Vaginal septae and imperforate hymen

Abstract

Aim: To present the various options for the treatment of imperforate hymen, longitudinal vaginal septa and, mainly, of vaginal transverse septa.Brief description of the reviewed data: Vaginal Longitudinal and Transverse Septae are the result of late fusion defects of the Müllerian duct. Vertical fusion defect lead to TVS and lateral fusion defect lead to LVS. Imperforated hymen is the failure of perforation process of the hymen that takes place during fetal life. These rare vaginal obstructive anomalies diagnosis and surgical treatment present in childhood and adolescence. TVS usually becomes symptomatic by menarche once menstrual flow is obstructed while LVS may not be found until initiation of coitus. Magnetic resonance imaging and sonography are currently the most efficient to define the complex and abnormal anatomy and differentiate among other pathologies. Occasionally the distensibility of the vagina delays the appearance of the symptoms due to Mallerian anomalies.Clinical implications: A high index of suspicion is necessary for proper diagnosis and resection of the septa and hymen are the sole treatments. Timing of vaginal reconstruction is crucial and highly depends on the age of the patient, menarche and symptoms. Although these obstructive anomalies are very rare, the high incidence of endometriosis at early puberty and infertility problems in adulthood may propose the need of a screening for Müllerian anomalies to all female infants, at least those with positive family history for urogenital tract anomalies.Open issues for further research: Optimum timing and surgical technique for the treatment of obstructive vaginal anomalies should be further elucidated.