Management of hematocolpos in adolescents with transverse vaginal septum

The aim of this study was to underline the significance of premenarcheal gynecological examination in patients with transverse vaginal septum that could possibly be complicated with endometriosis.

Retrospective study including the period between January 2008 and December 2010.

Second Department of Obstetrics and Gynecology.

We searched our databases regarding cases of hematocolpos caused by transverse vaginal septum.

Among the patients presented with hematocolpos we identified 4 cases caused by transverse vaginal septum.

We present the management of these cases regarding diagnosis, differential diagnosis, and treatment. The mean age of the patients was 13.1 years. All patients presented in our department with hypogastric abdominal pain and hematocolpos. No problems in adrenarche or thelarche were mentioned. The U/S and MRI revealed a normal cystic in the upper part of the vagina--hematocolpos varying from 42 × 26 × 30 to 73 × 55 × 32 mm. Three of the patients had an upper transverse vaginal septum while one had a middle transverse vaginal septum. Only one patient had a concomitant anomaly of the urinary system (ectopic kidney). In our patients, after laparoscopic examination 3 out of 4 patients had findings of endometriosis (2/3 with stage I-minimal endometriosis and 1/3 with stage II-mild endometriosis).

Physicians should be aware of transverse vaginal septum in the differential diagnosis of hematocolpos with abdominal pain and primary amenorrhea in the early adolescent years. Early diagnosis could be based on premenarcheal gynecological examination and could lead to correct management in order to avoid the complications of endometriosis (dysmenorrhea or infertility).