Vaginal adhesions in a woman with the history of dystocia
A 32-year-old woman (gravida 4, para 2) visited our institution due to dyspareunia lasting for 5 months after her second delivery. Seven years before her visit, she delivered her first baby by Cesarean section due to progression failure. However, she succeeded in vaginal birth after a Cesarean delivery (VBAC) for her second delivery at another institution. She reported that during her second labor, she underwent numerous pelvic examinations because her labor did not progress smoothly. Finally, she underwent a vaginal delivery of a female infant weighing 3,580 g without applying vacuum or forceps. She did not visit at her scheduled postpartum examination after her second delivery, therefore, her perineal area was not explored after her vaginal birth.\nAfter her second birth, she experienced dyspareunia and her husband could not resume his sexual activity due to inability to achieve full penile insertion. Also, she reported the immediate leakage of semen after intercourse. In addition, her menstruation did not resume, but she attributed this phenomenon to breastfeeding. There was no abnormal finding in her vital signs and laboratory tests. However, it was hard to insert the speculum fully into her vagina because of her blind vagina canal. Also, her cervix could not be visualized by speculum examination. As a result of a thick transverse vaginal septum blocking her vaginal cavity, we could insert a speculum only 2 to 3 cm into her vagina (). Transvaginal ultrasonography (Voluson 730 Expert, GE Medical Systems, Zipf, Austria) showed a transverse vaginal septum measuring 0.94 cm thick and a fluid-filled cavity beyond it (). Vaginal adhesion was diagnosed and she was admitted for treatment of this rare condition.\nAfter hospitalization, prophylactic intravenous antibiotics (3rd-generation cephalosporin with metronidazole) were administered first. After the day of admission, the fluid in the obstructed vaginal cavity was aspirated and examined. This fluid was turbid and had a foul odor but no bacteria were found upon culture examination. With this aspiration, we excised the vaginal septum and sutured the remained edge of this septum to the vaginal wall using 2-0 Vicryl (Ethicon Inc., Somerville, NJ, USA) (). After the operation, we inserted Vaseline gauze into the vaginal cavity to prevent re-adhesion and hemorrhage. This packed gauze was maintained during the whole hospitalization period and changed every day. Antibiotics were administered intravenously for 5 days and she was discharged on day 5 after the operation. Three months following surgery, she noticed an improvement in her dyspareunia and resumed sexual activity. Pelvic examination revealed a well-maintained vaginal cavity.