Two Wrongs Can Never Do One Right: Polycystic Ovarian Syndrome with Concomittant Mullerian Anomaly : A Case Report
This was a case of an 18-year old nulligravida, diagnosed with Polycystic Ovarian Syndrome (PCOS) presenting with primary amenorrhea and with concomitant Mullerian Duct Anomaly Type I (vaginal agenesis). Although PCOS more commonly present with Secondary Amenorrhea, the reported percentage of Primary Amenorrhea as an initial feature in PCOS among small cohorts varied between 1.4% and 14%. Mullerian anomalies, on the other hand were reported in up to 3.2% of all women. One study, which correlated the two disease entities, concluded that an embryologic defect in the ovaries might have given rise to the non-development of the Mullerian duct thereby producing various anatomic defects of the uterus, cervix and upper part of the vagina. When presented with such a case, efforts should be made to diagnose and treat the PCOS first to minimize the development of symptoms and prevent the onset of cardiovascular and metabolic disturbances. The creation of a neovagina to address the vaginal agenesis, on the other hand, can be done later on.