Definition:

• Uterine fibroids, also called leiomyomas or myomas, are non-cancerous (benign) growths.
• They develop from the smooth muscle tissue in the wall of the uterus.
• They can vary in size from very small to quite large and can grow inside the uterine wall, just under the lining, or on the outer surface.

Two symptoms:

• Heavy Menstrual Bleeding (Menorrhagia): Periods that are much heavier or last much longer than usual, sometimes leading to anemia.
• Pelvic Pain or Pressure: A feeling of fullness, heaviness, or aching in the lower abdomen or pelvis, or pain during periods or sexual intercourse.

Bicornuate Uterus:

• This happens due to *incomplete fusion* of the Mullerian ducts.
• The uterus is shaped like a heart, with two distinct "horns" at the top, often seen externally.
• There may be a partial division *inside* the cavity, but the main problem is the external shape.

Septate Uterus:

• This happens due to *incomplete resorption* of the wall (septum) after the Mullerian ducts have fused.
• The external shape of the uterus is usually normal.
• There is a fibromuscular wall (septum) *inside* the uterine cavity that divides it, which can extend partly or completely down to the cervix.

• Vaginal Childbirth: The process of pushing a baby through the birth canal can stretch and weaken the muscles and ligaments that support the uterus. The risk increases with multiple vaginal deliveries or difficult births.
• Aging and Menopause: As women get older, the pelvic floor muscles naturally lose some strength. After menopause, the decrease in estrogen levels can make the pelvic tissues thinner and weaker.
• Increased Abdominal Pressure: Activities or conditions that constantly strain the muscles of the abdomen and pelvis can push down on the pelvic organs. Examples include chronic coughing, long-term constipation with straining, and regularly lifting heavy objects.

• Vaginal Agenesis: This is when the vagina is either completely absent or much shorter than normal from birth.
• Transverse Vaginal Septum: A horizontal wall of tissue located within the vagina that can block the canal, sometimes completely.
• Imperforate Hymen: The hymen, which is supposed to have an opening, completely covers the vaginal opening from birth.

An imperforate hymen typically becomes noticeable when a girl reaches puberty and is expected to start menstruating (around age 12-15). The main way it presents is:

• Primary Amenorrhea: She does not have her first menstrual period.
• Cyclic Pelvic Pain: She experiences monthly pain in her lower abdomen or pelvis, similar to menstrual cramps, because menstrual blood is being produced but cannot escape.
• Abdominal Swelling/Mass: Over time, the trapped menstrual blood can build up in the vagina (hematocolpos) and sometimes the uterus, causing the lower abdomen to swell or a mass to be felt during examination.

• Recurrent Pregnancy Loss (Miscarriage): Some uterine shapes, particularly a septate uterus, can make it difficult for a pregnancy to continue because the blood supply to the septum is poor, or the space is restricted, leading to repeated miscarriages.
• Preterm Birth: An abnormally shaped uterus might not expand properly as the baby grows, leading to the baby being born too early (before 37 weeks of pregnancy).
• Fetal Malposition: The irregular shape of the uterus can prevent the baby from turning into the head-down position for delivery, increasing the chances of needing a Cesarean section or leading to breech presentation.

Ultrasound is the primary imaging method used to check for abnormalities in the female reproductive organs because it is:

• Visualisation: It provides clear images of the uterus, ovaries, and often the vagina. Transvaginal ultrasound (where a probe is inserted into the vagina) gives the best views of the uterus and ovaries.
• Structure Assessment: It helps doctors see the size, shape, and internal structure of the uterus, which is crucial for identifying anomalies like septums, horns, or absence of the uterus. 3D ultrasound is particularly good for mapping the uterine cavity and external shape.
• Identifying Blockages: In cases like imperforate hymen or vaginal septum, ultrasound can show the buildup of menstrual blood behind the blockage.
• Initial Screening: It is often the first test done when a congenital anomaly or condition like fibroids is suspected because it is widely available, safe, and relatively inexpensive.

