|Year : 2018 | Volume
| Issue : 1 | Page : 63-64
Acquired vaginal stenosis with secondary infertility; A rare complication of traumatic PPH
Anita Kumari, Jaya Kumari, Anjili Kumari, Syed Nazaneen, Sangeeta Pankaj
Department of Gynecological Oncology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
|Date of Web Publication||12-Feb-2018|
Additional Professor, Gynecological Oncology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar
Source of Support: None, Conflict of Interest: None
Secondary gynaetresia may occurs due to trauma to the female genital tract with secondary infection and adhesions. Post traumatic vaginal stenosis after full term vaginal delivery is rarely seen in gynaecological practise. We report a case of 25 years old women presenting with secondary infertility, scanty flow during menses and pain lower abdomen. On per speculum examination she was found to have vaginal septum. She had full term vaginal delivery 8 years back with history of traumatic post partum haemorrhage in the first delivery. Ultrasonography showed normal uterus, 7x4 cm right sided dermoid cyst. Laparotomy was done along with right oophorectomy. With help of combined abdomino-vaginal approach septum was incised horizontally. Continuous interlocking suture were taken at raw bleeding edge of vaginal septum to secure hemostasis.
Keywords: Secondary gynaetresia, post-partum hemorrhage, vaginal stenosis, vaginal septum
|How to cite this article:|
Kumari A, Kumari J, Kumari A, Nazaneen S, Pankaj S. Acquired vaginal stenosis with secondary infertility; A rare complication of traumatic PPH. J Indira Gandhi Inst Med Sci 2018;4:63-4
|How to cite this URL:|
Kumari A, Kumari J, Kumari A, Nazaneen S, Pankaj S. Acquired vaginal stenosis with secondary infertility; A rare complication of traumatic PPH. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Aug 10];4:63-4. Available from: http://www.jigims.co.in/text.asp?2018/4/1/63/302992
| Introduction :|| |
Gynaetresia is defined as occlusion of lower genital tract of female especially occlusion of vagina by a thick membrane. Congenital transverse vaginal septum is a rare condition and results from incomplete fusion between the vaginal components of the mullerian ducts and the urogenital sinus. Its incidence is approximately 1 in 30,000 to 1 in 80,000 women. These septa may be located at various levels in the vagina although most are found in the upper and mid vagina and thicker septa are closer to cervix .
Acquired gynaetresia is much less common than the congenital type in the developed countries. In the developed countries it is mostly iatrogenic due to surgical procedures on vagina like colporraphy and sequel to intravaginal radiation in the treatment of gynaecological malignancies. In developing countries acquired gynaetresia is due to some cultural practices and vaginal insertion of local herbs in the treatment of infertility amenorrhoea and for induction of abortion. Trauma & infection of the genital tract causes vaginitis with formation of adhesions leading to gynaetresia, other causes include female genital mutilation & prolonged obstructed labour leading to traumatic post-partum haemorrhage.
| Case Report :|| |
A 25 years old female P1+1 attended gynecological oncology OPD of Indira Gandhi Institute of Medical Science Patna on 20/3/201 with complaints of pain lower abdomen, scanty flow during menses and secondary infertility for last six years. Menstrual cycle was regular scanty flow with a cycle of 30 days lasted for 2-3 days. There was history of mild dysmenorrhea and dyspareunia for years but no history of weight gain, or any other chronic illness. She had history of one complete spontaneous abortion and there after one full term difficult vaginal delivery of a female child of 3 kg 8 years back at a private hospital followed by traumatic postpartum hemorrhage with vaginal tears which was repaired and one unit of blood transfusion was done as told by patient verbally. No documentation was available.
