Is your vagina not fully formed? Let's talk about vaginal agenesis.

Sometimes our daughter, or maybe you yourself, may have a problem where she does not start her monthly period even after reaching puberty. Or she may experience other vaginal discomfort. One reason for this could be a condition called 'vaginal atrophy'. This may sound a bit complicated, but let's talk about it simply, in a way that you can understand.

What is this so-called vaginal agenesis?

Simply put, this is because a female baby's vagina does not develop properly when she is in the womb. Medically speaking, this is a congenital anomaly . The vagina may be completely absent, or only part of it may be formed. Keep in mind that even if this condition is present at birth, it may not be recognized until puberty. This is because most of the time the external genitalia appear normal.

Most people only find out about this when they reach a young age, that is, when they have not started their monthly periods (what we also call menstruation) even after they are around 15 years old.

Along with this condition called anovulation, there can sometimes be problems with other parts of the reproductive system. For example, the uterus, where the baby grows, or the fallopian tubes, which carry eggs from the ovaries to the uterus, may not have developed properly. Also, there may be problems with the kidneys or the spine.

But there is nothing to worry about. There are treatments for this condition. The vagina can be enlarged gradually using medical devices. Sometimes, a minor operation (`(surgery)`) can be performed to create a vagina. True, this condition can sometimes make it difficult to have children, depending on the affected reproductive organs. However, with treatment, many women can live healthy lives and have a normal sex life.

How common is this condition?

This condition is actually very rare . According to statistics, it affects about one in 5,000 women. It has been found that about a third of women with this type of vaginal prolapse also have kidney problems. Also, about 12% can see problems with the bones of the spine, ribs, or limbs.

Why is this happening? What is the reason?

Doctors still don't know the exact cause . It happens when a fetus develops in the womb. It usually happens when a woman's reproductive system doesn't develop properly during the first 20 weeks of pregnancy. It can cause abnormalities in the development of the vagina, uterus, fallopian tubes, or cervix.

It is thought that environmental factors, such as exposure to toxic chemicals during pregnancy, may also play a role . Or, there may be genetics. Some conditions associated with vaginal insufficiency may be inherited.

Vaginal insufficiency is a symptom of, or can occur with, several other conditions. These are called disorders of sex differentiation (DSD). Two of the main conditions are:

• Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: This is a very rare condition. It causes abnormalities in the reproductive organs. MRKH syndrome is the most common condition associated with vaginal agenesis. In this condition, the vagina and uterus do not develop properly, or do not develop at all. Depending on the type and severity of this syndrome, other abnormalities may also occur in the cervix, spine, and limbs. Some people may also develop hearing loss, heart disease, and kidney problems.
• Androgen insensitivity syndrome (AIS): This is a genetic condition. In this condition, a child's uterus, cervix, fallopian tubes, and part of the vagina do not develop. In some cases, the vagina may not develop at all.

What are the symptoms of this condition?

There are several key characteristics of this condition that you should be aware of:

• Amenorrhea : This means that menstruation has not started by the age of 15. This is often the first sign. If this is happening to your daughter, see a doctor.
• Cryptomenorrhea : This is when menstrual blood, which is supposed to be released monthly, accumulates inside the body without a way to exit. Imagine, menstrual blood is produced every month, but there is no way for it to come out. Then it accumulates inside and can cause things like stomach aches and backaches. This can be very painful.
• The opening of the vagina may be a small dimple or there may be no opening at all.
• Pain during sex. This can happen if the vagina is too short.

How do you recognize this? What tests are done?

Sometimes, doctors detect this condition in infancy or childhood. However, most often it is detected in your teens. Many people find out they have this condition when they go to see a doctor because they haven't started their monthly period by the age of 15.

To diagnose a condition called vaginal prolapse, your doctor (or your child's doctor) will perform tests like these:

• First, a physical examination is performed. This means examining the vaginal area and the area around the anus.
• An ultrasound scan is performed . This allows images to be taken of the vagina and other organs inside the pelvic cavity (such as the uterus and ovaries).
• An MRI scan (MRI) can also be done . This can produce very clear, detailed images of the vagina and other reproductive organs.
• In addition, your doctor may also recommend a blood test to check for chromosomal abnormalities. A DNA blood test can confirm whether you have a genetic condition, such as MRKH syndrome, because sometimes vaginal prolapse can be associated with these genetic conditions.

Can this condition be treated?

Yes, there are treatments for this. You can talk to your doctor or your child's pediatrician to decide when is the best time to start treatment. Some people start treatment at a young age. Others start treatment after they reach puberty or become sexually active. This is a very personal decision.