• Congenital Abnormalities:
  • These are problems that are present from birth.
  • They happen because the reproductive organs did not form or develop correctly while the baby was in the womb.
  • Examples: Bicornuate uterus, septate uterus, vaginal agenesis, imperforate hymen.
• Acquired Abnormalities:
  • These are problems that a person develops *after* birth, during their life.
  • They are caused by factors like infections, injuries, surgeries, or changes related to age or hormones.
  • Examples: Uterine fibroids, pelvic inflammatory disease (PID), uterine prolapse, vaginal fistulas.

Management for uterine prolapse in a woman who has had multiple children depends on how severe the prolapse is and her symptoms:

• Conservative Management (Mild Prolapse): For slight dropping with minimal symptoms, management includes advising on weight loss if overweight, avoiding heavy lifting, and teaching pelvic floor exercises (Kegel exercises) to strengthen the supporting muscles.
• Pessaries (Moderate to Severe Prolapse): These are removable devices inserted into the vagina to hold the uterus in place. They are a good option if the woman does not want surgery or has other health issues that make surgery risky.
• Surgical Management (More Severe/Symptomatic Prolapse): If conservative methods fail or the prolapse is significant, surgery can be done. This might involve stitching the pelvic floor tissues to provide support, or removing the uterus (hysterectomy) along with repairing the vaginal support.

• Accumulation of Menstrual Blood (Hematocolpos): If a transverse septum completely blocks the vagina and there is a functioning uterus, menstrual blood will collect above the septum, leading to severe pain, a noticeable mass in the abdomen, and potentially affecting kidney function over time due to pressure.
• Painful Intercourse (Dyspareunia): A rigid or thick septum can make sexual activity difficult and painful.
• Complications during Childbirth: If a vaginal septum is not identified and removed before pregnancy, it can cause problems during labor by blocking the baby's passage through the birth canal, potentially requiring a Cesarean section.

Causes of Uterine Fibroids:

• Hormones: Estrogen and progesterone, the main female hormones, seem to fuel the growth of fibroids. Fibroids tend to grow during the reproductive years when hormone levels are high and shrink after menopause when levels drop.
• Genetics: Fibroids often run in families, suggesting a genetic link.
• Other Growth Factors: Substances in the body that help cells grow also seem to play a role in fibroid development.
• Origin: They start from a single muscle cell in the uterus that multiplies repeatedly.

Signs and Symptoms:

• Heavy or Prolonged Menstrual Bleeding (Menorrhagia): This is the most common symptom, leading to anemia in some women.
• Pelvic Pressure or Pain: Large fibroids can press on the bladder (causing frequent urination), rectum (causing constipation), or cause a feeling of heaviness or fullness in the lower abdomen. Pain may occur during periods or sexual intercourse.
• Enlarged Abdomen: Very large fibroids can make the abdomen look swollen, similar to pregnancy.
• Infertility or Pregnancy Problems: Fibroids, especially those inside the uterine cavity, can make it hard to get pregnant, cause miscarriages, or lead to preterm labor.
• Lower Back Ache: Fibroids pressing on nerves or muscles in the pelvis can cause back pain.

Diagnosis:

• Pelvic Examination: The doctor may feel an enlarged or irregularly shaped uterus during a routine exam.
• Ultrasound: This is the main tool for confirming fibroids, showing their size, location, and number. Transvaginal ultrasound gives better detail.
• MRI: Used for more complex cases, large fibroids, or when planning surgery, providing detailed images.
• Hysteroscopy: A small camera is inserted into the uterus to visualize fibroids growing inside the cavity.
• Laparoscopy: A minimally invasive surgical procedure where a camera is inserted through a small cut in the abdomen to view fibroids on the outside of the uterus.

Management:

• Watchful Waiting: For small, asymptomatic fibroids, no treatment is needed, and they are monitored over time.
• Medications:
  • Pain relievers (like ibuprofen) for mild pain.
  • Hormonal medications (like birth control pills, progesterone, GnRH agonists) to reduce bleeding and shrink fibroids temporarily by lowering estrogen levels.
• Non-Surgical Procedures:
  • Uterine Artery Embolization (UAE): Blocking the blood vessels that supply the fibroids to shrink them.
  • Focused Ultrasound Surgery (FUS): Using ultrasound waves to destroy fibroid tissue.
• Surgical Treatment:
  • Myomectomy: Surgical removal of the fibroids while leaving the uterus intact, often chosen by women who want to have children in the future. Can be done through open surgery, laparoscopy, or hysteroscopy depending on fibroid location.
  • Hysterectomy: Removal of the entire uterus. This is a permanent solution, usually chosen by women who have severe symptoms and do not plan to have more children.

