Delayed diagnosis of partially obstructed longitudinal vaginal septa.

OBJECTIVE

To report delayed diagnosis in two cases because of subtle manifestations of partially obstructive müllerian anomalies.

DESIGN

Case report.

SETTING

Academic medical center.

PATIENT(S): The first case is a 30-year-old woman who was seen initially with irregular vaginal bleeding, dysmenorrhea, and dyspareunia. On physical examination she was noted to have an anterior vaginal mass with a fistulous tract adjacent to the cervix. Blood and mucus issued from the fistulous tract when the anterior blade of the speculum compressed the vaginal mass. In case 2 a 40-year-old nulligravida was seen with infertility and mild dysmenorrhea. Her history was significant for a Strassman's metroplasty. On examination she was noted to have a bulging at the apex of the vagina adjacent to the cervix.

INTERVENTION(S): Transvaginal ultrasound, fistulogram, hysterosalpingogram, resection of the longitudinal vaginal septa, and cycle day 3 FSH.

MAIN OUTCOME MEASURE(S): Symptoms.

RESULT(S): In case 1 the subject had resolution of irregular vaginal bleeding, dysmenorrhea, and dyspareunia. In case 2 the patient declined to pursue further therapy.

CONCLUSION(S): Common gynecologic symptoms resulted from partially obstructed vaginal septa. These cases demonstrate the importance of a high index of suspicion in subjects who do not respond to standard therapies.