Hydrometrocolpos--diagnostic and therapeutic dilemmas

Congenital distal vaginal obstruction is a rare condition, usually asymptomatic until menarche, thus often diagnosed only during puberty. Hydrometrocolpos is caused by such an obstruction, only when reasonable amounts of fluid are secreted from the mucosal lining of the genital tract. This presentation may be symptomatic and already diagnosed early in life, even during the perinatal period. There are various causes of congenital vaginal obstruction, and according to their etiology, surgical procedures may be either simple or more complicated. Timing of the surgical procedure for opening the obstruction is a dilemma. We suggest postponing the definite procedure to the menarche, when hematocolpos (accumulation of blood in the vagina) will develop, but before the further development of hematometra (accumulation of blood in the uterine cavity). This will cause stretching of the obstructed segment, will enable correct diagnosis, facilitate the procedure, and eventually minimize the complications. However, if the vaginal obstruction in neonates or in childhood is symptomatic, as in the described case, aspiration of the fluid and temporary release of the symptoms should be the optimal choice, followed by a final surgical correction latter in life.