She’s shocked after routine test reveals rare condition

IT was her first pap smear test and the Singaporean, in her mid-twenties, didn’t expect any surprises.

After all, she is youngand healthy.

But what was to have been a routine five-minute check-up last month turned complicated – she discovered she had two vaginas.

The discovery was also a first for her doctor.

Dr Chee Jing Jye, the medical director at The Obstetrics & Gynaecology Centre at Paragon Medical, had never encountered such a case in her 13 years of practice.

The discovery was made after the young woman was physically examined and had a 3-D ultrasound scan for abnormalities in the womb.

Fortunately, despite having two vaginas andt wo cervixes, her womb was fine.

Still, the news came as a blow for the woman,said Dr Chee.

The distraught woman declined to be interviewed byThe New Paper.

Dr Chee said that one of the first questions she asked was:“Am I normal?”

The doctor, who is in her 30s, assured her that her condition isn’t life-threatening and will not have a major impact onher life.

She told The New Paper: “Theoretically, the chances of her getting pregnant in the future should not be much of a problem.”

Pregnancy affected
But she said: “Because women with mullerian tube abnormalities have a higher risk of miscarriage and cervical incompetence, the pregnancy should be considered high-risk and should be monitored closely for possible complications.”

Having double vaginas is one of the ways in which mullerian duct anomalies can manifest itself.

The anomalies can happen during the embryo’s development.

The mullerian ducts eventually develop to form the fallopian tubes, the uterus and the upper part of the vagina.

This can lead to conditions including having no uterus and cervix, having half a womb or, in the woman’s case, two vaginas.

Doctors told The New Paper that such conditions affect about 0.5 per cent of women in the world.

No local figures are available.

Dr Chee said that she has seen about 10 cases of patients with various forms of mullerian duct anomalies.

Not easy to detect
She explained that it was difficult for patients to discover such anomalies on their own because “externally,you can never tell”.

It can be detected only through a physical examination, a 3-D ultrasound scan or a magnetic resonance imaging scan.

As such, some discoveries are usually made when patients seek treatment for fertility issues, have recurrent miscarriages or are in labour, said Dr Julinda Lee, 38, an obstetrician and gynaecologist at Pacific Healthcare Specialist Centre.

Like Dr Chee, she has also seen one case of double vaginas during her 13 years of practice.

This was 10 years ago and was discovered only when the patient was in labour. Because of that, the patient needed a caesarean to give birth safely, recalled Dr Lee.

Dr Anupriya Agarwal, associate consultant at the Department of Obstetrics &Gynaecology at the National University Hospital, has seen three cases of double vaginas, out of about 50 cases of mullerian duct anomalies, in her 13 years.

She stressed: “Most patients I see do not have any symptoms.”

Issues with sex
Said Dr Agarwal: “The main problems for the patients I see are those who have difficulty having sex because they either do not have a vagina or have a double vagina.”

They also have difficulty conceiving.

For those who have problems having sex, such as an inability to have sex or discomfort, surgery is an option, said Dr Agarwal.

Dr Lee said that the threat of miscarriages from mullerian duct anomalies can also be managed with surgical procedures like a cervical cerclage, where a stitch is placed around the cervix.

Patients’ initial reactions to the news can differ vastly, depending on how serious the anomalies are.

For instance, those who have no womb and cannot have children are usually the hardest hit.

Dr Chee said: “When they find out that they cannot have children after trying for years, the feeling is that of utter disappointment.” Others may express relief, said Dr Agarwal.

She explained that patients such as those who have sexual problems or recurrent miscarriages may feel better after diagnosis because they can then seek surgical correction to improve the problem.

All three doctors said the manner in which patients are diagnosed is important.

Dr Tan Heng Hao, a consultant from the Department of Reproductive Medicine at the KK Women’s and Children’s Hospital, said doctors have to counsel their patients thoroughly.

Apart from explaining the condition and the possible treatment, doctors must reassure patients too.

“These conditions are not life-threatening and, for the most part, life is normal. More importantly, these conditions will not be transmitted to their children,” he said.