Obstructive Anomalies of the Reproductive Tract

Abstract

Abnormalities of the reproductive tract are not rare; they occur in approximately 7% of women.1 When they are associated with obstruction of the outflow tract, a young, postpubertal woman may present with absent menses, cyclic abdominal pain, pelvic masses (due to endometrioma or hematocolpos), and/or infection (in cases of microperforation). It is important for gynecologists to be aware of these conditions to prevent long-term complications such as endometriosis and infertility.2 In addition, understanding of the embryology that may explain the resulting anatomy is essential so that optimal surgical repair is performed. Repair of some of these conditions is difficult and often is associated with significant complications; whereas others, such as imperforate hymen, can be managed with low complication rates. Because proper diagnosis and thorough understanding of these anomalies can be complex, there is a gap between ideal and common practice. This article reviews obstructive anomalies, their evaluation, and management. Although the anomalies discussed herein occur occasionally in conjunction with disorders of sex development or cloacal malformations, these latter conditions are more complex and are not discussed here.