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    What is vaginal agenesis?

    During pregnancy, a baby’s reproductive system may not develop completely in the mother’s uterus. She (female child) may be born without a vagina and have other absent reproductive organs. This condition is called vaginal agenesis.

    When it is diagnosed?

    Sometimes vaginal agenesis is recognized at birth but mostly the condition is not diagnosed until puberty, when the teen notices she hasn’t started her period and seeks medical advice.

    What are the clinical symptoms?

    • Mostly these patients have group of symptoms which may include an absent uterus and cervix, kidney, hearing loss, and a possible spinal abnormality such as curvature of the spine. All females will either have an absent vagina or an incomplete vaginal canal.
    • Young women with vaginal agenesis have normal ovaries and normal external genitalia and thus go through puberty and develop breasts, under arm and pubic hair, except they will not have periods.

    What is the goal of vaginal agenesis management?

      For management, the goal would be to create a vagina for sexual activity and then the option for reproduction would involve the utilization of assisted reproductive technologies using her eggs and her partner’s sperm and placing them within a gestational carrier, also known as a surrogate mother.

    What causes vaginal agenesis?

    The exact cause of this genetic abnormality is unknown, but many different congenital conditions are known to lead to vaginal agenesis.

    Is vaginal agenesis inheritable?

    There is little evidence that agenesis of the lower vagina runs in families. There are no known risk factors for vaginal agenesis. There may be genetical issues or hormonal problem like androgen insensitivity syndrome.

    How does vaginal agenesis impact sexual life or fertility?

    • Depending on the reproductive organs affected, sexual life and fertility could be impacted in a variety of ways. If she was born with a normal-sized uterus, she may be able to become pregnant and deliver a baby.
    • There are options for women born without a uterus or with a tiny uterus. The ovaries that make eggs function normally. With the help of assisted reproductive technology, your daughter’s own egg(s) could be fertilized with her partner’s sperm then placed in a surrogate carrier, when the time is right.
    • Much of female sexual pleasure comes from stimulation of the clitoris. Since patients with vaginal agenesis have normal external genitalia, she should be able to experience normal orgasmic function.

    What are the symptoms of vaginal agenesis?

    • Small pouch or dimple where vaginal opening should be
    • Lack of menstrual cycle
    • Lower abdominal pain if a uterus is present without a connection to a vaginal canal.

    What are the diagnostic modalities?

    Testing is important in order to understand the extent of the reproductive anomalies.

    Young women usually present for testing during the middle teen years when they experience no menstrual period after having normal breast development

    Examination start with

    • External genital exam
    • Modified internal exam
    • Ultrasound
    • MRI
    • Karyotyping: is a test to examine chromosomes in a sample of cells and pinpoint specific genetic causes of a disease.

    How can be vagina created?

    Many girls with vaginal agenesis decide to create a vagina during their teenage years. There are various method of vaginal reconstruction:

    Vaginal dilators

    • Dilator treatment is the one of treatment option to create a vagina for girls .
    • The main advantage of it that it doesn’t require surgery.
    • The main disadvantage is that it requires using a dilator once to twice a day until the vaginal canal is stretched to a normal length which may take between 2 months to 18 months.

    Mc Indoe Technique:

    • Surgically vaginal space is created.
    • Inner surface of cavity covered with skin graft and spacer in kept in cavity to avoid cavity contraction.
    • Ideal age of this procedure is premarital age.

    Flap techniques:

    • There are various flap techniques in which surrounding skin is used make inner surface of cavity. Sometimes large intestine or muscles are used to create cavity and surface vaginal cavity.
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