The clinical management of congenital absence of the uterine cervix

Eight women with cervical atresia were evaluated and treated for symptoms of pelvic pain. Two distinct anatomic variations of cervical atresia were observed among these patients. A fibrous cord, with islands of endocervical glands, was noted in two patients surgically treated with the creation of a cervico-vaginal fistula through the fibrous cord. Alternatively, a complete absence of the cervical stroma required a uterovaginal anastomosis in two women. One of the two women with the cervicovaginal fistula continues to menstruate. Both women, after the anastomosis, required additional surgery to maintain menstrual flow and ultimately received hysterectomy. Subsequently, four women with complete congenital absence of the cervical stroma were treated primarily with the removal of the uterine fundus. Although menstrual function may be maintained in patients with some cervical stroma, no pregnancies have occurred. Thus, removal of the uterine fundus remains the treatment of choice, relieving symptoms and avoiding additional surgery to maintain uterovaginal patency.