Imaging features are consistent with Mayer-Rokitansky-Küster-Hauser syndrome type 1. MRI, in this case, clarifies the diagnosis and differentiates from other differentials including MRKH type 2 and hematocolpometra due to an imperforate hymen. Surgical and non-surgical options are available for creation of a vagina to allow for sexual functioning. Assisted fertility techniques would be required and the patient would require counseling +/- referral to a fertility clinic.