Vaginal aplasia and its treatment options

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is characterised by complete or partial vaginal aplasia, meaning that the vagina is either absent or only partially developed. This condition occurs in about one in 4,000–5,000 women.

Depending on the type of MRKH syndrome, abnormalities of other organs may also occur. However, the typical form – characterised by the absence of vaginal, cervical, and uterine development – is the most common. In some cases, women with MRKH have rudimentary (underdeveloped) uteri that contain endometrium, the inner uterine lining, which can lead to pelvic pain. Because ovarian development is normal in women with MRKH, external sexual characteristics develop normally. The condition is most often diagnosed when an evaluation is sought for primary amenorrhea (absence of menstrual periods).

Common Symptoms in Women with Vaginal Aplasia

The most common reason women with MRKH seek medical attention is primary amenorrhea, meaning the absence of menstruation at puberty. MRKH syndrome is the second most common cause of primary amenorrhea after gonadal dysgenesis, accounting for approximately 10% of all cases.

As a girl with MRKH grows older, questions regarding sexual activity and, later, pregnancy inevitably arise. Although some girls with vaginal agenesis may engage in anal intercourse, research shows that the absence of a functional vagina and the resulting inability to have vaginal sex can significantly reduce quality of life and contribute to psychological distress. Unfortunately, pregnancy is not possible in women with MRKH because the uterus has not developed. Importantly, girls with MRKH have normal ovarian function, meaning that eggs can be retrieved for assisted reproductive technologies. Unfortunately, surrogacy – one potential option for women with MRKH – is not permitted in Latvia. Another possibility is uterine transplantation, but it is a very complex procedure and is only offered in a few countries around the world. Although the results are very promising, due to the strict exclusion criteria, only a few women have access to this method.

It should be emphasised that the care of patients with MRKH must be multidisciplinary – surgical vaginoplasty alone is not sufficient, and psychological support is often essential.

Vaginal Aplasia Treatment Options

Both non-invasive and surgical methods are available for creating a neovagina. If non-surgical treatment does not achieve the desired results, or if the patient does not wish to undergo self-dilation (Frank method), surgical techniques for creating a neovagina are available.