The two main treatments for vaginal dryness are:

1. Self-dilation of the vagina

If you have a vaginal opening or a small hole where the opening should be, your doctor will tell you to use a dilator to make your vagina wider. This involves using a small, thin tube to gradually enlarge the opening. This will be done gradually over the course of a few days. This usually takes about 20 minutes a day. You may feel some discomfort during the dilation, but it should not be painful. It is best to use the dilator when your skin is soft and pliable, such as after a shower.

2. Surgery (`(Surgery)`)

Sometimes, your doctor may recommend a procedure called vaginoplasty to create a vagina. The doctor will decide which method to use based on your body position and other factors. Doctors may use a traction device to create a vagina where there is no vagina, or they may use a skin graft (from your own cheek or a piece of intestine). After the surgery, your doctor will insert an insert to help keep the vagina in shape. Talk to your doctor about when you can remove this insert.

How long does it take to recover after these treatments?

If you have had surgery, ask your doctor what to expect during your recovery. You will usually be confined to bed for about a week. Your doctor may also tell you to keep a dilator (a device that can be inserted into your vagina) in place for several months. You can remove the dilator during sex, when you go to the bathroom, or when you shower.

Can someone with vaginal insufficiency have sex?

This is a common problem for many people. Ask your doctor when it is safe to have sex after treatment for a vaginal prolapse. Usually, you can start having sex about a month after surgery. However, recovery time varies from person to person. You may need to use artificial lubrication to make sex easier in the early stages.

After treatment, many people have a satisfying sex life. Your partner may not even realize that you have erectile dysfunction or that you have been treated for it.

Can I have children after treatment?

This is also a very important question. Ask your doctor if you will be able to have children after treatment. If your uterus, fallopian tubes, and cervix have developed normally, you may still be able to have children.

However, if you don't have a uterus (or if it's very small), meaning you have uterine factor infertility, you may not be able to carry a baby to term. But don't give up hope. You may be able to have a baby through surrogate motherhood using your own eggs. Your doctor will refer you to a fertility specialist to discuss this further.

Can vaginal dryness be prevented?

Vaginal prolapse is a congenital abnormality / birth defect . That is, it is something that is present at birth, something that happens while a baby is developing in the womb. Therefore, there is no way to prevent it. It is not something that happens through anyone's fault.

How do I know if my child is at risk of developing this condition?

If someone in your family has a history of disorders of sex differentiation (DSD), it's a good idea to talk to your doctor before starting a family. You can also meet with a genetic counselor before you get pregnant to assess your risk of passing on a genetic condition to your child.

If I have vaginal prolapse, what should I expect?

Your outlook depends on many factors. What treatment you received and what parts of your reproductive system were affected are important. However, with treatment, most people have a satisfying sex life. Some people may develop vaginal stenosis (a narrowing of the vagina) after vaginoplasty. If this happens, you may need to continue using a dilator or have another surgery.

When should I see a doctor?

Be aware of these things:

• If you or your child has not started menstruating by the age of 15, see a doctor immediately. It is important to get a full evaluation and physical examination.
• Also, if you have stomach aches or back pain without your period, see a doctor immediately.
• If you notice anything unusual in the vaginal area, see a doctor for an examination.

What else should I ask my doctor about vaginal dryness?

To better understand this condition, you can ask your doctor questions like these:

• What treatment method is best for me?
• Can you connect me to a support group that helps people with this condition?
• When can I return to my normal activities after treatment?
• When can I have sex after treatment?
• If there are people in my family who have vaginal prolapse, what is the risk that my child will also have this condition?

If you or your child have any of these symptoms, talk to your doctor openly and honestly. Vaginal insufficiency can cause problems with menstruation, reproductive health , and sexual function. However, treatment can help. If you want to have children after treatment, talk to your doctor about your options. Many people have a happy sex life after treatment.

The most important things to remember (Take-Home Message)

Although vaginal agenesis is a congenital condition, first remember that you are not alone in facing it. It is no one's fault.

• A proper diagnosis is very important. If you have not started menstruating by the age of 15, or if you have menstrual problems accompanied by abdominal pain, seek medical advice immediately.
• There are treatments. Self-dilation or surgery can be successful.
• Many people are able to have a satisfying sex life after treatment.
• Talk to your doctor about your fertility and learn about your options.
• Psychological support is also very important during this journey. If necessary, seek counseling and connect with support groups.

"Don't be afraid, there are doctors and loved ones to help you. With the right information and support, you can cope with this situation successfully."

` Vaginal Agenesis, MRKH Syndrome, AIS, Birth Defects, Amenorrhea, Reproductive Health, Gynecology