Rnal genitalia, a blind short vaginal pouch, no uterus or fallopian tubes, and intraabdominal testes. Affected males are usually raised as girls, with the underlying disorder being recognized when the patient is evaluated for lack of pubertal development (3, 4). The differential diagnosis of vaginal agenesis also includes imperforate hymen and low transverse vaginal septum. Patients with these latter conditions will have a normal cervix and uterus, both of which may be palpable on rectal examination. In contrast to most patients with mullerian aplasia, the patient with an imperforate hymen will not have the typical fringe of hymenal tissue. The patient with a low transverse vaginal septum will have a normal hymen, like the patient with mullerian aplasia. Conventional ultrasonography, three-dimensional ultrasonography, and magnetic resonance imaging can be used to better define the mullerian structures and are helpful in definitively defining anatomy. Correct diagnosis of the underlying condition affecting the genital anatomy is crucial before any surgical intervention. If the patient undergoes an operation because of an incorrect diagnosis (eg, an incorrect preoperative diagnosis of an imperforate hymen in cases of vaginal agenesis), it can be extremely difficult to correct the anomaly because of scar tissue. Evaluation of the patient with mullerian aplasia most patients with mullerian aplasia have small rudimentary mullerian bulbs without any endometrial activity. In 2. buy viagra online viagra for sale buy viagra with debit card generic viagra online buy cheap viagra generic viagra cheap viagra online buy viagra online cheapest place to buy viagra online cheap viagra
7% of patients with mullerian aplasia, active endometrium is found in these uterine structures (1). These patients will present with cyclic or chronic abdominal pain. Magnetic resonance imaging has been suggested to assess the reproductive anatomy, although it is rarely needed in the initial evaluation unless ultrasound evaluation for the presence of functional endometrium in a mullerian structure is equivocal (5). Although laparoscopy is not necessary to diagnose mullerian aplasia, it may be useful in the evaluation of patients with cyclic abdominal pain to exclude the possibility of endometrial activity in mullerian structures (6). When obstructed hemi-uteri are identified (uterine horns with the presence of active endometrium without associated cervix and upper vagina), then removal of the unilateral or bilateral obstructed uterine structures should be performed. The removal of the obstructed uterine structures can be accomplished laparoscopically (7, 8). Patients with mullerian aplasia often have concomitant congenital malformations, especially of the abdominal wall, urinary tract, and skeleton. I. My Name Is Bill
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