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Incomplete fusion or failure of canalization of the Mullerian ducts can yield a longitudinal vaginal septum (LVS). Mullerian duct anomalies occur with an incidence of 0.001- 10%.   Clinically, these patients can present with dyspareunia, difficulty with tampon insertion, hygiene issues, dysmenorrhea, amenorrhea, hematometra, recurrent pregnancy loss,  infertility, primary amenorrhea, dystocia during vaginal delivery (protracted first stage of labor or arrest of dilation) , or as in the case of our patient, an asymptomatic incidental finding on imaging or clinical exam The purpose of this report is to discuss childbirth outcomes, trauma, and dyspareunia with longitudinal vaginal septum. This case is important because of its unique clinical presentation and the consideration to change management of LVS due to potential increased morbidity of maternal trauma and childbirth outcomes.
A 25 year old G3P3003 presents with uterine didelphys, recently postpartum with dyspareunia due to a prolapsed vaginal septum. The patient is Tanner stage 5, with a BMI of 22 kg/m2 and is not currently sexually active. Diagnostic work up included, a transvaginal ultrasound which revealed unremarkable anatomy. Follow up MRI, reported an anteverted, septate uterus 6.1cm x 5.8cm x 2.8cm with a complete septum extending at least to the external cervical os. Adnexa were unremarkable and a 2.1cm x 1.4cm intramural fibroid was noted. Management of patient's condition was a surgical resection of the longitudinal septum. There were no postoperative complications and her postoperative appointment exam demonstrated granulation tissue at both the 7 and 12 O'clock position that bled with manipulation. The patient met all postoperative milestones and recovered appropriately.
Based on literature review, there are mixed recommendations on prophylactic septoplasty; however, in this patient's case, septal prolapse and significant dyspareunia could have been avoided. These outcomes should be taken into clinical consideration when a patient presents with a longitudinal vaginal septum during routine obstetric and/or gynecological care.
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