Evaluation and Resection of a Longitudinal Vaginal Septum in an Adult

Abstract

Objective: The objective of this video is to demonstrate the diagnosis, evaluation, and techniques for surgical management of a longitudinal vaginal septum, a rare Mullerian anomaly. DesignThis is a stepwise demonstration of evaluation and surgical techniques with video narration. SettingThe incidence of Mullerian defects, which can include any anomaly in the fallopian tube, uterus, cervix, or vagina, has been estimated to be 2-4%.1 30-40% of patients with Mullerian defects also have associated renal anomalies. 1,2 In normal development, the Mullerian ducts fuse at 10 weeks gestation and the septum between the two ducts is absorbed in a caudal to cephalad direction.3 The exact incidence of complete longitudinal vaginal septums is unknown as they are very rare.4 Longitudinal vaginal septums may cause dyspareunia, inability to have penetrative intercourse, labor dystocia, or hygiene issues and be very emotionally distressing for patients.5 InterventionPreoperative evaluation of an adult with longitudinal vaginal septum that included a careful physical exam and abdominal and pelvic imaging. Intraoperative resection with key strategies: 1. placing a foley catheter to help avoid urinary tract injuries 2. intermittent rectal exams to retract the rectum away from the plane of dissection. ConclusionsPatients who present with longitudinal vaginal septums should undergo evaluation for uterine and renal anomalies. Here, we show that resection of longitudinal vaginal septums in adults is feasible and appropriate for patients who present with inability to have penetrative intercourse. Intraoperatively, care should be taken to avoid injuring the rectum or urinary tract.