Congenital vaginal obstruction in young girls: need for standard post-operative dilatation protocol

Background: Congenital vaginal obstruction is a rare disorder in which there is blockage of the vaginal tract during the developmental stage and subsequently leading to accumulation of secretions and or menstrual blood. Surgical relief of obstruction is an effective treatment. Ensuring patency of the tract following surgery in young girls not sexually active can be challenging.Methods: This is a 10-years retrospective analytical study of cases of congenital vaginal obstruction in young girls seen in two centres from February 2007 to January 2017. Data retrieved from the case notes included age at presentation, presenting features, prior intervention, diagnosis, surgery performed, vaginal dilatations, outcome, duration of follow-up. Data was subjected to simple statistical analysis.Results: Eight patients met the inclusion criteria. The age range was 7 to 15years with a median of 12years. The cause of obstruction was transverse vaginal septum in 5 cases, imperforate hymen 2, vaginal hypoplasia 1. Three of the patients had no dilatation post operatively and of these, two came back with recurrent obstruction and hematometra. The third one was a case of imperforate hymen and did not develop stenosis despite not being dilated. There were no mortalities.Conclusions: The occurrence of recurrent obstruction following surgical treatment of congenital vaginal obstruction is high. Post-operative dilatation reduces incidence of recurrence.

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Spectrum of Etiologies Causing Hydrometrocolpos

Journal of Neonatal Surgery ◽

10.47338/jns.v2.17 ◽

2013 ◽

Vol 2 (1) ◽

pp. 5

Author(s):

Ayşenur Cerrah Celayir ◽

Gökmen Kurt ◽

Ceyhan Şahin ◽

Inanç Cici

Keyword(s):

Treatment Options ◽

Urogenital Sinus ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Incision And Drainage ◽

Persistent Cloaca ◽

Transverse Vaginal Septum ◽

Initial Procedure ◽

Cloacal Malformations

Background: Hydrometrocolpos (HMC) develops as a result of vaginal outflow obstruction and the accumulation of secretions. It might be secondary to persistent cloaca, urogenital sinus, some syndromes, presence of the vaginal septum, vaginal atresia, and imperforate hymen. Each of them has different treatment options and follow-up protocols. This study was performed to identify the etiology and the related management of patients with HMC.Materials and Methods: A descriptive series of patients with HMC managed in our hospital between 2004 and 2011 is being presented. The medical record of these patients was analyzed for etiology, management, and outcome.Results: Eight patients with HMC were managed during 7 years at our department. Underlying etiologies included urogenital sinus (n=3), and 1 each of imperforate hymen, transverse vaginal septum, Herlyn-Werner-Wunderlich syndrome, persistent cloaca, and a variant of the cloaca. Four patients were prenatally diagnosed. The patient with imperforate hymen was managed successfully with incision and drainage. Abdominal vaginostomy was done in three patients with urogenital sinus as initial procedure. In patient with persistent cloaca, a colostomy and abdominal vaginostomy were performed. Patient with cloaca variant died due to persistent acidosis and salt wasting.Conclusion: HMC may have different etiological factors which may dictate different surgical management. Etiology of HMC can be as simple as imperforate hymen to the most severe cloacal malformations.

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Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes

Japanese Journal of Radiology ◽

10.1007/s11604-021-01115-7 ◽

2021 ◽

Author(s):

Keizo Tanitame ◽

Nobuko Tanitame ◽

Saiko Urayama ◽

Kazuhiro Ohtsu

Keyword(s):

Correct Diagnosis ◽

Late Complications ◽

Diagnosis And Treatment ◽

Imaging Findings ◽

Vaginal Septum ◽

Renal Anomaly ◽

Imperforate Hymen ◽

Adequate Knowledge ◽

Transverse Vaginal Septum ◽

Urogenital Anomalies

AbstractHemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

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Management of Transverse Vaginal Septum by Vaginoscopic Resection: Hymen Conservative Technique

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1670714 ◽

2018 ◽

Vol 40 (10) ◽

pp. 642-646

Author(s):

Gennaro Scutiero ◽

Pantaleo Greco ◽

Piergiorgio Iannone ◽

Giulia Bernardi ◽

Francesca Greco ◽

...

Keyword(s):

Surgical Treatment ◽

Genital Tract ◽

Cultural Beliefs ◽

Foley Catheter ◽

Female Genital Tract ◽

Vaginal Septum ◽

Menstrual Flow ◽

Transverse Vaginal Septum ◽

Female Genital

AbstractTransverse vaginal septum is a rare female genital tract anomaly, and little is described about its surgical treatment. We report the case of a patient who wished to preserve hymenal integrity due to social and cultural beliefs. We performed a vaginoscopic resection of the septum under laparoscopic view, followed by the introduction of a Foley catheter in the vagina, thus preserving the hymen. After 12 months of follow-up, no septal closure was present, and the menstrual flow was effective. Vaginoscopic hysteroscopy is an effective method of vaginal septum resection, even in cases in which hymenal integrity must be preserved due to social and cultural beliefs.

