Distal vaginal atresia presented with apareunia with regular menses and not primary amenorrhea diagnosed by 3D ultrasound and managed by vaginal pull-through aided by 3D ultrasound: A case report and review of literature

Abdel Hamid, Ahmed Sherif; Fawzy El Hao, Mounir Mohamed; Abdel Hamid, Suzy Abdelaziz

doi:10.21608/egyfs.2023.333772

Distal vaginal atresia presented with apareunia with regular menses and not primary amenorrhea diagnosed by 3D ultrasound and managed by vaginal pull-through aided by 3D ultrasound: A case report and review of literature

Document Type : Original Article

Authors

¹ Assistant prof of Obstetrics and Gynecology Faculty of medicine, Ain Shams University, Cairo-Egypt

² Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt

³ Professor of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

⁴ Assistant Professor of Obstetrics & Gynecology, Faculty of Medicine, Cairo University Cairo, Egypt

⁵ Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

10.21608/egyfs.2023.333772

Abstract

Introduction: We report a rare case of distal vaginal atresia not presented by primary amenorrhea but with the inability to have the ﬁrst sexual intercourse after marriage.
Case: The patient had normal menarche and regular cycles. Thus, the challenge was in diagnosing such cases with vaginal atresia with normal menses. The menstrual ﬂow was small in amount. The complaint came after her marriage when her husband felt strong resistance. On examination, no vaginal opening was observed. When examined again during menses, a very small opening was observed, from which the menses ﬂow was discharged: it admitted only a pediatric Foley catheter (denoting a small ﬁstulous tract). 3D ultrasound revealed complete uterus, cervix, and vaginal pouch development. Vaginal atresia was identiﬁed: an operation was done under a 3D rectal ultrasound guide to identifying the dissection plane. Perineal dissection was done, and pull-through of the vaginal pouch, then suturing the lower end of the vagina to the perineum.
Conclusion: not all cases of vaginal atresia cause primary amenorrhea but may present later with sexual problems. 3D rectal ultrasound is an excellent aid in diagnosis and treatment aid.

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