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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 194-196

A torn longitudinal vaginal septum in a multiparous woman causing sexual dissatisfaction


Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria

Date of Web Publication9-Dec-2019

Correspondence Address:
Dr. Muhammad Baffah Aminu
Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_116_19

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  Abstract 


Longitudinal vaginal septum is one of the Mullerian abnormalities affecting the lower genital tract. It is a rare but frequent cause of dyspareunia in early adult life and occurs as a result of incomplete fusion of the lower part of the two Mullerian ducts or failure of canalization of the vaginal plate. We report the case of a multipara who had a fleshy mass protruding from the vagina and sexual dissatisfaction with no associated symptoms of uterovaginal prolapse. She had examination under anesthesia and simple surgical excision, following which she had relief of her symptoms. This is a unique case occurring in a multipara (para 4) that went unnoticed until after the fourth childbirth. A careful evaluation of all clients with dyspareunia or sexual dissatisfaction after delivery should be the watchword.

Keywords: Multipara, prolapse, sexual dissatisfaction, torn septum


How to cite this article:
Aminu MB, Shehu AM, Dattijo LM, Oranuka K. A torn longitudinal vaginal septum in a multiparous woman causing sexual dissatisfaction. Saudi J Health Sci 2019;8:194-6

How to cite this URL:
Aminu MB, Shehu AM, Dattijo LM, Oranuka K. A torn longitudinal vaginal septum in a multiparous woman causing sexual dissatisfaction. Saudi J Health Sci [serial online] 2019 [cited 2020 Jan 22];8:194-6. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/3/194/272436




  Introduction Top


Longitudinal vaginal septum is an abnormality of the female lower genital tract occurring due to the persistence of the vaginal plate that is expected to open up as the vaginal orifice in normal females. The vaginal plate results from the fusion of the urogenital sinus to the Mullerian duct. This abnormality occurs commonly in association with other uterine anomalies.[1] A longitudinal septum may coexist with a didelphys uterus and two cervices[2] or sometimes with two cervical openings and a unicornuate uterus.[3] In some cases, they may coexist with renal anomalies such as ectopic ureters, resulting in even incontinence of urine.[4]

Majority of women with this abnormality may go unnoticed in early childhood until at the insertion of a vaginal tampon during the first or subsequent menstruation or at first intercourse, delivery, or accidently during routine pelvic examination. However, in most cases, there is usually a complaint of sexual dissatisfaction among couple or only by the husband. Subfertility may occasionally be the presenting symptom in some rare cases.[5] This report aimed at highlighting the rarity of the problem and to indicate that a simple excision may be the only solution to this infrequent cause of dyspareunia in early life.


  Case Report Top


Mrs. A.I was a 23-year-old Para 4 + 2, 4 alive. Her last child birth was 18 months before presentation. She came to the gynecology clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, with a 5-year history of a mass intermittently protruding per vaginam and a 2-year history of lack of sexual satisfaction. Her partner had also complained of the same dissatisfaction. The protrusion usually follows each child birth but reduces after puerperium. It is painless but increased in size with subsequent deliveries. She had no history of prolonged labor, instrumental delivery, or perineal tear in all her deliveries. Also, there were no history of postcoital bleeding, vaginal discharge, urinary symptoms, and vulvar excoriation. All her previous pregnancies were unbooked and deliveries were at home.

General physical examination was normal. Pelvic examination showed normal female genitalia with a fleshy red mass protruding through the introitus; the cervix was healthy looking with the fleshy mass in the anterior vagina extending from the urethral orifice to the anterior fornix. There was equally another fleshy mass on the posterior vaginal wall in the midline, which was about 10 cm in length extending from the mid-vagina to the posterior fornix [Figure 1] and [Figure 2]; there was no accompanying cystocele or rectocele. Bimanual examination revealed a normal uterus; there were no adnexal masses, and the Pouch of Douglas (POD) was free.
Figure 1: Fleshy mass (the torn septum) protruding from the vagina on both anterior and posterior walls. The posterior mass measured about 10 cm in length

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Figure 2: The extent of the masses with healthy normal cervix

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Biochemical and hematological investigations were normal. Pelvic ultrasound showed a normal empty uterus with free adnexa and POD; both kidneys were well placed and normal. Hysterosalpingogram showed a single uterus with bilateral patent tubes. She had examination under anesthesia with simple excision of the torn septum [Figure 3] and [Figure 4]; she did well subsequently and was discharged a day after [Figure 5]. Subsequent follow-up after 6 weeks showed a normal vaginal wall with satisfactory sexual life.
Figure 3: The anterior vaginal wall with the sutured stump of the excised mass

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Figure 4: The posterior vaginal wall after the posterior mass was excised

