Narrow Vaginal Introitus, An Unnoticed Cause of Unexplained Infertility in Women of Indian Subcontinent

Objective: Unexplained Infertility (UI) is a diagnosis of exclusion. Main problem is to find a treatment plan. Nowadays Assisted reproductive technology (ART) procedures are undertaken in large number of them. A careful history taking and meaningful clinical examination may reveal few unnoticed causes of UI. One of them being narrow vaginal introitus. This is quite prevalent in women of Indian subcontinent as they start their sexual life mostly after marriage in later part of life as compared to western women who practice conjugal life since their teens. Due to narrow introitus deposition of semen in vagina is suboptimal and large proportion of it spills out. This remain unnoticed or undetected till leading enquiries are made. In this article this problem and its solutions are addressed Material and Methods: In a period of 4years 3700 new cases of Primary infertility attending a single centre were studied. Amongst them 530 cases (14%) of UI were identified as per ESHRE criteria. They had watchful expectancy for minimum of two years for spontaneous conception. Some of them had some empirical treatment or even attempt of IVF with no results. Careful history taking in relaxed mood and meaningful clinical examination were undertaken in them. Thereafter corrective procedures and exercises were advocated as detailed in the text. Results: Women were classified in three groups according to age. Groups A 20 to 30, B 31 to 35 & C 36 to 42. Pregnancy rate was maximum in younger age group A 33.8% intermediate in age group B 19.8%. In both the groups similar pregnancy rates were observed in first six months which were spontaneous and subsequent six months with ovulation induction. In advanced age group C pregnancy rate was much less (11.29%). Spontaneous pregnancy after correction of the problem were less than pregnancy following ovulation stimulation. Conclusion: Narrow vaginal introitus causes difficulty in sexual intercourse and dissatisfaction in women. This subsequently leads to unexplained infertility in around 20% of the couples. Even after being treated with adequate medications these patients fail to conceive due to improper sexual contact. Manual stretching of the vaginal introitus by the treating doctor or the patient herself can have a solution to this problem.