Vaginal atresia is a rare condition that occurs during fetal development, in which the vagina does not develop correctly or wholly.

It typically affects the development of the vaginal canal, and may cause blockage of the vaginal opening. The vaginal canal may be shorter or missing, or there may be a lack of connection between the lower vagina and upper vagina.

It is important to note that this condition is not referring to an imperforate hymen. A hymen is a thin membrane that may partially cover the vaginal opening. Many individuals have a hymen, and they can vary in shape.

For individuals with an imperforate hymen, the membrane may be naturally thicker or covering more of the vaginal opening—leading to blocked menstrual flow and discomfort.

While this may seem to have some similar symptoms to vaginal atresia, individuals with vaginal atresia have an underdeveloped vaginal canal.

Having an imperforate hymen does not alter the length or structure of the vaginal canal, and can typically be corrected with a hymenectomy. Vaginal atresia, on the other hand, is a congenital condition that requires other forms of treatment.

To explain the effects of vaginal atresia a bit further, let’s discuss the anatomy of the vagina. There are three “sections” of the vagina, the upper third, middle third, and lower third. In very basic terms, these sections can be described as such:

• Upper third: The area of the vaginal canal closest to the cervix and uterus
• Middle third: Area near the bladder base (lower portion of the bladder)
• Lower third: Area near the vaginal opening and vulva (external genitalia)

It may be helpful to have a general idea of these internal sections of the vagina, as these areas are what get affected by different types of vaginal atresia.

The external genitalia (labia, clitoris, and other portions of the vulva) are typically still present and fully developed.

Additionally, “vaginal atresia” refers to partial development or formation of the vagina that causes closure of the vaginal opening, whereas “vaginal agenesis” is the complete absence or lack of development of the entire vagina.

While these two terminologies may seem similar, they should be differentiated.

“Vagina atresia” specifically refers to the underdevelopment of the vagina, but this condition may be accompanied by other malformations of internal organs such as the uterus or fallopian tubes.

These internal structures may be absent, partially developed, or unaffected, depending on the individual case.

Vaginal atresia is most common with the following syndromes:

• Bardet-Biedl syndrome: An inherited disease that affects vision and often has other developmental abnormalities, including vaginal atresia in rare cases.
• Fraser syndrome: A rare developmental disorder that involves tissue abnormalities, including those that can affect the genitalia and the urinary tract.
• Mayer-Rokitansky-Küster-Hauser syndrome (MRKH): Genital condition that is characterized by an underdeveloped (or absent) uterus or vagina. This condition can cause painful or difficult sexual intercourse, as well as reduced vaginal depth and width. Reproductive organ development varies by the individual, but this condition often causes a lack of menstruation and removes the ability to experience pregnancy. 
• Isolated vaginal atresia: In some cases, an individual may have an underdeveloped vagina as their only symptom, with no other bodily anomalies present.

Symptoms of this condition depend on the severity of the condition, but may lead to functional difficulties involving menstruation, penetrative intercourse, or other aspects such as using menstrual products or sexual aids, or receiving an internal examination.

Outside of the direct physical effects of vaginal atresia, this condition can cause avoidance of pelvic exams or treatments, pelvic floor tension caused by anxiety and stress related to the condition, as well as other issues involving scars from surgical interventions.

Start Healing with Hive

As mentioned before, this condition is created by the underdevelopment of the vaginal canal during fetal growth. The developmental process of the vagina or other reproductive organs is disrupted, and therefore results in an incomplete formation.

This is usually due to chromosomal abnormalities, but the cause of these genetic disruptions is unknown. Therefore, the main risk factor for vaginal atresia is genetic dispositions.

Vaginal atresia can be discovered at birth, and is commonly discovered when a person comes of menstrual age but does not experience bleeding (due to the vaginal opening being covered).

The time of discovery, age of the individual, severity of the condition, and their unique treatment needs decide how a pelvic floor therapist is included in the process. When this condition is discovered, treatment requires a multidisciplinary approach that can vary from case to case.

When discovered at birth, treatment options for vaginal atresia are typically discussed with the individual’s parents so that they can plan to address the issue later when the child is older.

If this condition is discovered around the time of a child’s first menstruation, a physical therapist can be involved in multiple scenarios.

For example, if it is determined that surgery will be necessary for treatment of vaginal atresia, physical therapy will be essential before and after surgery.

