Vaginal Outlet Obstruction - A Review of Cases

The paper focuses on anatomical varieties of developmental anomalies of female vagina’s outlet, emphasizing the role of their early recognition in preventing retrograde menstruation by surgical treatment at the beginning of puberty. Three different types of vaginal outlet obstruction are described: imperforate hymen from the group of hymen misdevelopment, transversal vaginal septum from the group of failed transverse Mullerian fusion, and vaginal atresia from the Mullerian aplasia group of disorders. Diagnoses were made in different age of life, from neonatal to the teenage years. Clinical and ultrasound examinations dominated in establishing the diagnosis. Computed tomography and magnetic resonance imaging were included in search for associated congenital abnormalities. The time period of the analysis was 2003-2012. The total number of vaginal outlet obstructions was 19. Imperforate hymen was diagnosed in 15 patients 4 neonates, 1 toddler, 2 pre-pubertal girls without any oestrogen stimulation and 8 pubertal girls, after a period of recurrent low abdominal pain. The signs of hydrocolpos were in 5 cases, and only two female newborns were diagnosed on antenatal fetal ultrasound. Distal septum of the vagina was diagnosed and operated in 3 patients: one in a newborn, two in pre-pubertal girls. One girl was diagnosed with vaginal atresia at puberty. Prenatal ultrasound and careful genital examination of the newborn females may be helpful in early diagnostics of very distal vaginal obstructions like imperforate hymen and distal vaginal septum. Vaginal atresia is difficult to notice before the puberty and the menstruation cycle. A search for associated genital anomalies is necessary. In pubertal girls who haven’t got a menarche and suffer the recurrent lower abdominal pain, the pelvic ultrasound is recommended to identify the cause(s).