Geburtshilfe Frauenheilkd 2011; 71 - A15
DOI: 10.1055/s-0031-1292706

Female genital malformations: new hypothesis about embryo-morphogenesis

Z Makiyan 1, 2, 3
  • 1Scientific center of obstetrics, ginacology and perinathology named V.I. Kulakov, operative ginecology, Moscow, Russian Federation
  • 2Federal state institute, ginecology, Moscow, Russian Federation
  • 3Moscow medico-stomathological university, reproductive medicine and surgery, Moscow, Russian Federation

The famous german scientific professor Johannes Peter Muller suggested embryological theory about utero-vaginal morphogenesis 150 year ago, by investigation human emryos with simple light microscopy devices. According original Mullerian theory: Fallopian tubes, Uterus and Vagina formes by fusion of pair paramesonephral (Mullerian) ducts, so Vestibulum vaginae derivates from Sinus Urogenitalis [Muller I.P. Anatomie des Menschen, 1931, Berlin, p.272–275]. Mesonephral ducts completely reduced in female embryos, but derivates ductus seminipherus in male embryos.

Embryological investigations now made on laboratory rats and mouses. So Contemporary Mullerian theory seams to be different: Fallopian tubes, uterus and proximal 1/3 of Vagina formes by paramesonephral (Mullerian) ducts, and distal 2/3 of vagina and Vestibulum Vagina derivates from urogenital sinus [Sadler T.W. Langman's Medical Embryology. Williams&Wilkins USA, 2000; p.215].

Methods: Clinical examination and surgical correction of 452 patients since 1998 to 2011 with utero-vaginal malformations and disorders of sex development. Morphology of anomaly had investigated by MRI, laparoscopy, hysteroscopy, hysthological and immunohystochemical analisys.

Results: Literature review about 126 full articles and original monografies, revealed a lot of publication about Mullerian theory controversies, and induced authors create new embryological hypothesis (Acién P., Acien M, Sanches-Ferrer et al). Acien P, Acien M., 2006, affirms the human vagina derived from mesonephral ducts by immunohystochemical investigations

Clinico-morphological analysis of various female genital malformations comparatively with embryological datas allowed us to formulate our hypothesis:

  • Ovary, ovarian ligamentum proprium and ligamentum teres uteri – derived from Gonadal ridge

  • Fallopian tubes and Vagina derive from Mesonephral ducts

  • Uterus formes by fusion Mesonephral ducts with Gonadal ridge

  • Vestibulum Vaginae derived from Urogenital sinus [According original Mullerian theory]

Conclusion: Mullerian theory is actual up today, but thare is necessery to evaluate according development of new technology devices.

The new hypothesis of morphogenesis had suggested, allows to explane female normal and abnormal genital organs embryonal development.