Gynatresias

GYNATRESIAS, or gynecological atresias, are narrowings or closures of channels and openings in the female genital sphere. A distinction is made between congenital and acquired gynatresias. Congenital gynatresias represent particular cases of irregular development of the female genital organs (see). Most frequently they are observed in the region of the external and internal os of the uterine cervix, less frequently along the entire extent of the cervix (atresia cervicalis) or in the vagina. In the vagina, the most frequent site of atresias is the hymen (atresia vaginae hymenalis), and less frequently the overlying parts of the vagina (retrohymenal atresias). Congenital gynatresias are frequently combined with other developmental malformations of the genital organs (e.g., complete absence of the vagina—aplasia vaginae). According to Rosthorn, congenital atresias of the uterus and vagina occur in 0.02–0.04%. Acquired gynatresias are observed more frequently and are usually associated with prior ulcerative-inflammatory processes, representing consequently a special case of healing by fusion of contacting granulating surfaces and obliteration of the lumen. Such gynatresias are noted after severe vaginitids, for example in infectious diseases (diphtheria, measles, scarlet fever, etc.), during trauma, after deep cauterizations of the mucous membranes, e.g., following vaporization (see), after certain operations (amputatio colli uteri), repeated curettages of the uterus, and the like; senile atresias of the cervix and body of the uterus are comparatively frequent, although their inflammatory origin is not always proven with certainty. Moreover, even in congenital gynatresias, the significance of inflammation (during intrauterine life) cannot always be excluded. Congenital gynatresias acquire clinical significance with the onset of puberty, when menstrual discharges are retained above the site of atresia, which is accompanied by the accumulation of blood masses and significant stretching of the organ. Thus arise haematocolpos, haematometra (see) upon atresia of the cervical canal (less frequently in vaginal atresias), and haematosalpinx (see) upon atresia of the tubal openings; in the latter case, atresia of only the abdominal end of the tube may be observed. The significance of acquired gynatresias varies depending on whether the woman menstruates or not; in the first case, phenomena analogous to those described arise; in the second case, the clinical relevance of gynatresias drops significantly, and they are often an accidental finding at autopsy. With the continued discharge of inflammatory products from the genital tracts lying above the site of atresia, phenomena of stretching of these tracts arise, the so-called pyosalpinx, pyometra, pyocolpos. Upon the discharge of the usual secretion of the fallopian tube, hydrops of the corresponding segment occurs (hydrosalpinx, hydrometra, hydrocolpos). Atresias in the region of the hymen and vagina constitute a substantial obstacle to sexual intercourse; atresias in the region of the cervical canal prevent fertilization, and if atresia develops after the onset of pregnancy, difficulties for the birth process may arise.