Transverse vaginal septae: management and long‐term outcomes

Abstract

Objective To examine the management and long-term outcomes of transverse vaginal septae.Design Observational study with cross-sectional and retrospective arms.Setting Tertiary referral centre specialising in M€ ullerian anomalies.Population Forty-six girls and women with a transverse vaginal septum.Methods Data from medical records of all cases (1998-2013) of transverse vaginal septae were collected and reviewed. Patients over 16 years of age also completed a questionnaire.Main outcome measures Presentation, examination findings, investigations, surgery, and long-term reproductive outcomes.Results The septae in the study were described as follows: 61% (95% CI 0.46-0.74) were imperforate, and presented with obstructed menstruation; 39% (95% CI 0.26-0.54) were perforate, and presented with a variety of concerns; 72% (95% CI 0.57-0.83) were low, 22% (95% CI 0.12-0.36) were mid-vaginal, and 6% (95% CI 0.02-0.18) were high; 33% were managed via an abdominoperineal approach, 59% were managed via a vaginal approach, and 6% had laparoscopic resection (one patient did not have surgery); 11% (95% CI 0.05-0.23) of patients presented with reobstruction, all following abdominoperineal vaginoplasty; 7% presented with vaginal stenosis, two following vaginal resection and one following the abdominoperineal approach; 61% of questionnaires were returned. These results showed that 22/23 patients were menstruating and one had a hysterectomy, 74% had been sexually active, 35% had dyspareunia, and 36% complained of dysmenorrhoea. There were seven pregnancies, with one termination and six live births, all following the vaginal excision of a transverse vaginal septum.Conclusions Transverse vaginal septae resected vaginally or laparoscopically have low complication rates and good long-term outcomes. Complex septae require more extensive surgery, with an increased risk of complications.

Re: Transverse vaginal septae: management and long‐term outcomes

“…1 I have been interested in female genital tract anomalies for the last 40 years of my practice and have encountered some 30 women with obstructed vaginal patency (excluding imperforate hymen). 1 I have been interested in female genital tract anomalies for the last 40 years of my practice and have encountered some 30 women with obstructed vaginal patency (excluding imperforate hymen).…”

“…1 The paper, however, did not emphasise the importance of the antenatal diagnosis and treatment of iron deficiency anaemia, to ensure that every pregnant woman starts labour with optimum haemoglobin levels. 1 The paper, however, did not emphasise the importance of the antenatal diagnosis and treatment of iron deficiency anaemia, to ensure that every pregnant woman starts labour with optimum haemoglobin levels.…”

Tabique vaginal transverso diagnosticado en dos hermanas. Reporte de dos casos

“…4 Según revisiones recientes y con series de casos más amplias, se estima la presencia de un TVT alto en el 6% de los casos, un 22% en la zona media vaginal y un 72% en la zona vaginal inferior. 5 El septo puede ser completo o incompleto y suele tener un espesor inferior a 1 cm, frecuentemente, con una pequeña perforación. Cuanto más grueso es el tabique, más cerca se ubicará del cuello uterino.…”

The interdigitating Y‐plasty procedure for the correction of transverse vaginal septa

“…[1][2][3] The pathogenesis of these M€ ullerian anomalies is still unclear, but they are believed to be developmental defects of vaginal embryogenesis, resulting in incomplete canalisation of the vaginal plate at the junction between the urogenital sinus and the M€ ullerian duct. Their exact incidence is unknown, with reported numbers varying greatly from 1:2100 to 1:84 000.…”

“…Their exact incidence is unknown, with reported numbers varying greatly from 1:2100 to 1:84 000. 3 Most general gynaecologists will only rarely encounter TVS during their career, and management of them is generally reserved for tertiary centres with experience in the management of congenital abnormalities of the genital tract. 3,4 TVS may vary in thickness and can be found at any level in the vagina.…”