Congenital anomalies of the female genital organs can lead to various gynecological issues and pregnancy complications. These anomalies can range from mild to very severe. They may present in different forms, from a simple uterine notch to a completely closed hymen or severe anomalies such as a double uterus.
What Problems Do Female Genital Organ Anomalies Cause?
They can cause various clinical conditions and complaints such as menstrual irregularities, painful periods, recurrent pregnancy loss, preterm birth, fetal growth restriction, breech presentation, bleeding during pregnancy, placental attachment anomalies, infertility, and difficulty or pain during intercourse.
WHAT IS THE PREVALENCE OF FEMALE GENITAL ORGAN ANOMALIES?
In general, they are observed in 5% of women. While they can be seen in 10% of those with recurrent pregnancy loss, these anomalies can accompany up to 25% of those who have had a preterm birth. Female genital organ anomalies usually do not prevent conception; however, they lead to problems such as miscarriage and preterm birth in an established pregnancy.
What Are the Types of Female Genital Organ Anomalies?
Uterine agenesis, where the uterus does not develop at all, is the most severe anomaly.
In the anomaly called uterus unicornis, where only one side of the uterus develops, the uterus is smaller than normal, which may pose a risk of miscarriage and preterm birth during pregnancy.
In uterus didelphys, an anomaly where a double uterus develops, the fusion of the uterine ducts is insufficient, and the uterus is shaped like rabbit ears. This anomaly also carries a risk of preterm birth.
In uterus bicornis, where there is a partial problem in the fusion of the uterus, there is a depression in the middle of the uterus, giving it a heart shape. This anomaly can also lead to pregnancy-related problems.
Sometimes the wall present in the middle of the uterus during embryological life does not regress and remains as a “curtain” (septum) in the middle of the uterus; this anomaly is called uterus septus. This is the uterine anomaly that most frequently causes miscarriage. It is possible to treat it using an endoscopic method called hysteroscopy.
Conditions such as an imperforate hymen or a vaginal septum can cause severe pelvic pain, menstrual cramps, and difficulty during intercourse. It is possible to diagnose these anomalies during a gynecological examination, and their treatment is straightforward.
How Do We Diagnose Female Genital Organ Anomalies?
Diagnosis is easily possible through methods such as gynecological examination, ultrasonography, 3D ultrasonography, medicated uterine X-ray (HSG), MR imaging, and laparoscopy or hysteroscopy.
Is Treatment Possible for Female Genital Organ Anomalies?
These anomalies should be treated if they cause symptoms. Treatment must be recommended in the presence of difficulty or pain during intercourse, severe pelvic pain, painful periods, infertility, or a history of miscarriage or preterm birth in previous pregnancies. Endoscopic methods are frequently used in the treatment of these anomalies. Laparoscopy and hysteroscopy are the endoscopic methods used for treatment.
Are There Acquired Female Genital Organ Anomalies?
Intrauterine adhesions and the presence of space-occupying structures such as myomas (fibroids) or polyps within the uterus are acquired uterine anomalies. These anomalies occur due to previous surgeries, uterine interventions, and hormonal changes.
Are Acquired Uterine Anomalies a Cause of Infertility?
Particularly, intrauterine adhesions can prevent conception and cause the endometrium (the inner lining of the uterus) to remain thin. Therefore, if there is suspicion before assisted reproductive treatments, the presence of pathology inside the uterus should be investigated via hysteroscopy. Space-occupying structures like polyps or myomas should also be removed during hysteroscopy. In couples with previously unsuccessful IVF treatments, checking the inside of the uterus with a procedure called office hysteroscopy—which does not require anesthesia—before a new treatment can increase the success rate.
