Treatment of Patients with a Congenital Transversal Vaginal Septum or a Partial Aplasia of the Vagina. The Vaginal Pull-through Versus the Push-through Technique

Abstract 

Study Objective

The aim of this study is to describe the different modalities of congenital obstructing vaginal malformations and the evaluation of techniques to solve the problem.

Design

A retrospective study.

Setting

The University Hospital Nijmegen, the Netherlands.

Participants

The medical records of 18 patients with congenital obstructive malformations of the vagina operated on by one gynecologist were retrospectively reviewed. The conditions were classified in three groups: group I with one uterus and vagina and with a transverse vaginal septum, group II with a partial vaginal agenesis and group III with a double genital system and a septum with occlusion of one vagina.

Main outcome measures

Operating technique used, mold treatment after surgery, menstruation outflow, the possibility of having intercourse and the need for additional surgery.

Results

18 patients were evaluated. Of 10 patients in group I, 8 patients were treated with the pull-through technique and 2 patients with the push-through technique. Four of the patients with a pull-through operation did not get mold treatment; of these patients, 3 needed repeat surgery because of the tendency for constriction. Of 4 patients in group II, 1 patient was treated with the pull-through technique and 3 with the push-through technique. The patient with the pull-through technique needed repeat surgery because of constriction. There was no mold treatment after the first procedure. Group III were 4 patients all treated with the pull-through technique. None of them received mold treatment, and none of these patients needed repeat surgery.

Conclusions

The push-through method is a good surgical technique for the patients in whom problems of constriction after surgery are expected and for patients with difficulties during surgery. Mold treatment is recommended after surgery in patients with a thick transversal vaginal septum or a partial vaginal aplasia.

Key Words: Vaginal septum, Vaginal aplasia, Pull-through technique, Push-through technique, Mold treatment