The pitfalls in the diagnosis and management of distal vaginal agenesis: a report of three cases

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.

Cervical agenesis: a retrospective series

Objective: The objective is to describe the clinical presentation and management of cervical agenesis. Study Design: This is a retrospective analysis of 5 patients with cervical agenesis managed in a university tertiary institution and a review of similar cases cited in literature. Results: There are only 119 cases of cervical agenesis described to date, with pelvic pain and primary amenorrhea as common presenting symptoms. Forty-nine percent presented with associated vaginal agenesis. Successful canalization was performed in 41-46 percent. Nine successful spontaneous pregnancies and by zygote intrafallopian transfer have been cited. Conclusions: Cervical agenesis is a rare condition. Concomitant vaginal agenesis occurs in nearly half of subjects. Results of successful conservative surgery are comparable between cervicovaginal agenesis and cervical agenesis but there are more morbidities and mortalities associated with the former. Hysterectomy is another option. Careful patient selection, psychological support and individualized treatment are key to proper management.