Parulekar
SV
Congenital
malformations of the female genital tract have fascinated gynecologists owing
to both their complexity and their effects on the menstrual and reproductive
functions of the woman. Some of them are treatable very easily and the results
are quite satisfactory, as in the case of an imperforate hymen. Others do not
have good treatment, such as a bicornuate uterus. Some others have multiple
forms of treatment, none of them perfect, as in the case of cervical atresia.
Some of them have no treatment, as in the case of mullerian agenesis. Science
is evolving, and new forms of treatment continue to be found for conditions
which had no treatment in the past. A woman with mullerian agenesis could not
have a baby in the past. It became possible with in vitro fertilization and embryo
transfer to a surrogate mother. Now a uterine transplant has also become
possible. While science is making progress, one would expect everyone to work
in that direction. However gynecologists continue to work on aspects that one
would expect to have been settled long ago. Classification of various
malformations of the female genital tract was done quite well by Jones. Jones’
classification was the most basic and widely used one. We learned it as
students three and a half decades ago, and used it for these many years
thereafter. Division of the malformations into three groups: agenesis, lateral
fusion defects (obstructive and non-obstructive or symmetrical and
asymmetrical), and vertical canalization defects (obstructive and
non-obstructive) was clear, informative, explained the embryological basis, and
implied the type of treatment required. Despite availability of such good
classification, a large number of classifications evolved, developers of each
one finding deficiencies with the previous ones. Buttram et al, Jarcho, Fenton
and Singh, American Fertility Society, Semmens, Oppelt et al, Acién, and European Society
of Human Reproduction
and Embryology produced their own
classifications. In fact, American Fertility Society produced two of them, one
for mullerian anomalies and one for uterovaginal anomalies. None of them could
explain the need to change over from the established Jones’ classification
convincingly. None of them was comprehensive, unambiguous, and easy to use.
None of them made any impact on the mode of management of these cases or
prognosis, because the treatment and prognosis would not vary depending on into
which class and subclass a particular malformation was placed. In this issue we
have a new classification of the malformations of the female genital tract,
that is said to be comprehensive, unambiguous, precise, and easy to use. A
clinical study is in progress comparing this classification to the older
classifications. The results of that study and of other studies inspired by
this article may decide if this classification gains wide acceptance.