The female reproductive system is a complex, beautiful thing. Most female sex organs are located inside the body and have many parts working together for you to menstruate and be able to carry and give birth to a baby if you choose. With so many systems working together, things sometimes don’t develop properly, as is the case with MRKH.

How does MRKH work?

Mayer-Rokitansky-Kuster-Hauser syndrome, or MRKH, is a rare disorder affecting about 1 in every 4,500 people assigned female at birth. MRKH causes the vagina and uterus to be underdeveloped, while external sex characteristics are present. MRKH varies from person to person, but commonly the vaginal canal won’t fully develop, resulting in a particularly shallow vagina, and the uterus and cervix will not fully develop or be present at all. Healthy ovaries are often still present in people with MRKH, however, as well as fully developed secondary sex characteristics such as pubic hair and breast tissue. 

How does MRKH affect someone?

There are two types of MRKH. Type 1 includes an underdeveloped uterus and vagina, keeping other organs around these areas healthy and functional. Type 2 can affect the kidneys, causing complications or kidney failure altogether.

Since someone with MRKH doesn’t have a uterus or cervix, they won’t ever have a menstrual cycle. MRKH is often diagnosed during puberty because of a lack of a menstrual cycle during someone’s teenage years or when other markers of puberty are present. Pain or difficulty during vaginal sex is also a way to help diagnose MRKH. Since the vagina is underdeveloped, it is often very painful for something to be inserted. MRKH will be officially diagnosed by a doctor after doing several tests, of course, but these are common indicators. 

What is the cause of MRKH?

The cause of MRKH isn’t completely known, although it is clear it’s a result of an underdeveloped Mullerian duct. The Mullerian duct helps develop the uterus, fallopian tubes, cervix, and upper portion of the vagina. The cause of problems with this duct is unknown, and MRKH does not appear to be inherited. The rarity of this condition also makes it hard to pin down a cause. 

Can someone with MRKH have a child?

Since a uterus does not develop if you have MRKH, carrying a child without medical intervention is not an option. If someone with MRKH does want to have a baby, though, there are alternatives. Since the ovaries can still be healthy, using a surrogate with your fertilized egg is an option. Some successful uterus transplants have also occurred, although this is a newer and less common procedure. This procedure takes the uterus of a deceased donor and transplants it into the patient needing a healthy uterus. As of 2019, only two babies in the nation have been born from successful uterus transplants. Although this is a newer option, it is very promising for treatment. 

How does someone with MRKH have sex?

If someone with MRKH doesn’t want to have a baby but wants to treat pain with penetration, they can use dilators to slowly stretch their existing vaginal tissue over time. Dilators are wand-like tools that you slowly put into the vagina, increasing the size of the dilator over time to slowly stretch the vaginal tissue. Dilators are also a great tool for treating pain with penetration for people that don’t have MRKH. Some people will also undergo vaginoplasty surgery, where the vaginal tissue is reconstructed by a doctor. Medical treatment isn’t necessary though if you are able to find other ways to enjoy pleasure and sexuality without vaginal penetration. MRKH does not need to be surgically treated, it is of course, up to the patient.

Although people with MRKH don’t menstruate, sometimes they might still feel menstruation symptoms. They can seek treatment for this as well. It is totally possible to live a healthy, fulfilled life and even reproduce safely with MRKH. 

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