Parulekar SV

Congenital malformations of the female genital tract have fascinated gynecologists owing to both their complexity and their effects on the menstrual and reproductive functions of the woman. Some of them are treatable very easily and the results are quite satisfactory, as in the case of an imperforate hymen. Others do not have good treatment, such as a bicornuate uterus. Some others have multiple forms of treatment, none of them perfect, as in the case of cervical atresia. Some of them have no treatment, as in the case of mullerian agenesis. Science is evolving, and new forms of treatment continue to be found for conditions which had no treatment in the past. A woman with mullerian agenesis could not have a baby in the past. It became possible with in vitro fertilization and embryo transfer to a surrogate mother. Now a uterine transplant has also become possible. While science is making progress, one would expect everyone to work in that direction. However gynecologists continue to work on aspects that one would expect to have been settled long ago. Classification of various malformations of the female genital tract was done quite well by Jones. Jones’ classification was the most basic and widely used one. We learned it as students three and a half decades ago, and used it for these many years thereafter. Division of the malformations into three groups: agenesis, lateral fusion defects (obstructive and non-obstructive or symmetrical and asymmetrical), and vertical canalization defects (obstructive and non-obstructive) was clear, informative, explained the embryological basis, and implied the type of treatment required. Despite availability of such good classification, a large number of classifications evolved, developers of each one finding deficiencies with the previous ones. Buttram et al, Jarcho, Fenton and Singh, American Fertility Society, Semmens, Oppelt et al, AciĆ©n, and European  Society  of  Human  Reproduction  and  Embryology produced their own classifications. In fact, American Fertility Society produced two of them, one for mullerian anomalies and one for uterovaginal anomalies. None of them could explain the need to change over from the established Jones’ classification convincingly. None of them was comprehensive, unambiguous, and easy to use. None of them made any impact on the mode of management of these cases or prognosis, because the treatment and prognosis would not vary depending on into which class and subclass a particular malformation was placed. In this issue we have a new classification of the malformations of the female genital tract, that is said to be comprehensive, unambiguous, precise, and easy to use. A clinical study is in progress comparing this classification to the older classifications. The results of that study and of other studies inspired by this article may decide if this classification gains wide acceptance.