What are Congenital Malformations of the Uterus?

• These are birth defects where the uterus doesn't form in the typical way while a female baby is developing in the womb.
• They happen due to problems with how the Mullerian ducts form and fuse together.
• These malformations can affect the shape, size, or presence of the uterus, fallopian tubes, cervix, and upper vagina.

Types of Uterine Anomalies:

• Septate Uterus: The most common type. A wall (septum) divides the inside of the uterus, usually impacting the uterine cavity shape more than the external shape.
• Bicornuate Uterus: The uterus has two distinct horns, often giving it a heart shape externally, due to partial fusion failure.
• Unicornuate Uterus: Only one side of the uterus develops fully, resulting in a smaller uterus with a single horn.
• Didelphys Uterus: Complete failure of fusion results in two separate uteri, each with its own cervix, and sometimes a double vagina.
• Arcuate Uterus: A mild indentation at the top of the uterine cavity; often considered a normal variant.
• Uterine Agenesis/Hypoplasia: Complete absence (agenesis) or underdevelopment (hypoplasia) of the uterus.

Clinical Features:

• Many women with uterine anomalies have no symptoms and may only discover the condition incidentally during imaging for other reasons.
• Reproductive Problems: The most common issues are difficulty getting pregnant (infertility), recurrent miscarriages, and preterm birth. Septate uterus is strongly linked to recurrent pregnancy loss.
• Menstrual Issues: Some anomalies, especially those with associated vaginal blockages (like a transverse septum in the vagina), can cause absence of menstruation (amenorrhea) with cyclic pain.
• Pelvic Pain: Less commonly, some anomalies might cause pelvic pain.

Management:

• Observation: If the anomaly is not causing symptoms or reproductive problems (like an arcuate uterus or some bicornuate uteri), no treatment may be needed.
• Surgical Correction: Surgery is typically offered when the anomaly is causing recurrent miscarriages or infertility.
  • Hysteroscopic Septum Resection: Surgery done through the vagina using a camera to remove a uterine septum. This is a common procedure with good success rates for improving pregnancy outcomes in women with septate uteri and recurrent loss.
  • Metroplasty: More complex surgeries to reconstruct the uterus (e.g., joining the two horns of a bicornuate uterus), less commonly performed now compared to septum resection.
  • Vaginoplasty: Creating a vagina if it is absent or underdeveloped (as in vaginal agenesis).
• Counseling: Providing information and support regarding the potential impact on fertility and pregnancy.

What is Vaginal Agenesis?

• Vaginal agenesis is a congenital condition where the vagina is absent or significantly shorter than normal.
• It often occurs as part of a syndrome called Mayer-von Rokitansky-Küster-Hauser (MRKH) syndrome, where the uterus is also typically absent or very underdeveloped, while the ovaries are usually normal.
• Isolated vaginal agenesis (vagina is absent, but uterus is present and functional) is less common but possible.

Causes:

• Vaginal agenesis is a birth defect resulting from problems during the early development of the reproductive system in the womb.
• It is primarily due to the failure of the Mullerian ducts to develop properly, which are supposed to form the uterus, fallopian tubes, cervix, and upper vagina.
• The exact reasons why this happens are often unclear, but it is sometimes associated with genetic factors.

Management:

• The main goal of management is to create a functional vagina for sexual intercourse if desired by the individual.
• Non-Surgical Dilation: This is often the first approach. It involves using a series of progressively larger dilators (smooth, rod-like instruments) to stretch the existing vaginal dimple or pouch over time, creating a functional vaginal canal. This requires commitment and consistency.
• Surgical Creation of a Vagina (Vaginoplasty): If dilation is unsuccessful or not suitable, surgery can be performed. Different surgical techniques exist, including using skin grafts, portions of the bowel, or other tissues to create a new vaginal canal.
• Timing of Intervention: Treatment is typically delayed until the individual is old enough to understand her condition, is emotionally mature, and desires to be sexually active.
• Psychological Support: Counseling is very important to help individuals and their families understand the condition and cope with the emotional and psychological impact, especially concerns about body image, identity, and relationships.
• Addressing Associated Anomalies: In MRKH syndrome, the ovaries are functional, so hormonal development and secondary sexual characteristics (like breast growth) occur. However, because the uterus is absent, pregnancy is not possible directly, though having genetic children via surrogacy is an option if ovaries are present. Other associated abnormalities, like kidney or skeletal problems, also need to be evaluated and managed.