Her general physical examination was normal. She was average built. On local examination vulva was normal. Per speculum examination showed vaginal septum 3-4 cm above the introitus. Cervix was not visualized. On per vaginal examination cervix could not be felt. On per rectal examination uterus was normal in size, her baseline investigations and hormonal profile was within normal limit. The semen analysis of husband was normal and hysterosalpingography could not be done due to nonvisualization of cervix. Ultrasonography showed normal uterus, 4x4cm right sided dermoid cyst. Her all tumor marker was normal. Patient was planned for right sided oophorectomy and vaginal recanalization.
Under spinal anesthesia pre- operative findings were confirmed and abdomen opened. With help of combined abdominovaginal approach septum was incised horizontally. Old blood was drained vaginally showing haematocolpous. Cervical lips could be felt digitally. Continuous interlocking suture were taken at raw bleeding edge of vaginal septum to secure hemostasis of transverse incision. On opening the abdomen Right ovarian dermoid cyst was with no healthy tissue was found. Right oophorectomy was done, uterus was mobilized and dye test done through uterine cavity. Bilateral spillage of dye was seen. Vaginal packing was done and removed on first post operative day. Patient was discharged on tenth post operative day with advice for regular follow up.
| Discussion :|| |
Congenital transverse vaginal septum is a rare condition due to mullerian fusion defect but few cases of acquired vaginal septum also have been reported.
Acquired gynaetresia in this patient must be due to trauma and infection of the genital tract during first delivery which led to transverse vaginal septum. There may be a pin point hole for the flow of small amount of menstrual blood, but not complete blood flow. A search of literature revealed few reports on vaginal atresia. Singhal and associates reported a post traumatic vulvo-vaginal stenosis in 24 year old woman following perineal injury 10 years back due to fall from height on staircase. She was treated by modified Mc Indoes operation.
Agarwal and associates reported a case of secondary gynaetresia in 28 years old women due to traumatic post partum haemorrhage following vaginal delivery of a male baby 8 years back. She was diagnosed in second pregnancy when per speculum examination done in incomplete abortion. She was treated by septotomy and evacuation of product of conception.
Omale’s team reported a 20 year old student presenting with history of termination of 8 weeks pregnancy by insertion of chemical per vaginally and subsequent evacuation of product of conception with syringe like instrument 5 months back .Since then she had cyclical monthly lower abdominal pain but remained amenorrhoeic. Examination revealed dense adhesions in vagina with complete obliteration of cervix. Adhesiolysis of vagina and cervix was done. Cruciate incision on vagina was given and evacuation of altered blood was done.
| Conclusion :|| |
Secondary vaginal atresia is a rare complication of traumatic post partum haemorrhage. So patients with traumatic postpartum haemorrhage should be handled with great care, in expert hands and should be followed up on long term to prevent this complication.
| References|| |
Lippincott William and Wilkins Baltimore, Maryland. Stedman’s medical dictionary. 28thed; 2006.p. 841
Deligeoroglou E, Iavazzo C, Sofoudis C, Kalampokas T, Creatsas G. Management of hematocolpos in adolescent with transverse vaginal septum. Arch Gynecol Obstet 2012;285(4):1083-7.
Omale EA, Ogunniyi SO, Iliyasus Z. Complications of Female Genital Mutilation in Ile Ife, Nigeria: A ten year review. Nig J of Basic and Clinical Sciences 2004; 1 (20): 50-4.
Hafeez rahman, Nikita Trehan, Suchita singh, meenakshi goyal. Transverse Vaginal Septum With secondary Infertility; A Rare Case.j-jmig2016; 23(5): 673-674
SinghalVP,Saxena N,Sukriti S,Tripathi P,Sharma B.Post Traumatic vulvo -vaginal Stenosis rare case. International Journal of Gynae Plastic Surgery .2013 Nov; 5(2):48-50
Agarwal A ,Agarwal A, Meena ML, Meena P, Goyal R.IOSR Journal of Dental and Medical Sciences.2015:14(5):18-21
Omale AE,IbrahimSA &Anor F.Acquired gynaetresia with cryptomenorrhoea secondary to induced abortion A case report.Ibom Medical Journal 2008 Aug;3(2):64-7.