Primary amenorrhea with transverse vaginal septum

Abstract

Transverse vaginal septum is a rare congenital anomaly with an incidence of 1:2100 due to incomplete fusion of mullerian duct and the urogenital sinus component of the vagina. Surgical management of the transverse vaginal septum is based on its thickness and its location in the vagina. A 13-year-old girl presented with cyclical abdominal pain for 3 months without attaining menarche. Examination revealed a blind ending vagina. Ultrasound and MRI revealed hematocoplos and hematometra. Septum was located 2.5 cm away from vaginal introitus, of 3.4 mm thickness. Vaginal septal resection was performed under general anaesthesia followed by drainage of the hematocoplometra and vaginal reconstruction by suturing cut edges of septum with the hymen with interrupted sutures with vicryl. Cervix was visualised under endoscopic guidance during the procedure. Patient tolerated the procedure well with no postoperative complications or bleeding. Patient was discharged on day 3 on oral antibiotics and a metronidazole and lignocaine gel for local application. Patient was followed up in OPD on Day 7 postoperatively and was advised to use a vaginal dilator. Patient attained her regular menstrual cycles after 1 month of surgery. Timely diagnosis of transverse vaginal septum is essential to prevent future complications of amenorrhea, endometriosis and infertility. The management is essentially surgical taking into account the risk of postoperative stenosis and need of vaginal molds or dilators.