The surgical correction of congenital aplasia of the vagina: An evaluation of operative procedures, end result, and functional activity of the transplanted epithelium

Abstract

A LTHOIJGH congenital absence of the vagina has been recognized since earliest antiquity, its surgical correction began only a little over a century ago. Since the first reported attempt at surgical correction by Dupuytrenl in 1817, there have been many hectic years of trial and error, of weighing -the psychological evils of the anomaly against the risks of operation. Today, fortunately, all this has changed. There no longer appears to be any valid reason why girls with congenital aplasia of the vagina should not receive the benefit of modern surgical correction, and at a sufficiently early age to minimize psychological trauma. For these young women there are today satisfactory methods of treatment, but this was not always so. Indeed, the cycle through which their wheel of fortune has revolved represents a small, but interesting phase in gynecologic history. Steinmetz2 presented an interesting historical review of the subject in 1940. The incidence of vaginal aplasia is not definitely known, but Engstadt considers one in five thousand births a fair figure. Probably the condition is more common than was formerly believed because some afflicted individuals fail t.o seek treatment and many treated cases remain unreported. While the condition must have been recognized since earliest times, Burrage* states that the first reported case was described by Realdo Columbus in 1752. By 1895, however, Neugebauer had knowledge of one thousand collected cases. The condition represents an embryonal or developmental defect and may reveal itself as a partial OP complete absence of the vagina. Since the genital and urinary organs have a close embryonic origin, developmental anomalies of a,djacent urinary organs may also be encountered. This is an important point to remember since a pelvic mass found in connection with aplasia of the vagina may mean a pelvic kidney. One of our patients had only one kidney (Fig. 1). Counseller a.nd Sluder, Jr.,3 investigated 15 of their patients urologically and found only 6 had normal kidneys. Of the remaining 9, the left kidney was congenitally absent in 6. Two had ectopic pelvic left kidneys and one had a d.uplication of the left ureter.