Treatment of Haematocolpos in Distal Vaginal Agenesis
Clinical Scenario
This protocol addresses haematocolpos arising in the context of distal vaginal agenesis — a
congenital condition in which the urogenital sinus fails to form the lower segment of the
vagina, or the vaginal plate incompletely canalises, resulting in obstruction and blood
accumulation within the vagina.
Condition
Distal vaginal agenesis results from failure of the urogenital sinus to contribute the lower
vaginal segment, or from partial failure of the vaginal plate to fully open. The extent of
the absent segment — short versus long — is a key determinant of the surgical approach.
Treatment Approach
Surgical vaginoplasty is the primary intervention. The technique used depends on the length
of the absent vaginal segment, with distinct approaches applied for shorter versus more
extensive defects.
Full surgical algorithm and technique selection available in the complete protocol.
References
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As the lower segment of the vagina develops from the urogenital sinus, distal vaginal
agenesis is the failure of the urogenital sinus to form the lower segment of the vagina
or partial failure of the vaginal plate to canalize.
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In surgical treatment, local pull-through vaginoplasty with direct anastomosis of the
upper vaginal mucosa to the introitus via a perineal incision is performed when the
distance between the perineal surface and the caudal aspect of the distended vagina is
2 cm or less.
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Vaginoplasty using skin or bowel grafts has been performed when a large segment of the
vagina is absent.
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Fibrin glue improves graft stability.
DOI: 10.1007/s11604-021-01115-7
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