What Does It Mean When a Babys Vaginal Openning Is Notbopened All the Way

What is the cause of absent vaginal opening in a daughter?

Imperforate hymen

• In female infants, there is usually a sparse membrane (hymen) that surrounds the vaginal opening.
• In rare weather, a congenital vaginal blockage occurs due to an imperforate hymen. Therefore the vaginal opening remains covered.

Labial adhesions

• Fusion of labial skin extending from the posterior fourchette towards the urethral opening. A thin membrane tin be seen in the midline.
• Occurs in 3% of the pre-pubertal girls with summit incidence in the first year of life.
• The aetiology is unknown but lack of oestrogen may probably contribute to its occurrence.

Anomalies of the vagina

The vagina is a muscular canal connecting the cervix of the uterus to the vulva.

1. Vaginal agenesis
   • Absence of the vagina (vaginal agenesis) occurs when the vaginal plate fails to form vagina during intrauterine life.
   • Information technology is besides known equally mullerian aplasia or Mayer-Rokitansky-Kuster-Hauser syndrome (congenital absenteeism of the vagina with variable uterine development)
   • It affects approximately i in every 5,000 female infants
   • It normally occurs with absence of uterus/neck just presence of normal ovaries. The patient without uterus will not menstruate and cannot become pregnant. With the presence of normal ovaries, patient can accept normal chest and pubic hair evolution.
   • It may be associated with other malformations, such as:
     • Kidney abnormalities in 25-50% of patients (absence of one kidney or the dislocation of one or both kidneys, fusion of 2 kidneys forming a horseshoe-like shape)
     • Skeletal abnormalities in 10-15% of patientsaffecting the spine, ribs or limbs
     • Urinary tract abnormalities. The urethra tin open into the vaginal wall or the vagina tin can open up into a persistent urogenital sinus
     • Rectal abnormalities (vaginorectal fistula, vulvovaginal anus, rectosigmoidal fistula)
     • Other less common anomalies include congenital heart lesions, abnormalities of the manus, deafness, cleft palate, inguinal or femoral hernias.
2. Vaginal atresia or absence of the lower vagina
   • The lower portion of the vagina is replaced by fibrous tissue
   • Usually associated with normal development of the ovaries, uterus, cervix and upper vagina
   • Surgical reconstruction is the treatment
3. High transverse vaginal septum
   • Occurs due to incomplete canalization of the vagina during development

How does a patient with vaginal aberration present?

Though absenteeism of vaginal opening may exist detected early on during neonatal period, it tin besides get unnoticed until pubertal years.

Imperforate h ymen

• In afflicted infants, they may have bulging introitus mucocolpus (due to accumulation of vaginal secretions in response to maternal oestradiol). If the diagnosis is not made, the mucus gets reabsorbed and the kid remains asymptomatic until menarche. The daughter may present during adolescence with cyclical abdominal pain or pelvic hurting due to haematocolpus(accumulation of menstrual claret in the vagina).

Labial adhesions

• Virtually infants are asymptomatic.
• Some may have urine puddle behind the vaginal adhesions and crusade post-micturition dribble, soreness and vulval irritation.

Vaginal agenesis

• Vaginal agenesis is typically non diagnosed until puberty (around age 15) considering the external genitalia announced normal from nascency
• Usually the young daughter notices that she has not had her menstrual period and seeks medical attention
• A subgroup of patients may exist diagnosed during infancy during which the abnormality detected during an examination or test for other unrelated bug

Importance of accurate diagnosis:

• Vaginal agenesis tin potentially be misdiagnosed as an imperforate hymen, and attempts at hymenotomy may result in secondary scar formation. This can lead to treatment difficulties in the time to come.
• Labial adhesions must exist differentiated from other paediatric vaginal disorders to avoid unnecessary intervention causing anxiety to a child and her

How to diagnose this status?

Concrete examination

• Patients with imperforate hymen may exist diagnosed during neonatal period. An abdominal swelling (vagina filled past secretions from the cervical glands in response to the mother'southward hormones) may exist felt during concrete examination.
• The diagnosis of labial adhesion can be fabricated on examination alone and normally no investigations are indicated.
• Patient with vaginal agenesis by and large have normal appearance of the external ballocks. In place of the vagina, there can be a small pouch or dimple that is I – 4 cm in depth.

