Diagnostic challenges of hemihematocolpos and dysmenorrhea in adolescents: obstructed hemivagina, didelphys or bicornuate uterus and renal aplasia is a rare female genital malformation

Abstract

To develop a clear diagnostic and therapeutic strategy for adolescents presenting with abdominal pain and vaginal tumor caused by congenital female genital anomalies, such as blind hemivagina and uterine anomalies, as the lack of the correct diagnosis of the underlying anatomical genitourinary malformation frequently leads to destructive surgical procedures. Retrospective study, study group: patients with double/bicornuate uterus, blind hemivagina and hematocolpos (n=13), controls: patients with uterine malformation and complete vertical vaginal septum (n=11), analysis for: menarche, age at onset of symptoms, type of malformation, symptoms leading to admission and diagnostic/surgical techniques applied. Median age at diagnosis study group 19.85 (SD±6.23, range 13-23years) versus controls 26.09years (SD±7.44, 16-36years); predominance of imperforated hemivagina: 69.2% right-sided versus 30.8% left-sided septum; renal agenesis ipsilateral to imperforate hemivagina 100% study group versus 9.1% controls; 84.6% previous surgical interventions in the study group, such as partial removal of the septum and re-obliteration, unilateral salpingo-ovarectomy and vaginal drainage of pyometra. We used a single transvaginal surgical procedure, including removal of the obstructed vaginal septum and marsupialization of the blind hemivagina. A diagnostic and therapeutic algorithm for young women presenting with progressive dysmenorrhea and abdominal pain and/or vaginal tumor reduces destructive interventions.