Results of vaginal reconstructive surgery in patients with transverse vaginal septum and vaginal agenesis, Tehran Imam Khomeini Hospital, 2014-2019

Obstructive vaginal anomalies such as transverse septum and vaginal agenesis usually present with primary amenorrhea and pelvic pain. This study was performed with aim to evaluate the results of vaginal reconstructive surgery (vaginoplasty) in patients with vaginal agenesis (Rokitansky syndrome) and transverse vaginal septum.

This cohort study was performed on all patients with vaginal agenesis and transverse vaginal septum who had underwent vaginoplasty in the pelvic floor disorders department of Imam Khomeini Hospital ,Tehran in 2014-2019. Basic information, clinical symptoms at admission, type of Mullerian anomaly, type of surgery, complications during surgery, vaginal re-stenosis and pregnancy were collected from patients' files and by phone calls and follow up visits after surgery. Central and dispersion indices were used to describe the data. Frequency distribution was presented in the form of tables.

33 patients had transverse vaginal septum and 35 cases had vaginal and uterine agenesis (Rokitansky syndrome). In terms of early symptoms at admission, the most common symptoms were amenorrhea, pelvic pain, and inability to sexual intercourse or dyspareunia. In 11 cases (33.33%), vaginal re-stenosis occurred after correction of transverse vaginal septum, all of which occurred in the first 3 months after surgery due to incorrect use of vaginal dilator. Laparotomy was performed in 2 cases (6%) due to severe abdominal pain after initial surgery that was diagnosed as pelvic endometriosis. In the vaginal agenesis group, vaginal re-occlusion occurred in5 cases (14.28%) after the surgery.

The most common complication after surgery was vaginal re-obstruction, so training the patient and emphasizing on the regular use of vaginal dilator is very important to prevent this complication.