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Müllerian Anomalies: A Cause for Primary Amenorrhea

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1499 ◽

2017 ◽

Vol 9 (3) ◽

pp. 221-224

Author(s):

Anuja V Bhalerao ◽

Richa Garg

Keyword(s):

Correct Diagnosis ◽

Management Strategies ◽

Androgen Insensitivity Syndrome ◽

Primary Amenorrhea ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Secondary Sexual Characters ◽

Transverse Vaginal Septum ◽

Preservation Of Fertility ◽

Secondary Sexual

ABSTRACT Introduction Primary amenorrhea is a challenging entity as it affects the reproductive outcome. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age. Aim The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of primary amenorrhea. Materials and methods All girls who had not attained menarche until 16 years of age in the absence of secondary sexual characters and until 14 years, if no secondary sexual characters, and were willing for follow-up were subjected to investigations and were treated as per the etiology. Results Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome was the most common cause of primary amenorrhea (42.85%) followed by imperforate hymen (28.57%) and transverse vaginal septum (21.42%), one each of low, mid, and high varieties. There was one case of androgen insensitivity syndrome. Conclusion Establishing correct diagnosis is essential for planning treatment and management strategies in primary amenorrhea as treatment goals are preservation of fertility and progression of normal development. How to cite this article Bhalerao AV, Garg R. Müllerian Anomalies: A Cause for Primary Amenorrhea. J South Asian Feder Obst Gynae 2017;9(3):221-224.

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An interesting rare case of spontaneous pregnancy with imperforate hymen and high transverse vaginal septum with bicornuate uterus

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164692 ◽

2016 ◽

Vol 6 (1) ◽

pp. 341

Author(s):

Bharathi KR ◽

Vijayalakshmi S. ◽

Divya Alamelu N.

Keyword(s):

Reproductive Tract ◽

Genetic Mutation ◽

Interesting Case ◽

Female Reproductive Tract ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Bicornuate Uterus ◽

Spontaneous Pregnancy ◽

Transverse Vaginal Septum ◽

Huge Impact

Congenital anatomic disorders of the female reproductive tract may result from genetic mutation, developmental arrest and abnormal hormonal exposure during embryonic development. These anomalies have a huge impact on the woman’s menstrual, sexual and reproductive functions. Pregnancy with these anatomic disorders is quite challenging. Here we present a rare interesting case of spontaneous pregnancy with multiple anatomic disorders namely- imperforate hymen, high transverse vaginal septum and bicornuate uterus.

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Perforated transverse vaginal septum - report of an unusual case

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401728 ◽

2013 ◽

Vol 02 (04) ◽

pp. 221-224

Author(s):

Vuba Ramarao ◽

P Revathi ◽

Anirban Das Gupta ◽

B.Rama Mohanrao ◽

Aditi Saha

Keyword(s):

Andhra Pradesh ◽

Unusual Case ◽

Medical Sciences ◽

Vaginal Septum ◽

Transverse Vaginal Septum

AbstractA case of perforated transverse vaginal septum in the middle third of the vagina, in a 21 yrs old recently married lady who came for evaluation of dyspareunia at OPD of Gynaecology, Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh is reported here. Diagnosis was made clinically and later on confirmed by USG. The patient was treated surgically by excision of the septum following which she conceived successfully. The patient is presently carrying 10 weeks as on the day of reporting and is under our constant follow up.

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Term Pregnancy in a Woman with Incomplete Transverse Vaginal Septum- An Interesting Case

Surgical Case Reports ◽

10.31487/j.scr.2020.08.15 ◽

2020 ◽

pp. 1-3

Author(s):

sathiya priya subburaj ◽

Jyotsna sharma ◽

HARITHA SAGILI

Keyword(s):

Cesarean Section ◽

Interesting Case ◽

Elective Cesarean Section ◽

Term Pregnancy ◽

Obstructed Labor ◽

Vaginal Septum ◽

Transverse Vaginal Septum ◽

Elective Cesarean ◽

First Time

Transverse vaginal septum is a rare Mullerian duct anomaly presenting for the first time in pregnancy and labor. A 24-year-old primigravida presented at 39 weeks gestation. Speculum examination revealed a thick transverse vaginal septum with a pinpoint opening in the upper aspect. Elective cesarean section was done followed by digital perforation and dilatation of the septum. The postoperative period was uneventful. At six week follow up there was no restenosis or scarring of the vagina. To avoid complications like obstructed labor and laceration of vagina prophylactic cesarean section is advocated when the thickness of the septum cannot be ascertained on clinical examination.

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A Case Report of Microperforate hymen presented with primary infertility

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i4.4897 ◽

2021 ◽

Vol 12 (4) ◽

pp. 2519-2522

Author(s):

Pavithra Baskaran ◽

Nidhi Sharma

Keyword(s):

Case Report ◽

Unique Case ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Primary Infertility ◽

Main Complaint ◽

Transverse Vaginal Septum ◽

Paediatric Age ◽

Tract Infections

Micro perforate hymen is an uncommon congenital defect in which the hymen has a microscopic pinpoint aperture. It is a different entity from imperforate hymen, but it might present with more or less similar complaints. Here we are discussing about a unique case of pinpoint hymenal opening or microperforate hymen where the patient presented to us with primary infertility. Most cases of micro perforate hymen present in the paediatric age group with recurrent urinary tract infections and recurrent vulvovaginitis. Rare cases in a review of literature noted that a patient was seen to present with urethral dilatation during coital activity. In this case report, we present a patient who came with primary infertility who has never been examined in the past. She had regular menstrual cycles but scanty flow with the main complaint of dyspareunia. After examination, she was found to have microperforate hymen and suspected transverse vaginal septum defect. Hence, routine investigations were done, and we proceeded with hymenectomy. This example demonstrates the importance of a thorough genital examination and the inclusion of hymenal abnormalities in the differential diagnosis of women with recurrent dysuria, vaginitis, primary infertility, and oligomenorrhoea, so that early intervention can be done to improve the woman's quality of life and reduce pregnancy difficulties.

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