Investigation

• Ultrasound may be done to check if the uterus and ovaries are both nowadays. Ultrasound tin can confirm mucocolpus/hydrocolpos (aberrant swelling of the vagina) or hydrometrocolpos (abnormal swelling of both the vagina and uterus).
• In patients with vaginal agenesis, intravenous pyelography may notice congenital urinary tract abnormality and radiography may be needed if skeletal abnormalities are suspected.

How to treat?

Treatment depends on the cause of the vaginal blockage.

Labial adhesions

Spontaneous resolution is common. Treatment is commonly non necessary in the absence of symptoms.

Oestrogen cream can exist used topically at the midline of the fusion for a brusque duration of non more than six weeks. Information technology will cause the membrane to carve up only recurrence afterward discontinuing treatment is common. Prolong employ is not allowed equally oestrogen can cause breast swelling and tenderness. Surgical separation is rarely needed unless urinary symptoms are persistent and oestrogen therapy has failed. Recurrence is common even later surgery.

Imperforate hymen

The urologist will make a simple incision that does non crave anaesthesia. Once drainage occurs, the anatomy should exist examined for other abnormalities.

Vagina with high transverse septum

Surgical correction depends on its thickness and location.

Vaginal agenesis

Generally the handling for this condition includes psychosocial support and medical/surgical correction of the anatomic abnormality. Strong back up and counseling and psychological preparation before treatment is very of import to ensure satisfactory event. A normal sex life is possible.  Since the condition is ordinarily associated with absence of uterus, the patient volition be unable to carry a pregnancy.

Support and counseling for a kid with vaginal agenesis:

Professional person counseling of the patient and her parents should exist provided timely after the condition is diagnosed. This volition help them to cope with problems of gender/sexual identity and uncertainty.

The patient should be informed that she was born with a vagina that did not develop completely and not "born without a vagina".

Emphasis should exist placed on the female person features and functions that the child has and non on the abnormality. The child and her parents should be reassured that the health care team can assist them accomplish a adept outcome.

Patient should be reassured that a "more functional" vagina can be developed with the assist of the wellness care team. Avert using the term "bogus vagina" in the communication.

When vaginal agenesis is diagnosed during adolescence, the daughter may react with stupor and inability to have the condition. She may fear rejection. The patient and her parents should be reassured that she can achieve normal development of breasts, pubic hair, vulva and clitoris. The patient should exist reassured that a normal sex life is possible.

Figure1: A. Müllerian and wolffian ducts. B. Fusion of müllerian ducts. C. Regression of mesonephric ducts. D. Uterus, neck, and vagina.

Figure two:  Diagram of diverse lesions causing hydrometrocolpos. A. Imperforate hymen. B. Transverse septum. C and D. Low and high atresia of vagina.

Reference:

1. Handbook of clinical pediatric endocrinology. Charles G.D.Brook and Rosalind Brown. Beginning Edition 2008. Blackwell Publishing. ISBN-978-ane-4051-6109-1
2. Paediatric Endocrinology, the requisites in Pediatrics. Thomas Moshang, First Edition 2005. Jr. Elsevier Mosby. ISBN 0-323-01825-4
3. Urology Intendance Foundation. The official foundation of the American Urological Association. urologyhealth.org Muckle, C, Feinberg, E, Glob. libr. women's med., (ISSN: 1756-2228) 2008; DOI ten.3843/GLOWM.10002
4. Spencer R, Levy DM: Hydrometrocolpos: Report of three cases and review of the literature. Ann Surg 155: 558, 1962.)
5. Labial adhesions. Kenneth G Nepple et al. Medscape. emedicine.medcape.com

Last Reviewed	:	28 Baronial 2020
Writer	:	Dr. Janet Hong
Accreditor	:	Dr. Fuziah bt. Dr.. Zain
Reviewer	:	Dr. Zainab bt. Kusiar

What Does It Mean When a Babys Vaginal Openning Is Notbopened All the Way

Source: http://www.myhealth.gov.my/en/abnormal-genitalia-no-vaginal-opening/

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