What is Uterine Prolapse?

• Uterine prolapse occurs when the uterus drops down into or out of the vagina.
• It happens because the pelvic floor muscles, ligaments, and connective tissues that support the uterus weaken and can no longer hold it in its normal position.
• It is a type of pelvic organ prolapse, which can also involve the bladder (cystocele), rectum (rectocele), or vagina itself.

Causes:

• Vaginal Childbirth: The most common cause. The stress and stretching of the pelvic floor during labor and delivery, especially with multiple births, large babies, or assisted deliveries (like forceps), can damage the support structures.
• Aging: As women age, muscles naturally lose tone and strength, including the pelvic floor muscles.
• Menopause: The decrease in estrogen after menopause causes tissues to become thinner and less elastic, weakening the pelvic support.
• Increased Abdominal Pressure: Chronic conditions that put pressure on the abdomen and pelvis, such as:
  • Chronic cough (e.g., from smoking or asthma)
  • Chronic constipation and straining during bowel movements
  • Heavy lifting (occupation or exercise)
  • Obesity
• Genetics: Some women may have a genetic predisposition to weaker connective tissues.

Degrees (Staging): The severity is classified based on how far the uterus has descended:

• Stage 1: The uterus drops into the upper part of the vagina.
• Stage 2: The uterus has dropped further and reaches the opening of the vagina.
• Stage 3: The cervix (the lower part of the uterus) is outside the vaginal opening.
• Stage 4: Most or all of the uterus is outside the vagina.

Clinical Features (Signs and Symptoms):

• Symptoms vary depending on the stage; mild prolapse may have no symptoms.
• Feeling of Heaviness or Pressure: A dragging sensation in the pelvis or lower abdomen.
• Vaginal Bulge: The sensation of a lump or "something falling out" in the vagina.
• Difficulty with Urination: Frequent urination, feeling of incomplete bladder emptying, or stress incontinence (leaking urine with cough, sneeze, or exercise). In severe cases, difficulty passing urine.
• Difficulty with Bowel Movements: Constipation or the need to press on the vagina to help empty the bowels (in cases of associated rectocele).
• Lower Back Pain: May be associated with the dragging sensation.
• Pain or Discomfort during Intercourse: Can be affected by the presence of prolapse.

Treatment Options:

• Conservative (Non-Surgical):
  • Lifestyle Changes: Weight loss, managing constipation, avoiding heavy lifting, stopping smoking (to reduce cough).
  • Pelvic Floor Exercises (Kegels): Strengthening the muscles to improve support. Most effective for mild prolapse or prevention.
  • Vaginal Pessaries: Removable devices made of silicone or rubber inserted into the vagina to hold the uterus and other organs in place. A good option for symptomatic relief, especially if surgery is not desired or possible.
• Surgical:
  • Surgery aims to repair the weakened pelvic floor tissues and return the organs to their correct position.
  • Hysterectomy (Uterus Removal): Often part of surgical repair for uterine prolapse, followed by stitching the top of the vagina to stable ligaments to prevent vaginal vault prolapse.
  • Uterine Suspension: Techniques to reattach the uterus to other pelvic structures, preserving the uterus (for women who still want to have children).
  • Repair of other associated prolapses (cystocele, rectocele) is often done at the same time.
• The choice of treatment depends on the severity of the prolapse, the woman's age and overall health, her symptoms, desire for future pregnancies, and personal preference.

Mullerian Anomalies Explained:

• Mullerian anomalies are birth defects of the female reproductive tract.
• They happen very early in development (in the first few months of pregnancy) when two structures called Mullerian ducts do not form, fuse, or clear out properly.
• These ducts are supposed to develop into the uterus, fallopian tubes, cervix, and the upper part of the vagina.
• Problems with this process lead to abnormal shapes or absence of these organs.

