A case of 17 year-old nulligravid who initially presented with a 3 year history of cyclic hypogastric pain with gradual abdominal enlargement. She was assessed with Imperforate Hymen and underwent hymenectomy and ultrasound-guided aspiration of blood clots per vagina. No vaginal canal was noted. Patient was subsequently lost to follow up.

Patient returned due to recurrence of hypogastric pain and enlargement of abdomen. Transrectal ultrasound revealed hematocolpos with hematometra. Assessment was Cervical and Vaginal Agenesis. Patient underwent exploratory laparotomy, total abdominal hysterectomy with bilateral salpingectomy.

According to American Fertility Society, there is no classification for a complex mullerian malformation such as mixed vaginal and cervical Agenesis. There is no reported case of mixed vaginal and cervical agenesis in the Philippines.

The best surgical management is still controversial. Conservative surgical method should be considered. A rare case of mixed vaginal and cervical agenesis is being presented where the management is a dilemma.