Congenital Vaginal Adenosis: Causes, Symptoms, and Treatment

Introduction

Congenital vaginal adenosis (CVA) is a rare condition that affects the female reproductive system. It occurs when the cells that are supposed to form the cervix and vagina instead form glandular tissue. This results in the development of small glands within the vaginal wall, which can lead to various symptoms and complications.

What Are the Causes of Congenital Vaginal Adenosis?

The exact cause of CVA is not well understood, but research suggests that it results from abnormal reproductive system development during fetal development. The cause of CVA is not always clear, and a combination of different factors can cause it. Below are some of the proposed reasons for CVA as follows-

• Exposure to Environmental Toxin - One of the most well-known risk factors for CVA is exposure to certain environmental toxins, such as diethylstilbestrol (DES). DES is a synthetic estrogen that was prescribed to pregnant women in the past to prevent miscarriage. It is now known that exposure to DES during pregnancy can cause abnormal development of the reproductive system, leading to CVA and other conditions.

• Genetic Factors - There is also evidence to suggest that genetic factors may cause CVA. Studies have found that some women with CVA have a family history of the condition, which indicates that there may be a genetic component to the disorder.

• Immune Disorders - There is a theory that CVA is related to some immune disorders, as it has been found that some women with this condition have other autoimmune diseases.

• Hormonal Imbalance - Hormonal imbalances during fetal development can also lead to abnormal reproductive system development and CVA development.

What Are the Symptoms of Congenital Vaginal Adenosis?

The symptoms of CVA can vary depending on the severity of the condition and the presence of any complications. Some women may not experience any symptoms, while others may experience a range of symptoms. Below are some of the most common symptoms of CVA as follows-

• Vaginal Bleeding - One of the most common symptoms of CVA is vaginal bleeding, which can occur due to the presence of glandular tissue within the vaginal wall. This bleeding may occur anytime, ranging from light spotting to heavy bleeding.

• Discharge - Women with CVA may also experience release from the vagina. This discharge can be transparent or cloudy and may have a slight odor.

• Pain During Intercourse - Some women with CVA may experience pain during intercourse due to the presence of glandular tissue within the vaginal wall.

• Infertility - CVA can also cause infertility, as the abnormal development of the reproductive system can make it difficult for a woman to conceive.

• Abnormal Vaginal Shape or Size - CVA can cause the vaginal opening to be smaller or distort its shape, making it difficult for women to have intercourse, insert tampons, or even experience pain during a gynecological examination.

• Urinary Incontinence - CVA can also cause urinary incontinence (the involuntary release of urine). The weakening of the pelvic muscles and the surrounding tissue can cause this.

• Painful Urination - Women with CVA may experience pain or discomfort when urinating due to the presence of glandular tissue in the vaginal wall.

• Recurrent Urinary Tract Infections - Women with CVA may be more prone to recurrent urinary tract infections due to the presence of glandular tissue in the vaginal wall.

How Congenital Vaginal Adenosis Is Diagnosed?

Diagnosis of CVA is typically made during a pelvic examination, where the presence of glandular tissue within the vaginal wall can be observed. Additional tests confirm the diagnosis and rule out other conditions. Below are some of the diagnostic procedures used to diagnose CVA as follows-

• Pelvic Examination - During a pelvic exam, a healthcare provider will visually inspect the vaginal walls for the presence of glandular tissue.

• Biopsy - A biopsy is a procedure in which a small tissue sample is taken from the vaginal wall for examination under a microscope. This can confirm the diagnosis of CVA and rule out other conditions.

• Colposcopy - A colposcopy is a procedure in which a healthcare provider uses a special microscope to examine the vaginal walls in more detail. This can help to identify any abnormal cells or tissue, which can confirm the diagnosis of CVA.

• Imaging Tests - Imaging tests such as ultrasound or MRI may be used to visualize the glandular tissue within the vaginal wall and check if the tissue is confined to the vagina or has spread to other organs.

• Endocervical Curettage - Endocervical curettage (ECC) is a procedure in which a healthcare provider uses a small instrument to scrape cells from the cervix and the endocervical canal. This can help identify abnormal cells or tissue, confirming the diagnosis of CVA.

• Cervical Cytology - A cervical cytology test, commonly known as a pap smear, is a procedure in which a small sample of cells is taken from the cervix and examined under a microscope. This can help identify any abnormal cells, confirming the diagnosis of CVA.

• Human Papillomavirus (HPV) Test - HPV is a common sexually transmitted infection that can cause cervical cancer. Women with CVA may be at a higher risk of cervical cancer, so HPV testing may be used to screen for this condition.

What Is the Treatment of Congenital Vaginal Adenosis?

CVA treatment typically involves removing the glandular tissue through a vaginal excision. Below are some of the treatment options available for CVA as follows-:

• Surgery - The most common treatment option for CVA is surgery. This can include a traditional surgical approach or a minimally invasive procedure known as a vaginal laser excision. The surgery involves removing the glandular tissue from the vaginal wall. Surgery aims to remove all the glandular tissue while preserving the normal vaginal tissue as much as possible, to avoid complications and to improve the quality of life.

• Reconstruction - In some cases, the glandular tissue is removed through a procedure called vaginal reconstruction. This involves using tissue from other body areas to rebuild the vaginal wall. This procedure is typically used when the glandular tissue has spread to other organs, and it is impossible to remove it altogether.

• Hormone Therapy - Hormone therapy may be used to shrink the size of the glandular tissue; this treatment is typically used as an adjunct to surgery.

• Regular Screening - Women with CVA may also be advised to undergo regular cervical and vaginal cancer screenings, as there is an increased risk for the occurrence of these conditions.

• Radiation Therapy - In some cases, radiation therapy may be used to shrink the size of the glandular tissue and prevent its recurrence. This treatment is typically used as an adjunct to surgery, particularly in cases where the glandular tissue is not completely removable.

• Chemotherapy - Chemotherapy may be used to shrink the size of the glandular tissue and prevent its recurrence. This treatment is typically used as an adjunct to surgery, particularly in cases where the glandular tissue is not completely removable.

• Immunotherapy - Immunotherapy may be used to shrink the size of the glandular tissue and prevent its recurrence; this type of treatment is based on the use of drugs that boost the immune system to fight cancer cells.

• Physical Therapy - Women with CVA may also be referred for physical therapy to help improve their pelvic muscle strength, which can help to prevent incontinence and improve sexual function.

Conclusion

The symptoms of CVA can vary from woman to woman. If a person has any concerns about the symptoms or suspects that they may have CVA, they must speak with a healthcare provider for further evaluation and diagnosis. Diagnosis of CVA can be challenging, as the symptoms can be similar to those of other conditions. Therefore, working closely with a healthcare provider to ensure accurate diagnosis and appropriate treatment is essential. It is also important to note that the treatment plan for CVA will vary depending on the individual case and the severity of the condition. Also, it is important to remember that some treatments may have side effects, so it is essential to discuss these with the healthcare provider to make an informed decision about the treatment options.