Ever heard of a 'blind vagina'? Us neither, until not long ago. A piece of research published in the British Medical Journal in June shone a light on the case of a 20-year-old woman who was struggling to have sex and had never had a period because of the condition.
The woman, in Pakistan, was married and had become sexually active six months before her wedding. It was then that she realised penetration wasn't possible, so she visited a doctor and was told she had a 'blind vagina'. Her husband had been physically and verbally abusing her because of their sexual struggles, and the abuse culminated in the woman returning to live with her parents.
The condition also explained her absent period and the pain in the lower part of her stomach, which she'd been struggling with for three years but had continued to live with because her mother believed she was going through delayed puberty. (The doctors later wrote that her "breast development was normal for age, and other secondary sexual characters seemed normal.")
While this condition is rare and there is little information about it out there, here's what we do know.
What is a 'blind vagina'?
When doctors examined the woman, they discovered she had a 'blind vagina' – also known as a 'dead-end vagina' – which some claim is the female version of a micropenis. It was just 2cm long (less than an inch) and didn’t connect to her reproductive organs (her uterus was "normal-sized" and her "ovaries seemingly normal," the doctors said). For comparison, the average length of an unaroused vagina is around 6cm (2.4 inches), according to one study.
Women with a 'blind vagina' have either a horizontal or vertical 'wall' of tissue blocking the vagina (a transverse vaginal septum).
Women often don't realise they have one until they reach puberty and menstruation age, or start having sex, which they may find painful.
What causes it?
A 'blind vagina' is a congenital condition and results from the reproductive system not developing completely in the womb. "Blind-ending vaginas tend to occur in intersex conditions," explains Dr Leila Frodsham, a consultant gynaecologist who specialises in psychosexual medicine.
"Intersex conditions occur in 1.7% of the population but ambiguous genitalia at birth are responsible for 0.05% of live births. Blind-ending vaginas are somewhere between the two and tend to present after the onset of puberty when women find that their periods haven't started and seek advice from a gynaecologist."
Dr Frodsham says she's encountered several women with the condition over the years, most often they're in late adolescence and have grown breasts and body hair but their periods haven't started. "The most common cause is MRKH (Mayer-Rokitansky-Küster-Hauser syndrome) where women may have a very small uterus – womb – at the top of the vagina," she explains. "Occasionally, an imperforate or very partially perforate vagina – that allows periods through – may present later with difficulty having sex."
What are the side effects?
"The consequences can be devastating for women and it's vital that these are managed with great sensitivity by specialists in these conditions," Dr Frodsham says. "One of the first questions is usually regarding fertility and then sexual activity. Many women describe feeling that they're not 'normal' and not sure if they really are women."
Fertility options need to be discussed on a case by case basis, she adds, as some women may, for example, have functioning gonads (ovaries or testes from where gametes – eggs or sperm – can be collected for fertility treatments.
What can be done?
After her diagnosis, the woman received surgery to connect the two parts of her vagina by cutting the 'wall' of tissue (hers was horizontal). A mould wrapped in a condom was then inserted into her vagina to stretch it, which was replaced by a silicon mould a week later. After three weeks, she could live without the mould.
In very young girls, surgery and/or vaginal dilators may not be necessary and a blind vagina can be treated with oestrogen cream, says Dr Frodsham.
Does it have any lasting effects?
Based on this case study, it seems women with a 'blind vagina' can go on to lead pretty normal lives. The 20-year-old was cleared to have sex four months after her surgery, which causes "no discomfort" according to the doctors, and by the time seven months had passed, she was pregnant. Her healthy baby son was delivered through Caesarean section.
"This surgery has given me a new life in the true sense. I had to suffer a lot of verbal, physical, and emotional abuse from my own family and my in-laws," the woman told the doctors. "This treatment blessed me with happy marital relations, self-confidence, and a healthy baby."