Congenital anomalies can be detected at birth but sometimes are uncovered in adolescence. Remembering that the aim  of management is to achieve optimal health outcomes for the young woman, and that the care has to take into account her developmental stage is critical for good long term outcomes. Unlike some obstructive problems in other systems, those affecting the Mullerian tract can often be optimally managed with delayed intervention by suppressing menses. Increasingly the potential for maintenance of fertility by early and active involvement of gynaecologists can result in positive outcomes – this applies to conditions such as cervical agenesis. Some of the common anomalies and the principals of surgical care will be outlined in this presentation.