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Nathan Howard
Nathan Howard

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Hormone therapy with estrogen or progesterone, alone or in combination, may help menopause symptoms such as hot flashes or vaginal dryness and pain with intercourse. Hormone therapy has risks, so it is not for every woman. Discuss the risks and benefits of hormone therapy with your provider.

To help manage problems such as painful sexual intercourse, use a lubricant during sexual intercourse. Vaginal moisturizers are available without a prescription. These can help with vaginal and vulvar discomfort due to the drying and thinning of tissues. Applying topical estrogen inside the vagina may help thicken the vaginal tissues and increase moisture and sensitivity. Your provider can tell you if any of these measures is right for you.

Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 14.

The onset of puberty is associated with high GnRH pulsing, which precedes the rise in sex hormones, LH and FSH.[17] Exogenous GnRH pulses cause the onset of puberty.[18] Brain tumors which increase GnRH output may also lead to premature puberty.[19]

Perineal skin keratinizes due to effect of estrogen increasing its resistance to infection. The mucosal surface of the vagina also changes in response to increasing levels of estrogen, becoming thicker and duller pink in color (in contrast to the brighter red of the prepubertal vaginal mucosa).[53] Mucosa changes into a multilayered structure with superficial layer of squamous cells. Estrogen increase glycogen content in vaginal epithelium, which in future plays important part in maintaining vaginal pH. Whitish secretions (physiologic leukorrhea) are a normal effect of estrogen as well.[50] In the two years following thelarche, the uterus, ovaries, and the follicles in the ovaries increase in size.[54] The ovaries usually contain small follicular cysts visible by ultrasound.[55][56] Before puberty, uterine body to cervix ratio is 1:1; which increases to 2:1 or 3:1 after completion of pubertal period.

In girls, estradiol (the primary female sex hormone) causes thickening of lips and oral mucosa as well as further development of the vulva. In the vulva and vagina, estradiol causes thickening (stratification) of the skin and the growth of both the myoepithelial layer and the smooth muscle of the vagina. Typically estradiol will also cause pronounced growth of the labia minora and to a lesser degree of the labia majora.

Normal puberty is initiated in the hypothalamus, with de-inhibition of the pulse generator in the arcuate nucleus. This inhibition of the arcuate nucleus is an ongoing active suppression by other areas of the brain. The signal and mechanism releasing the arcuate nucleus from inhibition have been the subject of investigation for decades and remain incompletely understood. Leptin levels rise throughout childhood and play a part in allowing the arcuate nucleus to resume operation. If the childhood inhibition of the arcuate nucleus is interrupted prematurely by injury to the brain, it may resume pulsatile gonadotropin release and puberty will begin at an early age.

Rising levels of estradiol produce the characteristic estrogenic body changes of female puberty: growth spurt, acceleration of bone maturation and closure, breast growth, increased fat composition, growth of the uterus, increased thickness of the endometrium and the vaginal mucosa, and widening of the lower pelvis.

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Uterine cancer usually occurs after menopause, typically between the ages of 60 and 70. It also may occur around the time that menopause begins. Abnormal vaginal bleeding is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Women should not assume that abnormal vaginal bleeding is part of menopause. A woman should see her doctor if she has any of the following symptoms:

During pregnancy, a baby's reproductive system may not finish developing in the mother's uterus. She may be born without a vagina and have other absent reproductive organs. This condition is called vaginal agenesis. Some facts about the condition:

It's perfectly normal for your daughter to feel anxious and or sad when she hears this diagnosis and grasps that she will not be able to become pregnant and carry a child. Gender identity and body image issues are also expected, but it's important for you and your daughter to know that she is a genetic female with the ability to experience normal sexual feelings. After successful treatment, no future sexual partner will be able to tell that she was born with vaginal agenesis.

Mayer-von Rokitansky-Küster-Hauser's Syndrome (MRKH) leads to 90 percent of vaginal agenesis cases. There are several different variations of this congenital disorder. Some patients may have no vagina and no uterus. Others may have a midline uterus, but no vagina and no cervix. Sometimes MRKH is associated with kidney, skeletal, and hearing problems. Most commonly, a patient with MRKH will not have a uterus.

About 7 to 8 percent of patients with vaginal agenesis have a less common condition called androgen insensitivity syndrome (AIS). These patients have a normal female appearance, but lack a vagina, cervix, uterus, fallopian tubes, and ovaries.

Testing is especially important for vaginal agenesis, in order to understand the extent of the reproductive anomalies. Young women typically present for testing sometime during the middle teen years when they experience primary amenorrhea, or lack of a menstrual period, after having normal breast development.

Unlike most medical conditions in which you seek treatment immediately after diagnosis, with a vaginal agenesis your doctor will typically not intervene immediately unless there is pain, or a specific medical reason to proceed. It's entirely up to your daughter to decide when and if she is ready for treatment. She needs time to understand her condition and grieve the emotional disappointment of not having a complete reproductive system.

She may opt to wait or do nothing. If she plans to have sexual intercourse now or in the future, she may decide to create a vagina. Many girls with vaginal agenesis decide to create a vagina during their teenage years.

Dilator treatment is the standard, most efficient treatment for MRKH. It's recommended by the American College of Obstetricians and Gynecologists (ACOG) as the first choice of treatment to create a vagina for girls with MRKH.

The main advantage of vaginal dilation is that it doesn't require surgery. The main disadvantage is that it requires using a dilator once to twice a day until the vaginal canal is stretched to a normal length.

A vaginal dilator is hard, smooth plastic and shaped similar to a tampon. When pressure is applied by hand over time it stretches the vagina. Ideally, it should be used 15 to 20 minutes twice each day until the vagina is complete which can be anytime between two months to 18 months. The size of the dilator will be increased as time goes on. For more information, read the following guide: Instructions on the Use of Vaginal Dilators.

It should be noted that a young woman with vaginal agenesis can have normal orgasmic function as the clitoris and the external genitalia are formed normally. The vagina may have natural amount of lubrication, or a water-based lubricant is recommended during intercourse if there is a lack of natural lubrication. The success rate of vaginal dilatation with the utilization of dilators depends on how frequently and consistently the dilators are used as well as the amount of pressure that is applied.

The team at the Boston Children's Hospital Division of Gynecology and the Center for Congenital Anomalies of the Reproductive Tract are committed to working with females up to age 22 who are born with an anomaly of a reproductive organ, including vaginal agenesis. The multidisciplinary team of gynecologists, radiologists, nurse specialists, and social workers here have the expertise to treat your daughter. We are is equipped to provide a full range of services including testing, treatment, counseling, and follow-up, not only caring for the physical effects, but also providing much needed understanding and emotional support for the teen and her family. 041b061a72

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