The clinic and the diagnosis of anomalies of the female genital organs is difficult because a number of shortcomings do not manifest themselves, and for the first time they make themselves felt only in the puberty period.
Detection of anomalies of the genital organs has three peaks: at birth, during puberty, and when attempting to develop sex life. Leading, and sometimes the only symptom is menstrual dysfunction in the form of amenorrhea or polymenorrhea. These manifestations are due to the absence outflow of menstrual blood from the malformed genital tract.
Quite frequent symptom that appears in the puberty period are abdominal pain. Pains are aggravated every month, sometimes accompanied by loss of consciousness, nausea, dysuric phenomena. Pain symptom is associated with impaired outflow of menstrual blood and overdistension of abnormal genital tract, and the accumulation of menstrual blood in the vagina, hematocolpos, uterus-hematometer, fallopian tubes and hematosalpinx. Pain syndrome can also be a manifestation of a combination of defects with congenital endometriosis. A tumor-like mass is found in the lower abdomen among patients with a hematometer that has arisen on the basis of ginatresia in the abdomen during palpation, . The size of the hematometer is sometimes similar to the uterus in late pregnancy. The tumor is initially painless, mobile, located in the center, and when menstrual blood gets infected or enters the abdominal cavity, signs of peritonitis may appear. Percussion manages to determine the dullness of sound in hypogastria. Hyperthermia, which is observed, is caused by the absorption of pyrogens from the sites of blood accumulation or suppuration during stagnation.
Diagnosis of anomalies of the external genital organs
Examination of the external genital organs is of decisive diagnostic importance in case of atresia of the hymen. The cyanotic tumor (hematocolpos) causes the hymen to explode, and sometimes the entire perineum. There is a tension in this area, and sometimes a gaping genital slit. Sensing the vagina and uterus are proposed to identify such anomalies as membranes, speeches, additional moves. Obligatory diagnostic method is two-handed rectangular-chevnostinne research. In the presence of a hematometer and hematosalpinx, a large, round, elastic, fluctuating, painless tumor is rectally determined. It should not be forgotten that a dystopic kidney can be palpated in the lower abdomen or in the small pelvis. When conducting a vaginal examination, it is possible to find a doubling of the uterus, the presence of a rudimentary horn, an enlarged uterus (hematometer). Vaginoscopy allows a doctor to find a doubling of the cervix, the remnants of Gartner’s course, the membrane of the vagina, the opening of the fistula.With X-ray methods, informative hysterosalpingography is suspected in a two-horned uterus, the presence of a membrane in the uterus, as well as a rudimentary horn, if the lumen communicates with the uterine cavity. Gas pelvography is used, and bi-contrast gynecography carries important information for all types of abnormalities of the internal genital organs. Ultrasound as a method for diagnosing a hematometer and hematocolpos, as well as monitoring the effectiveness of treatment are very important. Intravenous urography is mandatory in almost all cases of genital abnormalities. In some cases, diagnostic laparotomy is crucial, which, if necessary, can be converted into treatment: gonadectomy, resection of the ovaries, plastic, cutting off rudimentary formations.
There are often anomalies of development that do not allow to visually determine the sex of a person. Establishing the correct gender in patients with malformations of the genital organs is important for deciding on the correct choice of rational corrective therapy and avoiding diagnostic and therapeutic errors. To establish the true (genetic) sex, it is necessary to determine the sex chromatin (Barr body) and examine the karyotype in peripheral blood lymphocytes.
Treatment of anomalies of the external genital organs with one type of pathology (saddle-womb, unicorn uterus, double sexual apparatus) is not required (you just need to know about abnormalities in the management of pregnancy and childbirth); for others, treatment is ineffective and boils down to ensuring sexual function (creating an artificial vagina before entering into marriage).
The most beneficial for the treatment is hymen atresia. In the center of the hymen, a puncture of the hematocolpus is performed, and then a 2×2 cruciate incision is made, and after the main blood is poured out (maybe up to 2 liters of dark blood), single edges of catgut sutures form the edges of the artificially created Himaleous opening. For the prevention of relapse, it is necessary to perform the buguvan-niya artificial hymenal holes. In cases of atresia or vaginal agenesis with established internal genital organs, surgical treatment to create an artificial vagina provides these women with the possibility of sexual life. At the present stage, the most effective and physiological is considered to be the peritoneal colpopoies compared with the methods that are associated with the use of segments of the intestine, skin, alloplastic materials. Method of single-stage colpopoiesis is the following: after dissection of the mucous membrane of the vestibule of the vagina and the underlying fascia, a bed is created in the transverse direction between the urethra and the rectum to the peritoneum, while the sciatic-cavernous muscles and connective tissue membranes are dissected, and the tissue adjacent to the peritoneum is widely visible from the rectum, bladder to the walls of the pelvis. Then it is necessary to open the abdominal cavity slightly backwards from the muscle roller (rudiment of the uterus) in the transverse direction for 4-5 cm. Four ligatures are placed on the peritoneum (on the anterior and posterior sheets and on the sides) and are ligated to the vaginal opening and hemmed with the individual catgut sutures to the edges of the incision in the vagina. After the patient is transferred to the Trendelenburg position and the dome of the vagina is formed. It is necessary to do this at a depth of 11-12 cm in the transverse direction impose catgut sutures on the anterior and posterior sheets of the peritoneum. The vagina is loosely tamped with gauze moistened with vaseline oil.
Rehabilitation of anomalies of the external genital organs
A girl suffering from an abnormal development of the genitals, or undergoing surgical correction is subject to follow-up. When signs of infantilism appear, the doctor begins hormone replacement therapy. In the process of observing this group of girls, it is necessary to exercise oncological vigilance, since the blastomatous campfire is often found on formed genitals. No less serious risk is the development of endometriosis. However, in most cases after surgical correction, the girl is able to conceive. Often there are signs of threatened abortion, and in childbirth, anomalies of labor and anxiety for hypotonic bleeding are almost always observed.