Transverse vaginal septum presenting as secondary amenorrhoea: a rare clinical presentation

Abstract

Transverse vaginal septum is one of the variants of Mullerian duct anomaly, caused as a result of defective fusion or recanalisation of vaginal and Mullerian organs. At an early age, it commonly presents as primary amenorrhea along with cyclical abdominal pain while later on usually it presents as dyspareunia and infertility. Our 22-year-old patient presented with secondary amenorrhea. It is very unusual for a transverse vaginal septum to cause secondary amenorrhea. MRI and clinical examination raised the suspicion of transverse vaginal septum causing secondary amenorrhea. She attained regular menstrual cycle after septum excision. The proposed theory behind it is obliteration of microperforated transverse vaginal septum because of menstrual blood and cell debris. Thus, a rare possibility of transverse vaginal septum should also be considered as a differential diagnosis of secondary amenorrhea.

Previously perforated transverse vaginal septum becomes obstructed: A case report

“…The etiology of TVS remains a debatable issue, between the theories of failure of fusion of the Mullerian system which forms the upper vaginal part and the sinovaginal bulb which forms the lower part, the theory of failure of canalization of the vaginal plate, or a combination of both [1,4] . The first theory fusion failure is support by histopathological examination of TVSs, in which the cranial side is lined by columnar epithelium of Mullerian origin, whereas, the caudal side is lined by squamous epithelium of the urogenital sinus.…”

“…The first theory fusion failure is support by histopathological examination of TVSs, in which the cranial side is lined by columnar epithelium of Mullerian origin, whereas, the caudal side is lined by squamous epithelium of the urogenital sinus. The theory of failed canalization is supported by the presence of TVSs at various levels in the vagina [1,9] . According to the consensus of the European Society of Human Reproduction and Embryology (HSHRE) and European Society of Gynecological Endoscopy (ESGE) [10] , our patient would be classified as U0C0V3, since she had no anomalies of either the uterus or the cervix with a TVS.…”

“…Transverse vaginal septum (TVS) is one of the rare congenital anomalies of the development of the Mullerian duct [1] , it was first reported in 1872 by Delaunay [2] , then reappeared in literature again 72 years later in a report by Dannreuther [3] . Most of the publications about TVS seem to agree on an incidence that varies between 1:40,000 and 1:84,000 [1,4,5] . Unlike the etiology which remains a matter of debate, although recently it is believed to be multifactorial [6] .…”

“…Unlike the etiology which remains a matter of debate, although recently it is believed to be multifactorial [6] . TVSs are broadly classified as perforated or imperforated, based on the presence or absence of communication between the vagina and the uterus [1] , accordingly, clinical symptoms vary. An imperforated TVS usually presents early, as early as the neonatal period due to obstruction of flow of vaginal secretions (hydrometrocolpos), or in the early puberty period, with features of obstruction of menstrual flow, such as primary amenorrhea, hematocolpos, and hematometra, which are usually associated with the complaint of cyclic lower abdominal pain [1,5] .…”

“…TVSs are broadly classified as perforated or imperforated, based on the presence or absence of communication between the vagina and the uterus [1] , accordingly, clinical symptoms vary. An imperforated TVS usually presents early, as early as the neonatal period due to obstruction of flow of vaginal secretions (hydrometrocolpos), or in the early puberty period, with features of obstruction of menstrual flow, such as primary amenorrhea, hematocolpos, and hematometra, which are usually associated with the complaint of cyclic lower abdominal pain [1,5] . On the contrary, perforated TVS may be asymptomatic and an incidental finding upon vaginal examination due to complains such as dysmenorrhea, dyspareunia, or infertility [7] .…”