Distal vaginal agenesis and differential diagnosis of other causes of hematocolpos

Abstract

Distal vaginal agenesis is an obstructive congenital malformation of the female reproductive tract. The distal part of the vagina is replaced by fibrous tissue and outflow of the menstrual blood and secretion of the cervical glands is disabled. This congenital anomaly most often manifests during expected menarche by primary amenorrhea and cyclic lower abdominal pain caused by kryptomenorrhea with gradually increasing hematocolpos and hematometra. Diagnosis is based on gynecological examination and the suspicion on this anomaly is confirmed by ultrasound examination and magnetic resonance imaging. Therapy of distal vaginal agenesis is exclusively surgical. Pull-through vaginoplasty is the method of choice for distal vaginal agenesis not exceeding three centimeters. With a greater extent of agenesis and the risk of postoperative vaginal stenosis, replacement of the missing part of the vagina with other tissues or modified balloon vaginoplasty can be used. The aim of the treatment is to allow evacuation of the menstrual blood, satisfactory sexual intercourse and reproduction.