Examples of Mullerian Anomalies:

• Septate Uterus: A wall inside the uterine cavity.
• Bicornuate Uterus: A heart-shaped uterus with two horns.
• Unicornuate Uterus: A uterus with only one fully formed side.
• Didelphys Uterus: Two separate uteri.
• Vaginal Agenesis: Absence of the vagina.
• Transverse Vaginal Septum: A blocking wall in the vagina.

Implications on Fertility and Pregnancy:

• Infertility: Some anomalies can make it harder to get pregnant. For instance, a severe septum or very abnormal uterine shape might make it difficult for an embryo to implant or grow. Anomalies affecting the fallopian tubes (though less common as a primary Mullerian issue) can also cause infertility.
• Recurrent Miscarriage: This is a major problem with certain anomalies, particularly the septate uterus. The poor blood supply in the septum can prevent a pregnancy from developing correctly, leading to repeated losses early in pregnancy.
• Preterm Birth: An irregularly shaped uterus may not stretch properly as the pregnancy progresses, increasing the risk of the baby being born too early.
• Fetal Malposition: The baby might not be able to get into the head-down position easily in an abnormally shaped uterus, leading to breech presentation or other positions requiring a Cesarean section.
• Obstructed Labor: If there are associated cervical or vaginal anomalies (like a rigid septum), they can block the baby's passage during delivery.
• Vaginal Agenesis (MRKH Syndrome): While ovaries are usually functional (meaning eggs are produced), pregnancy is not possible because the uterus is absent. Genetic children can be had through assisted reproductive technologies like IVF and surrogacy.

Causes of Imperforate Hymen:

• This is a congenital condition, meaning it is present at birth.
• During the development of the female reproductive organs in the womb, the hymen is supposed to have an opening.
• An imperforate hymen occurs when this opening doesn't form completely, leaving the hymen as a solid membrane covering the vaginal entrance.
• It's a developmental issue, not caused by infection or injury.

Management in Adolescent Girls:

• Imperforate hymen is usually diagnosed in adolescence when a girl does not start menstruating and develops monthly pelvic pain.
• The main treatment is a simple surgical procedure called a **hymenotomy** or **hymenectomy**.
• This involves making a small cut or removing a portion of the hymen to create an opening for menstrual blood to escape.
• The procedure is usually minor and done under anesthesia.
• It is important to perform this relatively soon after diagnosis to relieve pain and prevent long-term complications from the buildup of menstrual blood, such as pressure on the urinary tract or potential effects on fertility (though less common).
• After the procedure, normal menstruation can begin, and sexual function is usually possible once healed.

Pelvic organ prolapse is a condition where organs in the pelvis, such as the uterus, bladder, rectum, or vagina, drop down from their normal positions and bulge into or outside the vagina. This happens when the pelvic floor, a strong set of muscles and tissues that support these organs, becomes weak or damaged.

Types of Pelvic Organ Prolapse:

• Cystocele: The bladder bulges into the front wall of the vagina.
• Rectocele: The rectum bulges into the back wall of the vagina.
• Uterine Prolapse: The uterus descends into the vagina.
• Enterocele: The small intestine bulges into the upper part of the vagina.
• Vaginal Vault Prolapse: The top of the vagina collapses after a hysterectomy (removal of the uterus).

Risk Factors:

• Vaginal Childbirth: The stretching and strain during vaginal delivery, especially difficult births, large babies, or multiple pregnancies, significantly weaken the pelvic floor.
• Aging: The natural process of getting older leads to loss of muscle strength and tissue elasticity.
• Menopause: Decreased estrogen levels after menopause contribute to weakening of pelvic tissues.
• Increased Abdominal Pressure:
  • Chronic cough (e.g., from smoking or respiratory conditions).
  • Chronic constipation and straining during bowel movements.
  • Heavy lifting.
  • Obesity.
• Surgery: Previous pelvic surgeries can sometimes weaken support structures.
• Genetics: Some women may have weaker connective tissues from birth.

