Congenital absence of the vagina with a functioning uterus

A functioning uterus may be present in 5 to 10 % of the patients with congenital absence of the vagina. The proper treatment for these patients depends on accurate pre-operative diagnosis on whether or not a cervix is present, because the mode of operation should be selected according to the type of abnormality. Ultrasonography or X-ray CT scan will not always be useful to answer this question. We encountered a 15-year-old female with cyclic lower abdominal pain and the failure of onset of menstruation. The external genitalia were normal except for the absence of the vaginal opening. Ultrasonography and X-ray CT scan revealed the presence of both uterine corpus and hematocolpos, but no definite findings were obtained on the integrity of the cervix. By using NMR-CT scan, we found a hematocolpos, properly developed uterine cervix and corpus above it. We treated the patient by preserving the uterine function and the potential for pregnancy in the future. NMR-CT scan seems more useful in some cases for diagnosis of pelvic mass than ultrasonography and X-ray CT scan. (author)