II. Acquired Structural Abnormalities

These develop due to trauma, infection, surgery, or disease.

A. Uterine Fibroids (Leiomyomas)

• Benign tumors of uterine muscle.

• Can distort uterine shape and impair fertility.

B. Endometriosis

• Ectopic endometrial tissue growth.

• Causes adhesions and anatomical distortion.

C. Pelvic Organ Prolapse

• Descent of uterus, bladder, or rectum due to weakened pelvic floor.

D. Fistulas

• Abnormal connections between genital tract and adjacent organs.

  • Vesico-vaginal fistula: Between bladder and vagina.

  • Recto-vaginal fistula: Between rectum and vagina.

E. Post-Surgical or Traumatic Scarring

• From procedures like dilation and curettage (D&C), cesarean section, or perineal tears.

 III. Clinical Features

• Primary amenorrhea (in congenital absence or obstruction).

• Dysmenorrhea or cyclical abdominal pain.

• Infertility or recurrent miscarriage.

• Dyspareunia (painful intercourse).

• Urinary or fecal incontinence (in fistulas).

• Pelvic pain or pressure (in fibroids or endometriosis).

IV. Diagnosis

• History and physical examination.

• Pelvic ultrasound: First-line imaging.

• MRI: Detailed soft tissue evaluation.

• Hysterosalpingography (HSG): Uterine and tubal assessment.

• Laparoscopy/Hysteroscopy: Direct visualization and treatment.

V. Management

• Surgical correction:

  • Septum resection

  • Metroplasty

  • Fistula repair

• Hormonal therapy:

  • For endometriosis or menstrual regulation

• Assisted reproductive techniques:

  • IVF for severe anomalies

• Supportive care:

  • Counseling

  • Pelvic floor therapy