Native vagina-Surgery for Pelvic Organ Prolapse - ACOG

Vaginal flora or vaginal microbiota are the microorganisms that colonize the vagina. The amount and type of bacteria present have significant implications for a woman's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus. Lactobacilli have been shown to inhibit in vitro growth of pathogenic microorganisms, e. Bacteroides fragilis , Escherichia coli , Gardnerella vaginalis , Mobiluncus spp.

Native vagina

Investigations have found that the presence of lacto-bacillus dominated bacteria in the vagina is associated with a lower incidence of sexually transmitted infections. Vagna graft versus native tissue repair. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. The pH further decreases during pregnancy. The hymenal tissue should be visible. The dilator is worn 24 hours a day, 7 days a week, Native vagina is removed only for urination, defecation, and cleaning. However, harmful Native vagina or an imbalance in bacteria can lead to vaginaa.

Pageant interview answers. Surgery Pelvic Organ Prolapse

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Congenital obstructive anomalies of the vagina are unusual and can be challenging to diagnose and manage.

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Congenital obstructive anomalies of the vagina are unusual and can be challenging to diagnose and manage. Evaluation and treatment of these anomalies is dependent upon the age of the patient, as well as the symptoms, and the timing of treatment should be individualized.

Agenesis of the lower vagina and imperforate hymen may present either in the newborn period as a bulging introitus caused by mucocolpos from vaginal secretions stimulated by maternal estradiol or during adolescence at the time of menarche. In neonates, it often is best not to intervene when obstructive anomalies are suspected as long as there is no fever; pain; or compromise of respiration, urinary and bowel function, and other functionality. And if the hymen remains imperforate, the mucus will be reabsorbed and the patient usually will remain asymptomatic until menarche.

In the adolescent time period, both anomalies often are identified when the patient presents with pelvic pain — usually cyclic pelvic pain with primary amenorrhea. Because the onset of menses typically occurs years after the onset of estrogenization and breast development, evaluating breast development can help us to determine the timing of expected menarche. An obstructive anomaly should be suspected in an adolescent who presents with pain during this time period, after evaluation for an acute abdomen Figure 2a.

When a vaginal orifice is visualized upon evaluation of the external genitalia and separation of the labia, a higher anomaly such as a transverse vaginal septum should be suspected. When an introitus cannot be visualized, evaluation for an imperforate hymen or agenesis of the lower vagina is necessary Figure 1b and 1c.

The simplest way to differentiate imperforate hymen from agenesis of the lower vagina is with visualization of the obstructing tissue on exam and usage of transperitoneal ultrasound. With the transducer placed on the vulva, we can evaluate the distance from the normal location of an introitus to the level of the obstruction.

If the distance is in millimeters, then typically there is an imperforate hymen. The distance as measured by transperitoneal ultrasound also will indicate whether or not pull-through vaginoplasty Figure 2b — our standard treatment for lower vaginal agenesis — is possible using native vaginal mucosa from the upper vagina.

A rectoabdominal examination similarly can be helpful in making the diagnosis of lower vaginal agenesis and in determining whether there is enough tissue available for a pull-through procedure Figures 2a and 2b. Because patients with this anomaly generally have normal cyclic pituitary-ovarian-endometrial function at menarche, the upper vagina will distend with blood products and secretions that can be palpated on the rectoabdominal exam.

If the obstructed vaginal tissue is not felt with the rectal finger at midline, the obstructed agenesis of the vagina probably is too high for a straightforward pull-through procedure. Alternatively, the patient may have a unicornuate system with agenesis of the lower vagina; in this case, the obstructed upper vaginal tissue will not be in the midline but off to one side.

MRI also may be helpful for defining the pelvic anatomy. The optimal timing for a pull-through vaginoplasty Figure 2b is when a large hematocolpos Figure 2a is present, as the blood acts as a natural expander of the native vaginal tissue, increasing the amount of tissue available for a primary reanastomosis. This emphasizes the importance of an accurate initial diagnosis. Too often, obstructions that are actually lower vaginal agenesis are presumed to be imperforate hymen, and the hematocolpos is subsequently evacuated after a transverse incision and dissection of excess tissue, causing the upper vagina to retract and shrink.

This mistake can result in the formation of a fistulous tract from the previously obstructed upper vagina to the level of the introitus. The vaginoplasty is carried out with the patient in the dorsal lithotomy position. A Foley catheter is placed into the bladder to avoid an inadvertent anterior entry into the posterior wall of the bladder, and the labia are grasped and pulled down and out.

The hymenal tissue should be visible. A transverse incision is made, with electrocautery, where the introitus should be located, and a dissection is carried out to reach the obstructed upper vaginal tissue. Care is needed to keep the dissection in the midline and avoid the bladder above and the rectum below. In cases in which it is difficult to identify the area of obstruction, intraoperative ultrasound can be helpful.

A spinal needle with a cc syringe also can be used to identify a track through which to access the fluid. The linear incision then is made with electrocautery and the obstructed hemivagina is entered.

Allis clamps are used to grasp the vaginal mucosa from the previously obstructed upper vagina to help identify the tissue that needs to be mobilized. The tissue then is further dissected to free the upper vagina, and the edges are pulled down to the level of the introitus with Allis clamps. The upper vaginal mucosa is sewn to the newly created introitus with a vicryl suture on a UR6 a smaller curved urology needle.

When the distance from normal introitus location to obstruction is greater than 5 cm, we sometimes use vaginal dilators to lessen the distance and reach the obstruction for a pull-through procedure.

Alternatively, the upper vagina may be mobilized from above either robotically or laparoscopically so that the upper vaginal mucosa may be pulled down without entering the bladder.

