Outflow Obstructions
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
Background
Genital tract outflow is important for the expulsion of normal secretions from the cervix and vagina. Outflow is also critical for menstrual efflux. Outflow obstruction may occur at different levels with resultant variations in clinical presentation.
Pathophysiology
Embryologically, the lower two thirds of the vagina develop from the urogenital sinus. The upper vagina, cervix, uterus, fallopian tubes, and ovaries form from the Müllerian duct system. Failure of vertical fusion or canalization of the 2 systems in utero may result in bicornuate uterus, uterus didelphus, cervical stenosis or atresia, vaginal atresia, or longitudinal or transverse vaginal septa. In addition, hymenal tissue may be imperforate.
Epidemiology
Frequency
United States
Female genital malformations occur in 5% of the general population.[1] The incidence of Müllerian agenesis is about one in 4500 women; 30-36% of such malformations are associated with other anomalies as well, particularly anomalies of the kidneys and skeleton.
International
Imperforate hymen is the most common genital outflow tract anomaly.
Mortality/Morbidity
Patients with undiagnosed imperforate hymen who have reached menarche may have recurrent, cyclic, lower abdominal pain.
Age
Although imperforate hymen is a congenital anomaly and can be detected early in life, imperforate hymen remains undetected until puberty in many patients. At birth, the presence of increased mucous secretions in the vagina secondary to maternal estrogen effects may result in a mucocele appearing as a bulging hymen, which is easily observed.
If not detected at birth, secretions resorb, and the condition may be undetected until puberty, when menstrual blood collects and causes hematocolpos, a bluish-colored bulging hymen.
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