Fig. 178.—Uterus septus (Cruveilhier).
Unilateral Vagina.—In this variety of malformation one of the ducts of Müller fails to develop at all. The condition always occurs with uterus unicornis. The vaginal canal is smaller than normal and may be situated to one side of the median line.
Absence of the vagina rarely occurs. There may be no sign whatever of this structure, or it may be represented by a fibrous cord. The external genitals may also be absent, or they may be well developed.
If the uterus and ovaries are well developed, much trouble may arise from retention of menstrual blood.
An attempt should be made, by means of a transverse incision between the rectum and the urethra, to reach the cervix, and, if possible, to make an artificial vagina by transposition of skin from the buttocks. Such treatment is usually unsatisfactory, as a patulous canal cannot be maintained. It may be necessary to remove the uterus and appendages.
Sometimes the vagina is absent in only part of its course, being open below and represented above by a fibrous cord; or the upper and lower portions may be developed, while the middle portion is imperforate.
Fig. 179.—Transverse septum of the vagina (Heyder).
These conditions are more amenable to operative treatment than in the case of complete absence of the vagina. The intervening septum should be incised, and the patulous condition maintained by the passage of bougies if necessary.
Sometimes the lumen of the vagina is obstructed by the presence of transverse bands or crescentic folds, which have been described as supplementary hymens ([Fig. 179]).