Secondary vaginal atresia following caesarean section: an unreported entity

Abstract

Postpartum genital tract adhesions are infrequent and exact incidence is not reported. Severe dystocia, obstructed labour and frequent pelvic examinations have been proposed as possible causes of vaginal adhesion following vaginal delivery. Atresia/adhesions of vagina following caesarean section is very rare. Here, we report a rare case of 21-year-old P1L1 woman presenting with secondary amenorrhoea associated with cyclical abdominal pain following caesarean section. Per speculum examination showed a blind vagina with no communication with the upper one-third. We created a neovagina after adhesiolysis. We hope to increase the awareness of the obstetricians around the globe about postpartum genital tract adhesion, which may even occur as a rare secondary complication of caesarean section. We also wish to bring to the light of obstetricians that numerous pelvic examinations or difficult vaginal delivery may lead to genital tract trauma, and thus, must be minimised in an attempt to prevent postpartum genital tract adhesions.

Keywords: gynaecology and fertility; obstetrics; pain; reproductive medicine.

Figure 1

(A) USG image—haematocolpos and haematometra (blue arrow). (B) Postdrainage USG image—no collection (blue arrow), bladder (green arrow). USG, ultrasonography.

Figure 2

(A) Vaginal stenosis at upper one-third and lower two-thirds of vagina. (B) Diagnosis of secondary vaginal atresia with haematocolpos by real time USG-guided aspiration. (C) Foley’s catheter in vagina to prevent readhesion after incision of fibrotic band. USG, ultrasonography

Figure 3

(A) Day 7 postoperative showing raw areas of vagina without adhesion formation. (B) Six weeks postoperative—healthy vagina and normal looking cervix.