STORY BY*Andrea Garcia grew up in Mexico and moved to the United States when she was 16 years old. Three years later she married *Eduardo. The couple left for their honeymoon looking forward to a special night with each other – their first.
“You see, in my culture, having sex for the first time is sacred. It’s not something we take lightly. Eduardo and I decided to save ourselves for that night,” says Garcia.
Their honeymoon night, they were to discover, would have to wait.
“We were not able to have sex. No one had ever told me that my body was different. Thankfully, I had a very understanding husband. He held me and said it was okay, that we would go see a doctor and find out what was wrong,” says Garcia.
As a 12-year-old in Mexico City, *Andrea couldn’t help but feel she was different. Having lost her mother three years before, she was on the brink of puberty, with many questions, yet with no one to ask. She knew her mother had started menstruating at the same age Andrea was now, and so had her sister. Something just wasn’t right, she felt.
She got up the courage to ask her father. “He sent me to a local physician. In Mexico, we don’t pay as close attention to what is going on (with our bodies). It is also harder for us to talk about sensitive subjects,” says Garcia.
The doctor declared that she needed “more proteins and vitamins,” Andrea remembers, “No examinations, no questions. We were so poor we couldn’t afford to see a specialist.”
The doctor was wrong and Andrea’s period never started.
She didn’t know it then, but her life would dramatically change over the next few years: a move to America, a new love and the crushing discovery that she was born with a condition called vaginal agenesis, the absence of a vagina.
After a year of doctors’ visits, Andrea and Eduardo found Jaou-Chen Huang, MD, associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at The University of Texas Medical School at Houston. “Finally, he was the person who could help,” Andrea says. “I don’t know if he quite knows how much it meant to hear that ‘This is okay, it’s normal, I can help you.’”
Jaou-Chen Huang, MD, associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at The University of Texas Medical School at Houston. Huang is board certified in Obstetrics & Gynecology and in Reproductive Endocrinology/Infertility. He received Ob/Gyn training at Harlem Hospital Center, Columbia University, and fellowship training at Brigham and Women’s Hospital, Harvard Medical School.
Vaginal agenesis occurs in about 1 in 5000 girls, making it one of the more common of the rare congenital anomalies. The condition is also known as Mullerian agenesis or MRKH syndrome and can involve the uterus and cervix as well. Young girls usually will notice there’s a problem when their periods do not begin.
“When I met Andrea, I knew I could help her,” Huang recalls. He tells his patients that the solution to congenital absence of vagina may involve three steps. First, if pain is the complaint, it should be relieved as soon as possible. Second, create the canal for sexual (vaginal) intercourse. Third, eventually help “fulfill the desire to have a child using her own eggs, by in vitro fertilization and a surrogate” which can be arranged later, Huang explains.
Externally, their genitalia appear the same as any other healthy woman. Puberty happens on schedule, with hair growth and breast development. Outwardly nothing seems abnormal. It is only upon closer examination that a young woman or her physician may discover an unusually shallow or totally absent vagina. For some women, the vagina will be just be a dimple in the skin, for others, a few centimeters deep. The ovaries always are present and functioning, which is why hormonal changes continue normally.
In some instances, the condition can have an impact on a woman’s overall physical health: their kidneys, spine and hearing also can be affected. Women with these other conditions would need to see specialists to be treated, Huang says.
In most cases, the uterus is missing as well, which, ironically can spare a woman great physical and undiagnosed pain. Pain occurs when there is a partial uterus with a functional endometrial lining. “Those women may experience monthly abdominal cramping, because, without an opening, the menstrual flow empties into the pelvis, which can be painful,” Huang explains.
That is where Huang’s three-step process comes into play. If the woman is experiencing pain because of monthly blood flow into the pelvis, relief comes by removing the malformed uterus, usually with minimally invasive surgery.
There are three options to create a new vagina for women with vaginal agenesis who want to be sexually active: self-dilation, active dilatation (Vecchietti procedure) and surgery (vaginoplasty).
Surgically, there are options: a skin graft or a bowel vaginoplasty. For a skin graft, a piece of skin is taken from the buttock or thigh, wrapped around a mold, and inserted in a space created where the vagina is normally located. However, with this procedure, the woman will still need to self-dilate to preserve the depth and width of the new vaginal canal after the procedure until she is actively engaged in vaginal intercourse.
For self-dilation, a physician shows the patient how to use dilators to construct their own vagina. The dilators slowly create an opening large enough and long enough for vaginal intercourse. It can take months, even years to achieve.
If a patient chooses the bowel vaginoplasty, a portion of bowel, usually a piece of the colon is removed and transplanted where the vagina would normally go. The woman does not need to do any self-dilation on her own with this method.
Andrea chose active dilatation (Vecchietti procedure.) This is how it works: a device the size of an olive is placed at the vaginal opening and connected by a suture via a set of springs to a traction device on the lower abdomen. The procedure is all done by minimally invasive surgery. The springs are tightened daily, gradually pulling the olive- sized device inward and upward to create a vaginal canal.
Andrea was in the hospital for five days while the active dilatation (stretching) took place. “There was only a little pain when they did the stretching, but once my body accepted it, the pain went away,” says Andrea.
Huang then removed the device and sent Andrea home with dilators for three weeks. She used them daily to preserve the newly created vagina and widen its diameter. Andrea also applied estrogen cream to the newly stretched skin to help it heal.
Over time, the tissue that now makes up the vagina will begin taking on the characteristics of a naturally formed vagina. The majority of women who have received the procedure report arousal and satisfaction with their experience during vaginal intercourse.
Andrea says she could feel the difference immediately. After just four weeks, Andrea was able to have vaginal intercourse with her husband for the first time. “Words couldn’t describe what it felt like to finally be able to share this with my husband. Now we know that anything is possible,” says Andrea.
Huang understands. “Sex is part of our life just like eating or sleeping. It is part of what and who we are. I want women to know that doctors can help them,” says Huang. He also hopes to establish a support group with Andrea’s help. Huang has been able to help more than a dozen women with congenital absence of vagina in the greater Houston area.
Andrea and Eduardo are now ready to begin a new chapter in their lives. They would like to see their family grow.
Andrea says she has already talked with Huang about their options. “I have my own eggs, so I am thinking about having a child through a surrogate mother. We are also considering adoption. We just know we are ready to share our love with a son or a daughter.”
Last Updated: 5-07-2008Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
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Dr. Jaou-Chen Huang is an associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UT Medical School.
Microwaves and 'Erupted Hot Water Phenomena'
Hot-water eruption can occur if you use a microwave oven to super-heat water in a clean cup. ("Super-heated" means the water is hot beyond boiling temperature, although it shows no signs of boiling.)
A slight disturbance or movement may cause the water to violently explode out of the cup. There have been reports of serious skin burns or scalding injuries around people's hands and faces as a result of this phenomenon.
Adding materials such as instant coffee or sugar to the water before heating greatly reduces the risk of hot-water eruption. Also, follow the precautions and recommendations found in microwave oven instruction manuals; specifically the heating time.
