A woman’s ability to conceive and carry a child to the full term of pregnancy is affected by a number of factors. While some of these factors are the result of health issues that occurred during or after her adolescence or puberty, quite a few are likely to have occurred in utero, that is, while she herself was developing in her own mother’s womb. Such issues of the female reproductive system that occur during the fetal stage of development are classified under the category of congenital abnormalities. In most cases, health issues like, for instance, congenital uterine anomalies, may have even gone unnoticed until fertility issues arose.
In this article, we examine in depth the causes and various types of congenital abnormalities of the female reproductive system, along with the typical symptoms, diagnostic methods, and treatments currently available to resolve such issues.
Unfortunately, it is difficult to pinpoint the exact reason behind the occurrence of congenital anomalies in the female reproductive system. A few studies have suggested that the cause of such health issues could stem from the lack, or even abnormality, of certain genes, while others have pointed the finger at developmental issues caused by a multitude of reasons, like the use of certain drugs or nutritional gaps during pregnancy, etc. It is important to understand that family medical history plays a vital role in ascertaining the cause of the congenital abnormality.
Congenital anomalies can occur at any part of the female reproductory system: external genitals (vulva), vagina, cervix, uterus, or fallopian tubes. Listed below are the different types of congenital issues that affect each part of the female reproductive tract:
- Labial Hypoplasia
This occurs when one or both of the labia (visible portions of the vulva) fail to develop normally.
- Labial Hypertrophy
Abnormal enlargement of the labia, or labial hypertrophy, is yet another congenital anomaly.
A hymen is a thin, small membrane formed from leftover embryonic tissue that covers parts of the vaginal opening. The three congenital anomalies that typically occur in the hymen are:
- Imperforate Hymen
Typically, the hymen surrounds the vagina and has a perforation or hole in the middle. This allows menstrual blood to flow out when females enter puberty. However, an imperforate hymen has no opening, subsequently leading to the accumulation of blood in the vagina or the uterus.
- Microperforate Hymen
As the name suggests, the hymen will only have a tiny opening or perforation that allows a small quantity of menstrual blood to flow during periods. Since the rate of drainage is low, longer menstrual periods may be experienced.
- Septate Hymen
A septate hymen occurs when there is an extra piece of membrane or tissue in the middle of the vaginal opening, giving the appearance of two hymens.
- Transverse Vaginal Septum
A transverse vaginal septum is a rare congenital abnormality where there is a horizontal collection of tissue that obstructs the vagina. There may or may not be a small hole (fenestration) in the septum. The absence of an opening will result in the accumulation of menstrual blood in the vagina.
- Vertical or Complete Vaginal Septum
A vertical or complete vaginal septum is a condition where a tissue wall runs lengthwise through the vagina, creating two separate cavities.
- Vaginal Agenesis
The partial or complete absence of a vagina is called vaginal agenesis. This rare congenital issue occurs when the vagina fails to develop in females while they are in their mother’s womb. At times, there might just be a small pouch where the vagina should be.
- Cervical Agenesis
Cervical agenesis refers to the absence of the cervix and, at times, the uterus and vagina. In case the uterus is present, there is a chance of retrograde menstruation occurring, whereby the menstrual blood flows backwards.
- Cervical Duplication
Cervical duplication refers to a rare congenital health issue where two cervixes are present.
- Bicornuate Uterus
A bicornuate uterus refers to an irregularly shaped uterus that looks like a heart.
- Septate Uterus
A septate uterus occurs when a collection of tissue or piece of muscle divides the uterus into two separate sections. This is a fairly common congenital abnormality.
- Arcuate Uterus
This congenital condition is similar to bicornuate uterus. However, an arcuate uterus only has a slight indentation and does not cause any severe health issues.
- Unicornuate
A unicornuate uterus is a rare congenital disorder where only one-half of the uterus is fully formed with a single fallopian tube.
- Didelphys
Women affiliated with didelphys have two uteruses and, subsequently, two cervixes.
Often, the signs of congenital abnormalities of the female reproductive system go unnoticed until the onset of puberty or when fertility issues crop up.
Here are some of the symptoms to look out for in infancy before adolescence sets in:’
● Inability to fully empty the bladder
● Unusually shaped or sized external genitalia
● Swollen clitoris
● Absence or incomplete formation of the vaginal opening
● Labia that’s fused
Once puberty sets in, the following symptoms may present themselves:
● Underdeveloped breasts.
● No menstrual periods despite crossing 15 years of age and being healthy otherwise.
● Menstrual cramps or pain without blood flow.
● A lumpy full feeling in the lower abdomen caused by the accumulation of blood in the uterus or vaginal.
● Menstrual blood flow despite tampon usage.
● Discomfort from tampon usage.
● Painful sexual intercourse.
● Fertility issues.
● Repeated miscarriages and premature births.
A number of tests are available to fully understand the type and extent of the congenial anomaly. Usually, the doctor may perform a physical exam, which may be done with or without anaesthesia. Apart from this, here are a few other diagnostic procedures that could be useful:
1. 3D Ultrasound
2. Hysterosalpingogram (HSG)
3. Magnetic resonance imaging (MRI)
4. Karyotyping (genetic testing)
5. Hormone tests
Treatment depends on the type and severity of the congenital disorder. In most cases, surgery may be required, especially if there is a blockage in any of the parts of the female reproductive system. A doctor may also recommend surgery in case there is an absence of the cervix and vagina. A non-surgical method may be employed for treating vaginal issues by using devices called dilators that are used to stretch and widen the vaginal opening.
Being diagnosed with congenital abnormalities of the female reproductive system can be a deeply personal and challenging experience and can severely impact a woman’s physical and emotional well-being. Early awareness and understanding are key to getting early diagnosis and treatment. Support from healthcare professionals and access to accurate information can empower women to manage their condition effectively, enabling them to live healthy and fulfilling lives.
The common types of congenital uterine anomalies are:
1. Bicornuate Uterus
2. Septate Uterus
3. Arcuate Uterus
4. Unicornuate
5. Didelphys
Yes, congenital uterine anomalies can affect a woman’s ability to conceive a child and carry it to full term.
Yes, congenital vaginal and cervical abnormalities negatively impact sexual health. Women with such health issues tend to have painful or uncomfortable sexual intercourse.
