Indian Academy of Forensic Medicine (IAFM) - Official website of IAFM

J Indian Acad Forensic Med. Jan- March 2012, Vol. 34, No. 1 ISSN 0971-0973
multitude of symptoms especially related to the
femininity of the female.
These females begin to question their
identity as a woman and to experience a sense
of confusion regarding their gender, bodies,
social and sexual roles .[11] Though much has
been written about the mental agony of such
females, there has been hardly any case
reported of suicide.
Case Report:
A 19 year old female was brought to
Safdarjung hospital with history of consumption
of unknown substance on 06/06/2010. She died
during the course of treatment on 07/06/2010 at
6 am. A detailed history revealed that the
deceased had been married for 6 months,
seeking gynaecological advice because of lower
abdominal pain and infertility. Her husband also
gave a history of mental distress of the
deceased as a result of which she didn’t bathe
for many days and hence suffered from infective
dermatitis. The ultrasound examination report
mentioned that the right kidney, uterus and right
ovary could not be delineated. [Fig 1] The
autopsy was conducted on 10/06/2010. On
external examination, it was a body of an adult
female with rigor mortis present all over the body
and hypostasis present over the back of the
body. Eyes were closed and cornea clear.
Features suggestive of infective dermatitis with
multiple scratch abrasions were present all over
the body. [Fig 2] Right ear canal was absent and
in place of the ear lobule a skin tag was present.
Right foot was inverted. [Fig 3] Vaginal opening
was present though the vagina ended abruptly,
with absent cervix. She had no scars or any
other marks on her body with normally
developed secondary sexual characteristics.
On internal examination, the stomach
wall was congested and hemorrhagic containing
100 ml of brownish material. The right kidney
and uterus were absent. [Fig 4] Both the ovaries
were present and normally developed. The
cause of death was reserved pending the
viscera analysis report.
Discussion:
The diagnosis of the syndrome is
usually made at puberty. However, in this case
the diagnosis was delayed till after marriage.
Case has been reported by Abdel-Fattah MS et
al [12] wherein the diagnosis of the MRKH
syndrome was made only after menopause.
With features such as normal secondary sexual
characteristics, absence of uterus, absence of
right kidney, ear defects, and skeletal deformity,
this case is consistent with type 2 variant of
Rokitansky syndrome.
87
Although, substantial literature is
available discussing the psychological effects of
MRKH syndrome on women, this is the first
reported case of a successful suicide, as per
the author’s knowledge. In a recent study,
Boersma et al concluded that the patients
suffering from the syndrome had varied
emotional reactions ranging from positive
responses like relief, fighting back, to negative
responses such as shock, confusion, fear,
depression and suicidal tendencies, feeling
isolated, ashamed, or guilty to more
avoidant/cut-off responses such as dismissal or
denial. [11] In the present case, the deceased
could not handle the distress associated with the
condition leading to self neglect by way of not
bathing subsequently resulting in infective
dermatitis. The increased stress further
culminated in a successful attempt to suicide.
Treatment:
As the condition has significant effect on
the mental well being of the individual, the
treatment should also focus on ameliorating the
psychological stress. Adequate and timely
counselling along with medical interference can
help the females to overcome depression.
Family support plays an imperative role to
console and raise the self respect. The surgical
or dilator treatments are often experienced as
shameful and may serve to strengthen their
negative beliefs. Although the successful
creation of a neo-vagina ameliorates some of
the difficulties, the disease often seems to have
a lasting negative impact on these women’s view
of themselves. [11]
Conclusion:
The MRKH syndrome greatly affects the
psychological profile of the female resulting in
mental trauma and stress. Psychological
counselling is the primary treatment modality
which can ameliorate the stress associated with
the condition.
Fig 1: Ultrasound Scan