Signs and Symptoms:

• Symptoms vary from mild to severe and may worsen throughout the day or after physical activity.
• Vaginal Bulge or Lump: A feeling of something coming down or out of the vagina.
• Pelvic Pressure/Heaviness: A feeling of fullness, aching, or dragging in the lower abdomen or pelvis.
• Urinary Symptoms: Difficulty emptying the bladder, frequent urination, urgent need to urinate, or leakage of urine (stress incontinence).
• Bowel Symptoms: Difficulty passing stool, needing to push on the vagina to empty the rectum (splinting), or feeling of incomplete emptying.
• Pain or Discomfort: Lower back ache or pain during sexual intercourse.

Management:

• Treatment options depend on the type and severity of prolapse, the woman's symptoms, age, health, desire for future pregnancies, and personal choice.
• Conservative (Non-Surgical) Management:
  • Lifestyle Changes: Losing weight, managing constipation, treating chronic cough, avoiding heavy lifting.
  • Pelvic Floor Muscle Training (Kegel Exercises): Strengthening the muscles to provide better support. Most helpful for mild prolapse or preventing progression.
  • Vaginal Pessaries: Removable devices inserted into the vagina to physically support the prolapsed organs. Need to be fitted and cleaned regularly.
• Surgical Management:
  • Surgery aims to restore the normal anatomy and function of the pelvic organs.
  • The type of surgery depends on the specific organs prolapsed. It may involve repairing the weakened tissues using stitches, or sometimes using surgical mesh for reinforcement.
  • For uterine prolapse, surgery might involve removing the uterus (hysterectomy) and providing support for the top of the vagina, or suspending the uterus to ligaments to keep it in place (uterus preservation).
  • Cystocele and rectocele repairs involve tightening the tissues supporting the bladder and rectum, respectively.
• Patients should discuss the risks, benefits, and success rates of different options with their doctor.

Uterine inversion is a rare but very serious complication that can happen immediately after childbirth. It means the uterus turns partially or completely inside out, pulling the top part down through the cervix. It requires urgent medical attention.

Causes:

• Uterine inversion usually happens during the third stage of labor (after the baby is born but before the placenta is delivered).
• Excessive Cord Traction: The most common cause is pulling too hard on the umbilical cord before the placenta has separated properly from the uterine wall, especially if the uterus is relaxed.
• Uterine Atony: A uterus that is not contracting well after delivery is more prone to inversion.
• Placenta Implantation: If the placenta is attached to the top part of the uterus (fundus), this area may be pulled down when the placenta is delivered.
• Other Factors: Short umbilical cord, rapid labor, use of certain medications that relax the uterus, or a history of previous inversion can increase the risk.

Diagnosis:

• Diagnosis is usually made quickly based on signs observed immediately after delivery.
• Severe Pain: The woman experiences sudden, severe pain in the lower abdomen.
• Postpartum Hemorrhage: There is often significant and sudden heavy bleeding.
• Fundus Not Palpable: When the doctor or midwife feels the abdomen, they cannot feel the top of the uterus in its normal position.
• Visual Inspection: The inverted uterus or cervix may be seen coming through the vagina or even outside the body.
• Shock: Due to severe pain and blood loss, the woman can quickly develop signs of shock (low blood pressure, fast heart rate, pale skin).

Emergency Management:

• This is a life-threatening emergency needing immediate action.
• Call for Help: Quickly alert senior medical staff, including obstetricians and anesthesiologists.
• Resuscitation: Give intravenous fluids immediately to treat shock and control bleeding. Blood transfusion is often needed.
• Manual Replacement: The most important and urgent step is to manually push the inverted uterus back into its normal position using a gloved hand inserted into the vagina. This must be done as soon as possible.
• Uterine Relaxants: Medications (like terbutaline or magnesium sulfate) may be given temporarily to relax the uterus and make manual replacement easier.
• Uterotonics: Once the uterus is back in place, medications (like oxytocin) are given to make the uterus contract and stay in place, and to control bleeding.
• Surgical Management: If manual replacement fails, surgery is required to reposition the uterus.

