Classification of Female Genital Malformations

Abstract

Aims: to critically review the current proposals for the classification of female genital tract anomalies and to present the new ESHRE/ESGE classification system. Brief description of the reviewed data: Classification of female genital anomalies is based on the systematic categorization of patients into classes having similar characteristics. Until recently, three systems were proposed for the classification of female genital anomalies: the American Fertility Society’s, the clinical & embryological and the Vagina Cervix Adnexa Uterus and associated Malformations classification systems. However, all of them were associated with serious drawbacks in the effective categorization of them. The European Society of Human Reproduction and Embryology (ESHRE) in collaboration with the European Society for Gynecological Endoscopy (ESGE) have recently published a new system using the anatomy of the female genital tract based mainly on the anatomy of the female genital tract. According to the ESHRE/ESGE system, anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance. Clinical implications: The ESHRE/ESGE classification system seems to overcome the existing limitations in the categorization of female genital anomalies and to fulfill the expectations and the needs of the clinicians working in the field. It represents a useful tool for the study of the clinical consequences of the various types of anomalies since it offers an objective categorization of them with its clear definitions. Furthermore, it could be used as the working basis for the development of recommendations for their diagnosis and treatment. Open issues for further research: The clinical value, the simplicity and the comprehensiveness of the ESHRE/ESGE classification of female genital anomalies needs to be proved in everyday practice.