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Figure 5: The cervix and the vaginal rugae post repair

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  Discussion Top


Longitudinal vaginal septum prolapse usually occurs in association with uterine and cervical descent;[6] no matter how long this septum is present, it will manifest during the woman's lifetime. Some of the most common symptoms of a longitudinal prolapse include pain during intercourse, difficulty in inserting tampon,[1],[7] and occasionally causing primary infertility.[5] It is a cause of sexual discomfort in adulthood as seen in this report and may also be the reason for a prolonged labor, a perineal tear, and an obstructed labor in pregnant patients or primary postpartum hemorrhage from a torn septum. The longitudinal vaginal septum is more common and can result in vaginal delivery as a result of displacement of the septum by the fetal head or sometimes by spontaneous tear.[8] This may be the possible reason why the index patient had four spontaneous vaginal deliveries and the septum remained unnoticed. In addition, although they were all home deliveries by unskilled personnel, no attempt was made to check the prolapsed mass until the time she presented. This scenario may not be usual with transverse vaginal septum as spontaneous vaginal delivery is not usually likely except following intervention. Thus, a transverse septum is one of the causes of emergency cesarean section in primigravida by unskilled personnel.

Treatment can be done depending on the type of septum using simple excision which involves clamping, cutting, and site closure using sutures,[1] as done in the index case. Alternatively, hysteroscopic excision using a resectoscope can be applied in facilities that have the necessary instruments and expertise.[9] Septoplasty can be done even in the second stage of labor, but the risk of postpartum bleeding should be anticipated. For patients with coexisting anterior and posterior vaginal wall prolapse, a longitudinal dissection of the septum can be performed together with colporrhaphy or just an isolated septum dissection through minimal access techniques.[10] More recently, ultrasonic shears or scalpels have been used[1],[7] to offer treatment with minimal morbidity. In women with septum who have completed family size and requiring permanent cure, a vaginal hysterectomy can be performed.[2]


  Conclusion Top


A torn longitudinal vaginal septum is a rare cause of sexual dissatisfaction in multiparous women. Careful evaluation of all women presenting with dyspareunia or sexual dissatisfaction following vaginal delivery should be the watchword.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bacon JL, McCoy T. Case series of resection of longitudinal vaginal septum using ultrasonic shears. J Pediatr Adoles Gynecol 2017;30:317.  Back to cited text no. 1
    
2.
Jawed A, Harmanli O, Jones K. 58: Vaginal approach to hysterectomy with uterine didelphys and longitudinal vaginal septum. Am J Obstet Gynaecol 2018;218:S971.  Back to cited text no. 2
    
3.
Kalpana B, Gupta R. Rare case report of complete uterine septum with longitudinal vaginal septum presenting as didelphic/unocornuate uterus. J Evol Med Dent Sci 2017;6:6920-3.  Back to cited text no. 3
    
4.
Smith AL, Kolon TF, Canning DA, Weissbart SJ. Partially obstructed longitudinal vaginal septum presenting in adulthood with complaint of urinary incontinence. Urology 2019;124:302-5.  Back to cited text no. 4
    
5.
Banu J, Fatima P, Dorji N, Chowdhury AA. Primary subfertility with partial septate uterus and longitudinal vaginal septum. Bangabandhu Sheikh Mujib Med Univ J 2017;10:32-4.  Back to cited text no. 5
    
6.
Vijaylakshmi AR, Rai S. A prolapsed longitudinal vaginal septum with invaginating cystocele and rectocele: A rare presentation with a unique management. Gynecol Obstet (Sunnyvale) 2016. DOI: 10.4172/2161-0932.1000358.  Back to cited text no. 6
    
7.
Perez-Milicua G, Hakim J, Adeyemi O, Dietrich JE. Longitudinal vaginal septum resection using the ligasure device. J Pediatr Adolesc Gynecol 2016;29:e95-e96.  Back to cited text no. 7
    
8.
de França Neto AH, Nóbrega BV, Clementino Filho J, do Ó TC, de Amorim MM. Intrapartum diagnosis and treatment of longitudinal vaginal septum. Case Rep Obstet Gynecol 2014;2014:108973.  Back to cited text no. 8
    
9.
Mazzon I, Gerli S, Di Angelo Antonio S, Assorgi C, Villani V, Favilli A, et al. The technique of vaginal septum as uterine septum: A New approach for the hysteroscopic treatment of vaginal septum. J Minim Invasive Gynecol 2019. pii: S1553-4650(19)30132-3.  Back to cited text no. 9
    
10.
Bule M, Engel M, Levashkevich A, Wiese DA, Frye I. Uterus with cervical duplication and a longitudinal vaginal septum: A case report. J Minim Invasive Gynaecol 2018;25:S202.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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