Oral Conception: a very interesting childbirth

No, that is not a type-o. I meant conception and not contraception. This morning’s edition of 102.1’s the Dean Blundell show had a very interesting Edge file. Dean described the story of a girl born with vaginal agenesis that presented to an emergency ward with extreme abdominal pain. Unable to diagnose the cause physicians performed an exploratory laparotomy. Their findings included a full-term 6 lb baby boy. The baby was delivered through cesarian section and was discharged with his healthy, and surprised, mom six days later. Remarkable? Consider that vaginal agenesis means the mother was effectively born without a vagina.

So how is it possible for a baby to be conceived and carried to term by a mother without a vagina? Let us take a minute to examine a simplified version of the development of the genitalia. In the first 1-2 months after conception baby boys and baby girls are actually gender-indifferent. Both male and female genitalia are derived from common embryonic cell groups. Some of these cells differentiate into the internal reproductive organs and others into the external genitalia (ref: Lin, 2002).

Due to the discrete nature of these various developmental pathways relatively isolated congenital disorders can arise in an otherwise healthy person. The subject of this case study, published in the British Journal of Obstetrics and Gynaecology in 1988, was a 15 y/o mosotho girl. The girl was healthy and normally developed in all other aspects of her body. Within her otherwise fully developed vulva was a small indentation, or “dimple”, where the vagina would have canalized. She was aware of her condition and led a normal life including romantic relationships. Unfortunately one of these romantic relationships was an unhealthy one.

Keep in mind that although the specifics and probablity of this part of the story may seem more urban lore than academia this case study was published in a respected peer reviewed OB/Gyn journal. After performing oral sex on a male sexual partner the female patient was discovered by a previous partner. A violent episode ensued in which all three parties were stabbed or otherwise injured. The female received minor lacerations to her left hand as well as a single penetrating wound to the upper abdomen. After surgery to repair two wounds to her stomach the female was discharged. Nine months and a few weeks later she returned with the afore mentioned abdominal pain to realize she had been carrying a child.

The stunned physician’s only theoretical suggestion was that laceration of the patient’s stomach allowed its sole contents (the results of the sexual act) to spill into the peritoneal cavity. It is then conceivable that the spermatoza may have survived to find their way to the girl’s internal reproductive organs. The probability of such a course of action is astoundingly low. Consider the unique chain of events that fostered the development of this child.

From Oltineau et al, 2009

  • First the mother survived the enraged knife fight with few complications.
  • Second the sperm cells survived numerous hostile environments to successfully meet with the mother’s reproductive organs. Sperm cells are extremely sensitive to acidic environments. A recent contraceptive research study found that the spermatoza are killed off (irreversible motility loss) after just 30 seconds inside the 4.0 pH level normally found in the vagina. They survive because the surrounding ejaculatory fluid temporarily neutralizes the vaginal environment to between 6.0 and 7.0. Although the stomach’s gastric acid is a very non-reproduction friendly 1.0 to 2.0 the peritoneal fluid usually has a pH of about 7.49 (ref: Simmen et al, 2003). There actually was a case study published last year describing sperm cells found in the peritoneal cavity a 52-year old man.
  • Third the incident would have to of occurred not only during ovulation but also during one of the girl’s first few menstrual periods. As was the case later on in the girl’s life, without the vagina’s natural ability to drain a painful condition known as cryptomenorrhea can develop. After two years the girl eventually began pharmacologically-induced amenorrhea to prevent the recurring abdominal pain associated with her menstrual complications.

As baffling as these odds are there are few alternative explanations. Subjectively the article’s authors noted the close paternal resemblance between the child and his suspected father. Quite the revelation for sexual health educators.

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