Abnormal formation of female organs

Question 1

Embryology

Answer 1

• Upper vagina, cervix, uterus, Fallopian tubes develop from the paramesonephric ducts (MULLERIAN DUCTS)
• These are outside of urogenital region and fuse to become uterus, Fallopian tubes cervix and upper 3rd of vagina
• In males: anti-mullerian hormones which suppress this

Question 2

Bicornuate uterus

Answer 2

• Two horns to the uterus
• Diagnosed on pelvic USS
• Rarely cause adverse pregnancy outcomes (miscarriage, premature, malpresentation)

Question 3

Imperforate hymen

Answer 3

• Hymen doesn’t have an opening
• Usually presents when a girl is starting menses and has cyclical pelvic pain and cramping but no vaginal bleeding (as this is sealed behind hymen)
• Diagnosed on clinical examination
• Tx: Surgical incision
• Complications: if not treated retrograde blood -> endometrosis

Question 4

Transverse vaginal septae

Answer 4

Septum goes transversely across vagina
Can be perforate (has a hole and menses will occur but pain with intercourse or tampons)
Complications: infertility, and pregnancy related complications
Dx: Examination, USS, MRI

Question 5

Vaginal hypoplasia and agenesis

Answer 5

• Hypoplasia = abnormally small vagina
• Agenesis = absent vagina due to failure of Mullerian ducts to develop = absent uterus and cervix
• Ovaries are unaffected but can be affected if androgen insensitivity syndrome
• Management: vaginal dilator or surgery