Dr Ramesh Bhosale
Professor and Head of the Department of Obstetrics and Gynaecology, B J Medical College and Sassoon General Hospital, Pune
A 13-year-old girl, who weighed 35kg, had been experiencing abdominal pains for three to four days every month. But the teenager had not been having her menstrual period. On examination it was found that she did not have a ‘normal’ vaginal opening.
On imaging investigation, a transverse vaginal septum – a congenital partition within the vagina – was detected. A septal operation was performed which established the outflow of menstrual blood. However within two months, restenosis – the recurrence of abnormal narrowing of a valve after corrective surgery – developed and the vaginal opening closed.
The girl then underwent plastic surgery with ‘pudendal flaps’ and menstrual flow was re-established. Unfortunately, this time too there was restenosis and the flow stopped within two months. Eventually after seven months, the patient sought an opinion at the gynaecology department of Sassoon General Hospital.
Disruptions in menstrual flow can be ‘stressful’ for the body and a delay in seeking medical help, mostly because of reluctance on the part of the patient to get a genital examination, can worsen the problem. Outflow tract obstruction is one of the reasons for delayed or complete blockage of menstrual flow. If the condition is not treated in time, the upper vital genital reproductive tract is permanently damaged resulting in sterility. This condition occurs in 1 in every 30,000-80,000 women.
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When the patient was examined at Sassoon General Hospital, we realised that her vaginal opening had completely closed due to extensive fibrosis. A sonography test revealed that there was accumulation of blood in her upper vaginal canal, which had created a 11X8.5cm size mass.
When the 13-year-old was examined in the operation theatre under spinal anaesthesia, extensive fibrosis and formation of a septum in the vagina was seen. A reconstruction operation was immediately undertaken. All fibrotic tissues along with the septum were completely removed, ensuring that the urethra and rectum were not affected. Finally, deformities that had occurred from the previous surgical fibrosis were corrected and the anatomy of the vagina and the vulva was restored successfully. The accumulated menstrual blood was released through the newly created passage.
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