Occasionally, with greater distances over 5 cm, the vaginoplasty may require utilization of a buccal mucosal graft or a bowel segment. Intraoperative ultrasound can be especially helpful for locating the obstructed vagina in women with a unicornuate system because the upper vagina will not be in the midline and ultrasound can help determine the appropriate angle for dissection.

Prophylactic antibiotics initiated postoperatively are important with pull-through vaginoplasty, because the uterus and fallopian tubes may contain blood an excellent growth media and because there is a risk of bacteria ascending into what becomes an open system. Postoperatively, we guide patients on the use of flexible Milex dilators CooperSurgical to ensure that the vagina heals without restenosis. The length of postoperative dilation therapy can vary from months, depending on healing.

The dilator is worn 24 hours a day, 7 days a week, and is removed only for urination, defecation, and cleaning. With adequate postoperative dilation, patients will have normal sexual and reproductive function, and vaginal delivery should be possible.

Skip to main content. Master Class. Vaginal anomalies and their surgical correction. By Marc R. Laufer, MD. Agenesis of the lower vagina Reproduced with permission from Laufer MR. Structural abnormalities of the female reproductive tract. Wolters Kluwer, Reproduced with permission from Laufer MR. Fig 1b: Agenesis of the lower vagina. Fig 1c: Imperforate hymen. Surgery Gynecology. Menu Menu Presented by Register or Login. Menu Close. Gyn News.

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Native vagina

Native vagina

Native vagina

Native vagina. 1. The Bony Vagina

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Vaginal flora - Wikipedia

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Click here to return to the Medical News Today home page. This article describes different types of vagina. We also discuss when to see a doctor based on the appearance of the vagina and factors such as discharge. When people refer to the vagina, they usually mean the visible, external part of the genitals.

The proper term for this area is the vulva. The vulva includes many structures, such as the labia majora and labia minora, or inner and outer lips.

These are folds of skin that surround the vaginal opening and the urethral opening. Depending on the size and shape of the external structures, the appearance of the vulva can vary widely. The outer lips of the vulva, or the labia majora, are longer in some people. The lips may hang low, and the skin may seem thin, or they may be thick and puffy.

In others, the outer lips may curve and meet at the ends, exposing some of the inner lips above. It is typical for the inner lips, or labia minora, to be visible. They may dangle below the outer lips or otherwise be prominent.

One inner lip may be longer than the other. Asymmetry in the labia is not necessarily a cause for concern. Some people may have short inner lips that the outer lips hide. In others, the outer and inner lips are of similar length. If the outer and inner lips are small and close to the inner thighs, the clitoral hood, which hides the clitoris, may be visible.

The inside of the vagina is like a long tube with folded areas that can expand and contract. Some doctors compare this characteristic to an accordion. This usually forms a "V" shape, although the width at the widest point can vary. Their vagina can seem wider or looser following childbirth. This is because the vaginal tissues expand to make room for a baby to pass down the birth canal.

The vagina may resume its pre-pregnancy size, or it may remain slightly widened. The vagina can change in size, or length, to accommodate a tampon, finger, or penis, for example. It does this by stretching and elongating. This also moves the cervix and uterus upward. The length of the vagina varies, but the average length, when a person is not aroused, is just under 4 inches, according to an article in BJOG: An International Journal of Obstetrics and Gynaecology.

However, the length can range significantly from person to person, from about 2. In a study published in the International Urogynecology Journal , researchers used MRI to measure the length, width, and angles of participants' vaginas. They found that, in some cases, they could predict variations in length based on a participant's height and age, but not necessarily their weight.

For example, a taller person may have a longer vagina. Skin colors naturally vary, including the skin of the vulva. Doctors report the following colors of the vulva:. The color can also vary, depending on blood flow. During arousal, the flow of blood increases, and the vulva may appear purplish. Some people note color changes when they have certain medical conditions. A yeast infection , for example, may cause the vulva to appear purple or red.

The following factors can also influence the appearance or smell of the vulva, and they naturally vary from person to person:. Pubic hair may help protect the genitals from bacterial illnesses. Pubic hair may also be a natural signal of reproductive maturity. Pubic hair that develops early — before age 8 — and excessive amounts of pubic hair may point to an increased risk of polycystic ovary syndrome. Some people use the color and consistency of their discharge to track their fertility.

For example, very stretchy discharge can occur during ovulation. Changes in vaginal discharge can indicate an infection, which requires medical attention. See a doctor if discharge is green, gray, or foul-smelling.

The vagina provides an exit for menstrual blood. The amount of blood that a person loses can vary from period to period. Some people tend to only have mild spotting, while others have heavy bleeding. A person can control their flow somewhat by taking hormonal medication, such as birth control pills.

Anyone whose menstrual flow routinely soaks pads or makes them feel dizzy or short of breath should see a doctor. They may have heavy menstrual flow , which can disrupt daily activities. The vagina naturally contains bacteria and yeasts that can cause odors. The smell can vary from sweet to metallic. A person's menstrual cycle, their overall health, and the natural flora of the vagina can all affect vaginal odor.

Usually, variations in vaginal smell are no cause for concern. However, a foul smell can indicate infection. Anyone who has concerns about their vagina or vulva should see a doctor. Some common concerns include:. For example, some people have a wall — called a vertical vaginal septum — in the vagina. The wall essentially creates two vaginas. However, if a person has concerns about their vagina or vulva, they should consult a doctor.

Article last reviewed by Fri 30 August All references are available in the References tab. Congenital anomalies of the vagina. Grunwald, T. Polycystic ovary syndrome PCOS. Is it a problem if my vagina is purple?

Lloyd, J. Luo, J. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. Self-exam: Vulva and vagina. What are the parts of the female sexual anatomy? MLA Nall, Rachel. MediLexicon, Intl.

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Native vagina

Native vagina