Collaborative Advanced Reconstructive Evaluation (CARE) Clinic

Conditions We Treat

Anomalies of the Hymen

The hymenal membrane consists of connective tissue attached to the vaginal wall. The hymen can develop in ways that prevent the passage of menstrual blood (when the hymen completely blocks the vaginal opening) or cause difficulty with placing tampons or having intercourse (if the hymen only has small holes within it). Patients may present with amenorrhea (lack of menses) or chronic abdominal and pelvic pain.  

^{Hymenal Abnormalities}

Anomalies of the Vagina

Vaginal septa are common vaginal anomalies in which there is extra tissue within the vaginal canal. Septa can be oriented either horizontally in the vagina, as in “transverse vaginal septum,” or vertically in the vagina, called “longitudinal vaginal septum.” These septa arise from different variations in the embryologic development of the vagina and also can cause varying degrees of symptoms depending on the degree of obstruction.  

^{Transverse Septum}

Vaginal Agenesis or Atresia

Vaginal agenesis or atresia are more rare anomalies and may be diagnosed on physical exam during childhood but more commonly are identified in adolescence due to the absence of a period. In these cases, the vagina is very short or completely absent. These diagnoses may be associated with various anomalies affecting the uterus, most commonly, absence of a uterus which has been named Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

Vaginal-Cervical Agenesis

Uterine Agenesis

 

Sexual and Reproductive Healthcare for patients with Complex Congenital Genitourinary Anomalies Transitioning into Adulthood

Patients seeking continuity and transitional care for genitourinary symptoms after surgery for anorectal malformations, cloaca, cloacal exstrophy, bladder exstrophy as well as previously diagnosed differences in sexual development such as androgen insensitivity (AIS and PAIS) and congenital adrenal hyperplasia (CAH). Often, patients who were born with these conditions undergo corrective surgeries in infancy that may impact the development, location or function of their vagina. Once in adolescence or adulthood, patients with these conditions may find that they have difficulty with intercourse or have pelvic floor disorders such as vaginal prolapse. Treating these issues in adulthood is best done with a multidisciplinary team. Learn more.

Treatments We Provide

We focus on determining the most appropriate studies, imaging tests, and procedures to make the diagnosis and develop a treatment plan. Treatments may include:

• Surgery
• Vaginal dilation teaching
• Medication management
• Referrals to skilled physical therapists

Notably, our team has developed and perfected an innovative vaginoplasty technique for patients requiring creation of a vagina. Our team also offers the laparoscopic-assisted menstruation procedure (LAM) for patients with vaginal outflow obstructions. This procedure allows drainage of obstructed menstrual blood with lower risk of infection than percutaneous and perineal techniques, and without compromising the success of definitive surgery.

As we focus on long-term outcomes and continuity of care, we can also help with evaluating abnormal bleeding or discharge and pain, assessing functional outcomes such as uterine prolapse and incontinence, improving sexual function, and discussing quality of life concerns.

What to Expect

At the first visit, our patients can expect to meet with the treatment team and review symptoms, prior studies or procedures and goals of care. A physical examination may be done in clinic or may be planned for the operating room. Further studies or procedures will then be explained and scheduled.  

Our multidisciplinary team includes experts in pediatric surgery, urogynecology (female pelvic medicine and reproductive surgery specialists), pediatric and adolescent gynecology. To round out the team, we work closely with Reproductive endocrinologists, Pelvic floor physical therapists and Psychologists.

These specialists provide personalized, comprehensive, and compassionate care for all children and women with pelvic floor disorders.

Appointments

To make an appointment with the CARE Clinic, please contact coordinator Jacquelyn Searcy, 312.227.4758.