Prevention:

• Proper management of the third stage of labor is key.
• Controlled Cord Traction: Only apply gentle traction to the umbilical cord to deliver the placenta *after* confirming signs that the placenta has separated and while applying counter-pressure above the pubic bone.
• Avoid Excessive Cord Pulling: Do not pull hard on the cord, especially if the uterus is relaxed.
• Check Uterine Tone: Ensure the uterus is contracting well after delivery before attempting placental removal.
• Be vigilant for signs of inversion, especially in women with risk factors.

Surgery is often used to correct congenital structural problems of the female genital tract, particularly when they cause symptoms like blocked menstruation, pain, difficulty with sex, or affect the ability to have a successful pregnancy. The type of surgery depends on the specific abnormality:

Surgical Interventions:

• Hymenotomy/Hymenectomy:
  • Purpose: To open up an imperforate or abnormally thick hymen.
  • Procedure: A small incision or removal of the obstructing hymen tissue.
  • Used For: Imperforate hymen causing blocked menstrual flow.
• Vaginal Septum Resection:
  • Purpose: To remove a transverse or longitudinal vaginal septum.
  • Procedure: Surgical cutting and removal of the septum tissue.
  • Used For: Vaginal septums causing blocked menstrual flow, painful intercourse, or potential problems during childbirth.
• Hysteroscopic Septum Resection:
  • Purpose: To remove a septum that divides the inside of the uterus.
  • Procedure: Done using a hysteroscope (camera) inserted through the cervix. The septum is cut and removed from inside the uterus. Minimally invasive.
  • Used For: Septate uterus causing recurrent miscarriages or infertility.
• Uterine Reconstruction (Metroplasty):
  • Purpose: To reshape or unify an abnormally formed uterus.
  • Procedure: Various techniques, often open abdominal surgery, to reshape a bicornuate or other complex uterine anomaly. Less common now than hysteroscopic septum resection.
  • Used For: Selected complex uterine anomalies impacting pregnancy, though benefits can vary.
• Vaginoplasty:
  • Purpose: To create a functional vagina.
  • Procedure: Surgical creation of a vaginal canal using methods like skin grafts, bowel segments, or other tissues.
  • Used For: Vaginal agenesis (absence of the vagina), often as part of MRKH syndrome.
• Laparoscopy:
  • Role: Often used for diagnosis and sometimes for surgical correction (e.g., accessing a rudimentary horn of a unicornuate uterus or assisting with complex vaginal/uterine reconstruction). It allows visualization of the pelvic organs through small incisions.

The choice of surgery depends on the specific anomaly, its severity, the symptoms it causes, and the patient's future reproductive goals.

Structural abnormalities of the female genital tract, whether present from birth or developed later, can have significant effects on both a woman's ability to have children and her emotional and social health.

Impact on Reproduction:

• Infertility: Some anomalies can make it difficult or impossible to conceive naturally. For example, a complete vaginal blockage prevents intercourse, and severe uterine malformations may hinder implantation or development.
• Recurrent Miscarriage: Certain uterine shapes, especially a septate uterus, are strongly linked to repeated early pregnancy losses.
• Preterm Birth: Abnormal uterine shapes can lead to the baby being born too early because the uterus cannot expand normally.
• Complications during Pregnancy and Birth: Anomalies can increase risks like poor fetal growth, placental problems, or require a Cesarean section due to difficult labor or the baby's position.
• Primary Amenorrhea: Conditions like absent uterus or complete vaginal blockage cause a girl not to start menstruating, which is a clear sign of a reproductive system issue.

Impact on Psychosocial Wellbeing:

• Emotional Distress: Discovering a structural abnormality can lead to feelings of shock, sadness, anger, and confusion.
• Anxiety and Depression: Coping with infertility, recurrent pregnancy loss, the need for multiple medical appointments and procedures, and the uncertainty of outcomes can significantly impact mental health.
• Body Image Issues: Anomalies, especially those affecting the vagina or external appearance, can affect a woman's self-esteem and how she feels about her body.
• Impact on Relationships: Difficulties with sexual intimacy due to pain or structural issues can strain relationships with partners. Infertility can also put stress on a couple.
• Social Isolation: Some women may feel different or isolated from peers who do not face similar challenges, particularly regarding menstruation, sexual activity, or childbearing.
• Identity Concerns: For young women diagnosed around puberty, understanding their condition and its implications for their future can affect their developing identity and sense of womanhood.