WOMEN’S BODIES: UTERINE ABNORMALITIES. ABSENT UTERUS
The Müllerian ducts can completely fail to join up, resulting in a double uterus, cervix and vagina. More common are partial abnormalities of joining, resulting in varying degrees of septate uterus. However, often the evidence of incomplete joining is no more than an indentation in the fundus and a heart-shaped uterine cavity. Uterine malformations often cause no symptoms and may be discovered by chance. However, they sometimes cause problems with menstruation or pregnancy.
Rarely one or both compartments of the uterus don’t open into the vagina. In this case the uterus will begin to fill with menstrual blood at puberty, and will eventually need removal or a surgical procedure to connect it with the vagina so that the menstrual flow can drain.
The increased endometrial surface area in uteruses with a well-developed septum can be a reason for heavier periods.
Infertility isn’t a problem as long as there is a functioning ovary, a tube that connects with the uterine cavity and a cervix opening into the part of the vaginal where ejaculation takes place.
Some women with these abnormalities of the uterine cavity have no problem will pregnancy or delivery, but in general there is a higher risk of problems than in women with a normal uterus. Some abnormalities can lead to increased risk of miscarriage, often between the fourth and sixth month of pregnancy. The reason may be that the placenta can’t develop properly in the distorted uterine cavity, or because there isn’t enough room for the foetus to grow.
There can also be problems with delivery because of breech or transverse lit of the foetus, poor uterine contraction or maternal haemorrhage from abnormal placental attachment.
Surgical correction of any degree of septate uterus is only attempted if the abnormality causes problems.
Absent uterus
toy rarely all the organs derived from Müllerian tissue are absent (tubes, uterus and upper vagina). The cause of this depot is unknown. The lower vagina may be just a small dimple at the site of the introitus. Girls with this condition are generally otherwise healthy and have normal ovaries producing hormones that lead to normal pubertal development of breasts, external genitals, height, and body shape and hair; often nothing is suspected until menstruation fails to occur by the age of 16 years. In such cases a vagina can be created by plastic surgery or by using dims to stretch the vaginal ‘dimple’ to a space large enough for sexual intercourse. A normal sex life can follow, but of course pregnancy is impossible. Women with an absent uterus may also have kidney abnormalities; often one kidney is missing and the other is in an abnormal place, commonly in the pelvis. The kidneys should always be checked (usually by intravenous pyelogram): there are a few disastrous records of a single pelvic kidney being removed in the belief that it was a uterus or tumour!
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