Absence of Vagina

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Absence of Vagina

This is defined as it sounds; absence of primary sexual symbol. Vaginal abnormalities usually associated with absence of the uterus or rudimentary uterus. This is also known as Rokitansky syndrome. In rare cases, the uterus and the vagina may be present or a certain part of it. Cases of both absence of vagina and uterus are always presented when the patient is 16 years old due to amenorrhea. This does not affect the presence of ovaries which is the secondary sexual development. The combination of secondary sexual development and amenorrhea suggests an anatomical cause, such as imperfect or absent vagina, for the failure to menstruate.

Once the diagnosis is certain, management may be divided into two sections; one that is devoted to psychological conselling and second that is devoted to constructing a new vagina. Occasionally patients present having attempted to have sexual intercourse and the penis might have create the vagina space such that no further therapy is needed.

Thus it is important to examine the patient very well as vagina creation might not be needed. Inspection of the vulva and abdominal examination will be done to exclude the presence of any retained blood in the upper part of the genital tract. A very short vagina arising from androgen insensitivity may be mistaken for simple absence, so in every case of apparent vaginal absence a karyotype should be performed and chromosome analysis will be done. Renal ultrasound is performed to determine whether there is absence of a kidney and intravenous urography done if there is need to assess urinary tract. A laparoscopy is performed in rare cases.

The management of these cases is usually by non-surgical methods and if necessary a surgical approach. The principle of the method is that the region which the vagina should occupy is a potential space filled with comparatively loose connective tissue which is capable of considerable indentation. The patient is instructed to use graduated glass dilators which are placed against the introitus and the blind vagina and gentle pressure is exerted in a posterior direction for approximately 10-20min twice a day.

Gradually the dilators will go further and further into the space and the dilators may be then increased in size and length until a ‘neovagina’  is created. In general, it takes between 8 and 10weeks of repeated use of vaginal dilators to achieve a satisfactory result. 

In those patients who fail the non-surgical technique, a vagina plastic will be need to be performed. 


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