Abnormalities of female genital tract and intersex disorders

Transverse fusion abnormalities

The surgery required is a simple incision, which should be performed when the diagnosis is made to prevent too big a build up of menstrual blood, which may lead to a haematometra8 and consequent increased risk of endometriosis (secondary to retrograde menstruation). A transverse vaginal septum, due to failure of fusion or canalization between the Müllerian tubercle and sinovaginal bulb, may present like an imperforate hymen but is associated with a pink bulge at the introitus as the septum is thicker than the hymen. Great care must be taken during surgery to prevent annular constriction rings and the procedure should only be performed in dedicated centres by experienced surgeons. When there is a transverse septum it has been found to be high in 46 per cent of patients, in the middle of the vagina in 40 per cent and low in the remaining 14 per cent. It is the patients in the last two groups who have higher pregnancy rates after surgery.

Müllerian/uterine anomalies

Uterine anomalies occur in between 3 and 10 per cent of the fertile female population and are often discovered by chance during coincidental investigations for infertility. They have usefully been classified by the American Society for Reproductive Medicine into five groups. Women with uterine anomalies are usually asymptomatic, unless there is obstruction to menstrual flow, when cyclical pain may be experienced. While infertility per se is rarely caused by uterine anomalies, they may be associated with endometriosis if there is retrograde menstruation secondary to obstruction. Furthermore, recurrent miscarriage may be experienced by some women with uterine malformations.

Surgery is reserved for those cases where there is obstruction, for example the removal of a rudimentary uterine horn or excision of a vaginal septum. The excision of a uterine septum has been shown to improve pregnancy outcome and should be performed by an experienced hysteroscopist. On the other hand, metroplasty (Strassman procedure) of the horns of a bicornuate (having two horns) uterus is currently seldom performed as its benefit has been questioned.

Abnormalities of male genital tract

Bilateral castration and anorchia10 (incidence of 1 in 20,000 males) are rare causes of absent testicular tissue. Other rare anatomical causes of male  infertility include agenesis (absence) of the epididymis or other parts of the ductal system including the vas deferens. The latter is found in most males discount viagra Canadian with cystic fibrosis (CF). The majority of males found to have isolated bilateral agenesis of the vas deferens without any other signs of CF have been found to be carriers of a point mutation in the CF gene. In these individuals, genetic counselling is indicated.