Secondary amenorrhea attributed to occlusion of microperforate transverse vaginal septum

Abstract

To present a case of secondary amenorrhea after occlusion of microperforate transverse vaginal septum. Case report. Academic teaching hospital. A 19-year-old woman with new onset of irregular menses and pelvic pain, with history of menarche at age 14. Surgical evaluation and treatment, including laparoscopy, hysteroscopy, and excision of septum, followed by repeat surgery with lysis of adhesions due to agglutination of the area previously excised. Awareness of the possibility of secondary amenorrhea occurring due to septal scarring of a perforate transverse vaginal septum. Imaging revealed a hematometra and hematocolpos. Examination revealed a transverse vaginal septum. Ultrasound scans and magnetic resonance imaging revealed an enlarged uterus and an endometrial cavity and cervix distended with fluid and debris. Examination under anesthesia revealed a septum approximately 5 mm thick, which was revealed to be benign fibromuscular tissue with chronic nonspecific inflammation. This case demonstrates the evolution from a microperforate transverse vaginal septum with regular menses for over 4 years to an occluded septum. Although transverse vaginal septa causing amenorrhea are usually diagnosed at menarche, perforate septa have been shown to lead to hypomenorrhea, dysmenorrhea, dyspareunia, infertility, and issues with vaginal childbirth. We present a case in which a perforate transverse vaginal septum led to secondary amenorrhea.