of pregnancy and the course of physiological labor (if the formation of secondary atresia occurred during pregnancy).
Fistulous atresia of the vagina with the development of an ascending infection can be complicated by pyokolpos, which is manifested by periodically occurring purulent secretions. Often, during recto-abdominal examination or in the process of anti-inflammatory therapy, emptying of the piokolpos occurs. In the absence of a drainage hole in the vaginal septum, the rapid development of pyometra, pyosalpinx and reflux of pus into the free abdominal cavity occurs. At the same time, febrility, the phenomena of “acute abdomen”, deterioration of well-being are rapidly increasing. Sometimes the development of an ascending infection occurs so rapidly that even an emergency colpotomy does not prevent the development of pelvioperitonitis and peritonitis.
In rare cases, with vaginal atresia, combined with obstruction of the tubes, there is a rupture of the uterus and the outflow of its contents into the abdominal cavity. With high vaginal atresia, during vaginal plastic surgery, injury to the walls of the uterus, bladder or rectum is not excluded. One of the frequent complications of pathology is excessive scarring of the mucous membrane with the development of repeated vaginal atresia.
To recognize vaginal atresia in gynecology, recto-abdominal examination, ultrasound (MRI) of the pelvis, probing of the vagina (to determine the level of atresia) is used.
- Gynecological examination. When examined on the chair, the gynecologist may see a hematocolpos bulging into the genital slit in the form of a dome. Recto-abdominal examination with vaginal atresia allows you to detect a highly located, enlarged and sharply painful uterus and tubes. By probing, the depth of the vagina and the level of atresia are determined, which is important for planning vaginal plastic surgery.
- Laboratory tests. Bacteriological and microscopic examination of a smear from the genital tract makes it possible to determine adequate antibacterial therapy.
- Visualization of the pelvic organs. With the help of ultrasound, the hematometer (pyometer) and hematosalpinx (pyosalpinx), their sizes and localization level are detected. With a hematocolpose of small size, it is more expedient to conduct an MRI of the pelvis.
- Additional research. Sometimes, with vaginal atresia, diagnostic laparoscopy and vaginography (contrast radiography of the vagina above its obstruction) are resorted to. In case of acute urinary retention or pyuria in the case of fistulous piokolpos, a consultation with a urologist and a urological examination are indicated.
With vaginal atresia, surgical removal of the fusion of the vaginal tube and restoration of its patency is required – vaginoplasty. During the operation, the vaginal septum is opened, the piokolpos (hematokolpos) or hematometers are emptied through the cervical canal. After clearing the vagina of accumulated blood and washing with antiseptics, the septum is excised with scissors to the walls of the vagina. The edges of the resulting wound are circularly sutured with a catgut, providing patency, capacity and shape of the vagina. A sterile swab with vaseline oil is placed in the formed vagina.
With the accumulation of blood in the fallopian tubes, the first stage of the operation is abdominal ventricle and removal of the hematosalpinx, then the vaginal emptying of the hematocolpos is performed. In the postoperative period, antibacterial therapy is carried out. After the elimination of vaginal atresia, a woman is shown observation by a gynecologist, conducting a regular sexual life. If there is a threat of repeated vaginal atresia, vaginal augmentation (colpoelongation) is periodically performed.
Prevention of primary vaginal atresia should include adequate preparation and management of pregnancy in women, the exclusion of adverse intrauterine effects on embryogenesis. Prevention of secondary vaginal atresia provides for timely treatment of colpitis, careful gynecological manipulations (including termination of pregnancy), non-traumatic management of childbirth, refusal of frequent douching, etc. After childhood infections, it is recommended to show the girl to a pediatric gynecologist.