Surgery is traumatic to the bodily tissues, and pelvic floor therapy will be necessary to ensure healthy healing of the pelvic floor muscles. Pelvic floor physical therapy can provide the following benefits for surgical treatment:

• Supporting post-surgical healing
• Pain management
• Effective and safe vaginal tissue stretching via dilators
• Scar tissue management
• Desensitization
• Ensuring pelvic floor health and function

If the surgical route is not chosen and instead the focus turns to stretching tissue to reform a vaginal canal, a physical therapist will once again be very necessary—whether this is for a younger individual experiencing menstruation for the first time, or an adult finding complications later in life.

Although dilation is commonly an at-home practice, a pelvic floor physical therapist can be extremely important in properly guiding the individual (or a parent if necessary) through the process properly and effectively.

Regardless of the treatment route needed, pelvic floor physical therapy plays an essential role in restoring function and relieving pain associated with vaginal atresia.

Pelvic floor therapists can also provide valuable education regarding pelvic floor anatomy, general anatomy relating to the vagina, pelvic floor care, and the proper use of dilators to support vaginal health.

Here are some examples of how pelvic floor physical therapy can support individuals with vaginal atresia:

Rehabilitation Post-Surgery 

As described previously, pelvic floor therapy will be very necessary before and after surgical corrections for vaginal atresia.

Pelvic floor therapy can help promote optimal healing by restoring pelvic floor muscle health and ensuring the correct usage of dilators during the healing period.

Pelvic floor therapists can help individuals manage pain from surgery as they heal with pain-relieving modalities, and teach the patient massage techniques for scar tissue.

Scar tissue mobilization will be important to reduce the formation of adhesions and to reduce scar pain.

Pelvic Floor Training

Pelvic pain and anxiety from vaginal atresia or surgery can lead to muscle tension and pelvic floor dysfunction—which can cause more symptoms that involve the bladder or bowels.

To prevent worsened pain or other symptoms of pelvic floor dysfunction, a pelvic floor therapist can help the patient regain control over their pelvic floor.

This can involve neuromuscular re-education and biofeedback treatments, which allow a patient to feel their pelvic floor and better understand contraction and relaxation. Treatments aimed at pelvic floor health can improve muscle function and coordination, resulting in better comfort and control for the patient.

Pelvic floor training can include exercises to strengthen the pelvic floor, as well as relaxation techniques to relax the pelvic floor and reduce tension.

If necessary, manual therapies can be performed externally or internally by the physical therapist to address tight muscles or trigger points.

Desensitization and Dilation

One important aspect of pelvic floor therapy that is often necessary for individuals with vaginal atresia is dilation, as mentioned previously. Dilation involves tools of varying sizes that are inserted into the vagina to gently stretch the tissues and to desensitize the individual to penetration.

Dilation is effective and safe, and allows individuals with vaginal atresia to reform their vaginal canal and relieve pain.

This can relieve sexual dysfunction for adults who have lasting effects of vaginal atresia, and can help allow for more comfortable pelvic exams or the use of insertables (menstrual products, sexual aids, etc).

Education

As mentioned earlier, pelvic floor therapists are able to provide education to their patients to help them better understand their body, pain, and condition. Having a clearer idea of how your body works and how a condition affects you can help relieve fear or anxiety associated with a lack of understanding.

Additionally, physical therapists can teach their patients at-home care for relaxation, pain management, and again, dilator usage.

Another important part of pelvic floor education is informing patients of habits or postures that can harm their pelvic floor health.

Pelvic floor therapists can teach about standing, sitting, or toilet postures that can lead to pelvic floor tension and dysfunction, as well as other bathroom habits that can strain those important muscles.

They may make other lifestyle suggestions that can help protect a healthy pelvic floor long-term!

Collaboration

The physical therapists at Hive Therapy and Wellness take a holistic approach to patient care. They understand that many conditions such as vaginal atresia require more than just physical care—they require emotional care, too.

Vaginal atresia can not only create pain, but also anxiety and emotional challenges with self image or confidence.

Therefore, Hive Therapy and Wellness works to treat patients with compassion and can provide additional support by collaborating with other members of their health team, such as mental health professionals, if necessary.

Hive’s providers hope to not only help you feel great physically, but also emotionally, and hope to provide you with the tools and resources necessary to improve your quality of life.

The physical therapists at Hive Therapy and Wellness can utilize many different treatments in order to enhance holistic healing. While under Hive’s care, you can expect any of the following treatments to be a part of your comprehensive care plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback