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Congenital Male Formations

This document discusses various congenital malformations of the female genital organs. It describes developmental anomalies of the external genitalia such as perineal or vestibular anus. It also discusses vaginal abnormalities like narrow introitus and hymen abnormalities. Various uterine anomalies from failure of fusion of Mullerian ducts are explained, including arcuate uterus, uterus didelphys and bicornuate uterus.

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Arun Ahirwar
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98 views32 pages

Congenital Male Formations

This document discusses various congenital malformations of the female genital organs. It describes developmental anomalies of the external genitalia such as perineal or vestibular anus. It also discusses vaginal abnormalities like narrow introitus and hymen abnormalities. Various uterine anomalies from failure of fusion of Mullerian ducts are explained, including arcuate uterus, uterus didelphys and bicornuate uterus.

Uploaded by

Arun Ahirwar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Congenital

Malformations
of
Female Genital
Organs
Dr. Salini Mandal B.G.
Lecturer,
Dept of OBG
FMHMC
• These are genetic in origin…
• Major anatomic defect of the FGT is usually assoc
with normal gonadal function and urinary tract
abnormality.
Developmental
Anomalies
of the
External
Genitalia
PERINEAL OR VESTIBULAR ANUS
• Detected at the time of birth
• Usual anal opening site is evidenced by anal pit
• Either anus will be situated close to the posterior end
of the vestibule or in the vestibule.
• In vagina (rarely)  (congenital rectovaginal fistula)
• Opening is usually sufficiently big
• Future reproduction  not a problem
• Ceaserian section adviced in the future
ECTOPIC URETER
• Additional ureteric opening is usually
in the vestibule close to the urethra or
in the vagina.
• Symptom:-
• Uncontrollable wetness

• Partial nephrectomy and


ureterectomy may be indicated or
implantation of the ectopic ureter into
the bladder may be done.
Vaginal
Abnormalities
NARROW INTROITUS
• Revealed after marriage..
• DYSPAREUNIA MAY BE THE FIRST COMPLAINT or
it may be detected during investigation of infertility
• Treatment is effective by manual stretching under
general anaesthesia or by surgical enlargment.
HYMEN ABNORMALITY
• Imperforate hymen  of significance
abnormality.
• Always unnoticed until 14 – 16 yrs.
• Uterine functioning is normal  menstrual
blow is pent up inside vagina behind the hymen
(CRYPTOMENORRHOEA)
• Depending upon the amount of blood so
accumulated, it first distends the vagina
(HAEMATOCOLPOS)
• The uterus is next involved and cavity dilated
(HAEMATOMETRA)
• If late and neglected, tubes may also be
distended after the fimbrial ends becoming
closed by adhesions (HAEMATOSALPHINX)
C/F:
• Age – 14 -16
• Periodic lower abdominal pain which may be
continuous.
• Primary amenorrhoea
• Urinary symptoms
On examination
• Abdominal examination
• Suprapubic swelling

• Vulval inspection:
• Tense bulging membrane of bluish colouration

• Rectal examination:
• Bulged vagina
Treatment
• Cruciate incision is made in the hymen.
• Quadrants of the hymen are partially excised not too
close to the vaginal mucosa
• Spontaneous escape of dark tarry coloured blood is
allowed.
• Patient should be made to lie down with the head end
raised.
TRANSVERSE SEPTUM ABOVE THE
LOWER ONE – THIRD…
• Usually comes earlier than the previous one with the
septum placed higher and higher
• Same presenting features, but urinary symptom
absent.
• Same surgical treatment
Fallopia Tube
n

Uterus
Rectum
Urinary
Bladder Cervi
x
Urethra ---
Septum
......_-
Vagina
SEPTATE VAGINA
• Complete or incomplete longitudinal septum
• May be assoc with double uterus and double cervix
• May be asymptomatic or may produce dyspareunia o
may obstruct delivery
• Treatment: septum to be excised.
PARTIAL ATRESIA OF THE VAGINA
• A segment of the vagina may be atretic in the upper
third. May be assoc with cervical atresia
• Functioning uterus (usually)
• Primary amenorrhoea, periodic pain in lower
abdomen with a mass felt per abdomen or rectal
examination point to the diagnosis.
• Excision of the atretic portion from below and
suturing the upper and lower margins of the vaginal
walls are usually effective.
COMPLETE ATRESIA
• Assoc with absence of uterus
• Healthy gonads and fallopian tubes
• Pt is phenotypically female with normal karyotype
pattern
• Entity is often assoc with urinary tract abnormality
 called Rokitansky – Kuster – Hauser syndrome
Uterine
Anomalies…
FAILURE OF FUSION OF
MULLERIAN DUCTS
• In majority, the presence of deformity escapes
attention.
• Detection is made accidently during the investigation
of infertility or repeated pregnancy wastage.
• In other cases, diagnosis is made during D + E
operation , manual removal of placenta or during
Caesarean section.
Indentati
on

A
Uterus
B c
Uterus Uterus bi
d1delphys arcuatus cornis
with double
I vagina

-- Open part
of
D E F vagina
Uterus bicornis Atresia of Atres,a of
unicollis cervix vagina
1 rudimentary Inc.
horn
Copyright @2006 by The McGraw-Hill Companies,
TYPES:
• Arcuate

• Fundus looks concave with heart shaped cavity outline


• This looks more like a normal uterus, except it has a dip, or
slight indentation at the top.
• It is a common abnormality, affecting about one in 25 women
in the general population.
• It doesn't usually make conceiving difficult.
• Uterus didelphys
• Complete lack of fusion of the Mullerian ducts with a double
uterus and a double vagina.
• This is when the uterus has two inner cavities.
• Each cavity may lead to its own cervix and vagina, so there
are two cervixes and two vaginas.
• It is uncommon, affecting about one in 350 women.
• It is possible to conceive if you have this type of abnormality,
and have a straight forward pregnancy.
• Uterus bicornis
• There are varying degree of fusion of the muscle walls of the
two ducts.
• Uterus bicornis bicollis : 2 uterine cavity with double cervix
with or without vaginal septum.
• Uterus bicornis unicollis
• 2 uterine cavity with one cervix
• Horns may be equal or one horn may be rudimentary and
have no communication with the developed horn.
• Septate uterus
• 2 mullerian ducts fused together but there is persistence of
septum in between the two either partially or completely
Clinical Features
• May not produce any clinical manifestation.
• Gynaecological:
• Infertility and dyspareunia often related – vaginal septum
• Menorrhagia – due to increased surface area in bicornuate
uterus
• Obstetrical
• Midtrimester abortion – may be recurrent
• Increased incidence of malpresentation – transverse lie in
arcuate or septate, breech in bicornuate, unicornuate or
complete or septate uterus
• Preterm labour
• Prolonged labour – due to incordinate uterine action
• Obstructed labour
• Retained placenta and postpartum haemorrhage where the
placenta is implanted over the uterine septum.
Treatment
• Rudimentary horn can be excised to prevent any
obstetrical complications
• Uterine septum can be effectively resected
hysteroscopically either by scissors or laser
Abnormalities
of the
Fallopian
Tubes
• Tubes may be unduly elongated
• Rarely tube may be absent on one side
• These may lower the fertility or favour ectopic
pregnancy
Anomalies
of the
Ovaries
• There may be streak of gonads or gonadal dysgenesis
which are usually associated with errors of sex
chromosomal pattern.
• No treatment will help this condition
• Accessory ovary may be present
• Supranumerary ovaries may be present in the broad
ligament or elsewhere (rare)

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