Pre-Pubertal and Congenital Gynaecological Disorders - Congenital Structural Abnormalities

Question 1

Basic Embryological Development of Female Reproductive System.

Answer 1

Paramesonephric (Mullein Ducts) - give rise to Upper 1/3 Vagina, Cervix, Fallopian Tubes and the Uterus.

Question 2

Why does a male foetus not develop in the same way as a female foetus?

Answer 2

AMH (Anti-Mullerian Hormone) is produced - suppresses growth of the paramesonephric ducts.

Question 3

What is a Bicornuate Uterus?

Answer 3

Two horns to the uterus, giving the uterus a heart-shaped appearance.

Question 4

Diagnosis of Bicornuate Uterus.

Answer 4

Pelvic US Scan.

Question 5

Management of Bicornuate Uterus.

Answer 5

No specific management.

Question 6

Complications of Bicornuate Uterus (3).

Answer 6

1. Miscarriage.
2. Premature Birth.
3. Malpresentation.

Question 7

What is an Imperforate Hymen?

Answer 7

The hymen at the entrance of the vagina has fully formed without an opening.

Question 8

Clinical Presentation of Imperforate Hymen (2).

Answer 8

1. Cyclical pelvic pain and cramping (usually associated with menstruation) without vaginal bleeding.
2. Discovered when the girl starts to menstruate and menses are sealed in the vagina.

Question 9

Diagnosis of Imperforate Hymen.

Answer 9

Clinical Examination.

Question 10

Management of Imperforate Hymen.

Answer 10

Surgical Incision - create an opening in the hymen.

Question 11

Prognosis of Imperforate Hymen.

Answer 11

Retrograde Menstruation can lead to Endometriosis.

Question 12

What is Transverse Vaginal Septae?

Answer 12

Septum (wall) forms transversely across the vagina - due to error in development.

Question 13

Clinical Presentation of Transverse Vaginal Septae (2).

Answer 13

1. Perforate : Menstruation Unaffected but Difficulty with Intercourse/Tampon Use.
2. Imperforate : Similar to Imperforate Hymen.

Question 14

Diagnosis of Transverse Vaginal Septae (3).

Answer 14

1. Clinical Examination.
2. Ultrasound.
3. MRI.

Question 15

Management of Transverse Vaginal Sepate.

Answer 15

Surgical Correction.

Question 16

Complications of Transverse Vaginal Septae (3).

Answer 16

1. Infertility.
2. Pregnancy-Related Complications.
3. Surgery Complications : Vaginal Stenosis and Recurrence of Septae.

Question 17

What is Vaginal Hypoplasia?

Answer 17

Abnormally small vagina.

Question 18

What is Vaginal Agenesis?

Answer 18

Absent vagina.

Question 19

Aetiology of Vaginal Agenesis/Hypoplasia.

Answer 19

Failure of Mullerian Ducts to properly develop (associated with absent uterus and cervix). Ovaries are unaffected - normal female sex hormones.

Question 20

Management of Vaginal Agenesis / Hypoplasia.

Answer 20

1. Vaginal Dilator over a prolonged period to create an adequate vaginal size.
2. Vaginal Surgery.