Patient Information - Vaginal Agenesis

Vaginal agenesis (sometimes called congenital absence of vagina, Mullerian anomaly, or MRKH syndrome) is a congenital condition that affects one in 5000 girls. The most common complaint is failure to have a menstruation. Other complaints are cyclic abdominal pain, painful intercourse, or difficulty engaging in intercourse. The cause of vaginal agenesis is unknown.

Individuals with vaginal agenesis have a blind vagina. The length of the vagina varies from a dimple to a few centimeters. The uterus is usually absent. However, some individuals have mal-formed uterus. These individuals may have cyclic abdominal pain because the “menstrual blood” emptied into the pelvis. The ovaries are always present and normal.

In addition to the reproductive system (the uterus and the vagina), other organ systems may be involved in some individuals. These include the kidney, the bone (mainly the spine) and hearing.

Vaginal agenesis itself has no impact on general health (unless the kidney, bone or hearing is affected). Individuals with vaginal agenesis have normal female hormone levels. The hormone levels fluctuate just like any normal reproductive age women. Therefore, individuals with vaginal agenesis may experience cyclic breasts engorgement, moodiness.

Individuals with vaginal agenesis can have their own genetic children. However, it would require in-vitro fertilization (IVF) to create the embryos and a gestational carrier to carry the pregnancy. There is no report to suggest an increased incidence of vaginal agenesis in the offspring.

A vagina can be created to fulfill the sexual function. There are various ways to create a new vagina. They are listed below:

* Self-dilation
Under physician’s guidance, a new vagina was created by self dilatation using a series of dilators. Several months up to more than one year may be required to obtain a length for satisfactory intercourse. Motivation is needed.

* Active dilatation (Vecchietti procedure)
An olive (about 1 cm in diameter) is placed at the vaginal opening and connected via sutures to a traction device on the lower abdomen under laparoscopic guidance. The springs of the traction device are tightened daily, gradually pulling the olive inward/upward to create a new vagina. Approximately 1 to 1.5 cm new vagina is gained daily. It takes about five to seven days to gain 7-9 cm vaginal length. After the olive and the traction device are removed, daily manual dilatation is required to maintain the length and to increase the diameter of the vagina. Satisfactory intercourse can be expected approximately eight weeks after the surgery. Once regular vaginal intercourse is initiated, the frequency of manual dilatation can be reduced.

* Surgery (vaginoplasty)

1. Skin graft (McIndoe procedure)

A mold covered with split-thickness (25/1000 inch) skin taken from the buttock (or thigh) is inserted in a space created at a location where the vagina is normally located. The mold stays for seven days. After removing the mold, daily manual dilatation is required to maintain the length of the new vagina. Once regular intercourse is initiated, the frequency of manual dilatation can be reduced.

2. Variations of McIndoe procedure

Material from various sources (other than skin) has been used to cover the mold, such as amnion, synthetic material…etc.

3. Bowel vaginoplasty

In a bowel vaginoplasty, a portion of the colon is removed and transplanted to a space created at a location where the vagina is normally located. The remaining colon is then reconnected. Potential complications include bowel leakage at the reconnection site and mucus drainage from the transplanted colon (i.e. the new vagina). Continuous vaginal dilatation is not required after the procedure.

Dr. Jaou-Chen Huang* and his team at the Department of Obstetrics, Gynecology and Reproductive Sciences of the University of the Texas Health Science Center provides comprehensive care to patients with this condition. One of our patients is willing to share her personal experience with our new patients. If you are diagnosed with vaginal agenesis and wish to gain more information, please call Lisbeth at 832 325 7415.

* Dr. Huang received his Ob/GYN training at the Columbia University, Harlem Hospital Center and Reproductive Endocrinology/Infertility training at the Harvard Medical School, Brigham and Women’s Hospital.

For more information, please contact Lisbet at 832-325-7415

The University of Texas Professional Building, 6410 Fannin, Suite 350
Houston TX 77030, 832-325-7415, 8:00am - 5:00pm CST