Vaginal Reconstruction for Congenital and Acquired Abnormalities

Abstract

Most anomalies of the female genitalia are congenital and present at birth. These include vaginal atresia, vaginal obstruction due to imperforate hymen or a high vaginal septum, and anomalies of the internal and external genitalia in patients with intersex abnormalities. A smaller number of patients present at the time of puberty because of primary amenorrhea; this includes patients with the Mayer-Rokitansky syndrome and testicular feminization syndrome (TFS). The incidence of these anomalies varies between 1:4,000 live births and 1:10,000 live births. This wide range relates to differences in the definition and severity of these anomalies. The pediatric surgeon must have knowledge of a wide variety of presentations and the treatment for each entity. Surgical correction is predicated on the anatomy. Table 35.1 lists the common vaginal abnormalities and the surgical correction of each.