Vagina atresia

Description:

At an atresia of a vagina there is its fusion fibrous fabric, at the same time external genitals, a uterus (a neck and a body), pipes and ovaries are created and function correctly. The atresia of a vagina breaks outflow of menstrual blood and does difficult sex life.

The atresia of a vagina can have the acquired or inborn character. On localization of fusion of a vagina  the gynecology allocates full and partial forms of an atresia of a vagina in his lower, average or upper part. In the presence of an opening in a partition of a vagina speak about a fistular form of an atresia. Population occurrence of an atresia of a vagina makes 2 — 4 cases on 10 000 women.

Vagina atresia reasons:

Vagina atresia etiology multifactor. The inborn atresia of a vagina is a consequence of the wrong pre-natal formation of the myullerovy channels which did not merge with an urogenital sine as a result of various adverse factors (including STD at mother – mycoplasmosis, trichomoniasis, genital herpes, ureaplasmosis, a human papillomavirus infection, etc.)

The secondary (acquired) atresias can develop after operating rooms and birth trauma of a vagina, frequent inflammations (colpitises), syringings by the concentrated disinfecting solutions, the complicated medical manipulations. Quite often acquired atresias arise after the postponed infectious diseases of children's age – parotitis, scarlet fever, diphtheria, etc., complicated by an adhesive inflammation of a vagina.

Vagina atresia symptoms:

At primary form of an atresia of a vagina with arrival of menarche the girl has regularly repeating sharp pains in the bottom of a stomach, however outside menstrual bleeding does not come. Depending on localization of an atresia blood can accumulate and stretch walls of a vagina (hematocolpos), a uterus (gematometr), fallopian pipes (hematosalpinx). The aching pains, and gematometra - spastic, sometimes followed by a loss of consciousness are characteristic of a hematocolpos.

Less often the atresia of a vagina can be diagnosed for babies when owing to stimulation of cervical and vulval glands maternal estrogen develops мукокольпос – filling and a recolpectasia with a mucous secret. Мукокольпос it is found accidentally at complaints to concern of the child at an urination or at identification of volume education in an abdominal cavity more often. The considerable colpectasia at its atresia can lead to hydronephrotic transformation of upper urinary tract.

The inborn atresia of a vagina in some cases is combined with fistular or full both an atresia of an anus and an agenesia of uric system.

Except a false amenorrhea the atresia of a vagina can be followed by the vulval itch arising owing to lack of outflow of a secret outside, development of dysbacteriosis and a colpitis.

At the women having sex depending on vagina atresia level, the sexual contact is impossible or complicated in view of discomfort or the expressed pains at the intercourse. The atresia of a vagina interferes with approach of pregnancy and a current of a physiological childbed (if formation of a secondary atresia happened against the background of pregnancy).

The fistular atresia of a vagina at development of the ascending infection can be complicated by a pyocolpos that is shown by periodically arising allocations of purulent character. Quite often at a rectoabdominal research or in the course of antiinflammatory therapy there is emptying of a pyocolpos.

In case of lack of the draining opening in a partition of a vagina there occurs bystry development of a pyometra, a pyosalpinx and a reflux of pus in a free abdominal cavity. At the same time a febris, the phenomena of "acute abdomen", deterioration in health promptly accrue. Sometimes development of the ascending infection happens so promptly that even carrying out the emergency colpotomy does not prevent development of a pelviperitonitis and peritonitis.

Diagnosis:

For recognition of an atresia of a vagina in gynecology the rectoabdominal research, ultrasonography (MRT) of a small pelvis, sounding of a vagina is used (for determination of level of an atresia).

At gynecologic survey on a chair the gynecologist can see the hematocolpos eminating in a sexual crack in the form of a dome. The rectoabdominal research at an atresia of a vagina allows to find highly located, increased and sharply painful uterus and pipes. By sounding depth of a vagina and level of an atresia is defined that it is important for planning of a colpoplasty.

Bacteriological and microscopic examination of a smear from a genital tract allows to decide on adequate antibacterial therapy.

By means of ultrasonography the gematometra (pyometra) and a hematosalpinx (pyosalpinx), their sizes and level of localization come to light. At a hematocolpos of the small sizes carrying out MRT of bodies of a small pelvis is more reasonable. Sometimes at an atresia of a vagina resort to a diagnostic laparoscopy and a vaginografiya (a contrast X-ray analysis of a vagina its obstructions are higher).

At an acute ischuria or a pyuria in case of a fistular pyocolpos consultation of the urologist and urological inspection are shown.

Treatment of an atresia of a vagina:

At an atresia of a vagina surgical elimination of accretion of a vulval tube and recovery of its passability – a vaginoplasty is required.

In the course of operation opening of a partition of a vagina, emptying of a pyocolpos (hematocolpos) or gematometra via the cervical channel is made. After release of a vagina from the accumulated blood and washing by antiseptic agents the partition is excised scissors to vagina walls. Edges of the formed wound tsirkulyarno take in a catgut, providing passability, capacity and a shape of a vagina. In the created vagina establish a sterile tampon with a liquid paraffin.

At accumulation of blood in fallopian pipes the first stage of operation carries out a bryushnostenochny chrevosecheniye and removal of a hematosalpinx, then emptying of a hematocolpos is made by a vulval way. In the post-operational period antibacterial therapy is carried out.

After elimination of an atresia of a vagina observation at the gynecologist, maintaining regular sex life is shown to the woman. At threat of a repeated atresia of a vagina bougieurage of a vagina (kolpoelongation) is periodically carried out.

Complications:

At a piogematometra and a piogematosalpinksa there can be a throwing of the infected blood in an abdominal cavity to development of peritonitis. In rare instances at the atresia of a vagina which is combined with impassability of pipes there is a hysterorrhesis and the expiration of its contents in an abdominal cavity.

At a high atresia of a vagina during a colpoplasty wound of walls of a uterus, bladder or rectum is not excluded.

One of frequent complications of pathology is excessive scarring mucous with development of a repeated atresia of a vagina.

Prevention:

The prevention of primary atresia of a vagina has to include adequate preparation and conducting pregnancy at women, an exception of adverse pre-natal influences on an embryogenesis.

Prevention of a secondary atresia of a vagina provides timely treatment of colpitises, careful carrying out gynecologic manipulations (including abortion), nontraumatic conducting childbirth, refusal of frequent syringings etc. After the postponed children's infections the girl is recommended to be shown to the children's gynecologist.