Complete Labial Adhesion in a Post-Pubertal Girl: A Case Report

Labial adhesion usually occurs in the infancy period and in prepubertal girls. It is a rare entity in reproductive age without any hypoestrogenism condition. Voiding dysfunction is a rare manifestation of these conditions. Here, we report a 19-year-old girl with complete labial adhesion presented with urinary retention. A 19-year-old virgin girl was referred to the obstetrics and gynecology department of Ghaem Hospital. She complained of urinary retention. Physical examination was normal except that was moderate hypogastric tenderness and a huge vesical globe. Genital examination revealed complete fusion of the labia minora in the midline, extended from the posterior fourchette to the region of the clitoris covering the entire vaginal introitus, urethral meatus, and clitoris. Despite the use of topical estrogen cream and surgical labial separation, re-adhesion occurred for the third time. Vulvar biopsy confirmed severe inflammation. Finally, topical anti-inflammatory medication improved the symptoms. Although labial adhesion is very rare in the post-pubertal period, it can successfully be managed by medical and surgical treatment.

Life-saving with a vaginal condom catheter in postpartum haemorrhage due to vaginal lacerations in a low-resource setting

Postpartum haemorrhage (PPH) due to multiple vaginal lacerations is difficult to manage and tamponade is used as a life-saving measure. Condom catheter with stay sutures at the vaginal introitus for this purpose has not been reported. We describe successfully managing PPH due to multiple vaginal lacerations following a forceps delivery using a condom tied to an 18 FG Foley catheter. The device was introduced to the vagina, inflated with 700 mL of normal saline and was held in situ by sealing the vaginal introitus with interrupted nylon stitches running between the labia minora. Condom catheter is cheap and freely available in low-resource settings. The preparation and application can be done by a less experienced operator.

Spontaneous Pregnancy in Postoperative Microperforated Hymen: A Case Report

Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords:Abstract: Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords: hymen, microperforate, infertility, spontaneous pregnancy

A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery

Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.

Newborn With Vaginal Cyst

A full-term newborn female was born with a 0.5 × 0.5 cm golden-colored fluid filled sac at the posterior aspect of the vaginal introitus. Physical examination revealed a patent introitus without additional cysts, a normal positioned urethral meatus, and a patent anus. Stool and voiding occurred in the first 24 hours of life. Hymenal cysts are rare and spontaneously resolve in the first few weeks of life without intervention. Physical examination is important to distinguish hymenal cysts from other interlabial cysts that may require treatment.

Mayer-Rokitansky-Küster-Hauser syndrome

Abstrak. Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) adalah suatu sindrom yang ditandai dengan aplasia uterus, serviks, dan 2/3 vagina bagian atas karena perkembangan yang tidak sempurna dari duktus Mullerian. Dilaporkan seorang perempuan berusia 26 tahun yang mengeluh belum pernah menstruasi sampai saat ini. Secara fenotip pasien tampak sebagai perempuan yang memiliki perawakan normal. Payudara dan distribusi pertumbuhan rambut aksila serta kemaluan berkembang normal, disertai pertumbuhan lemak pada bokong dan paha. Tuba fallopi, rahim, dan vagina 2/3 proksimal tidak terbentuk. Pada pemeriksaan klinis ginekologi tampak introitus vagina dengan sonde vagina sepanjang 2 cm. Pemeriksaan USG abdominal, uterus berupa garis dan kedua ovarium sulit dinilai. Pemeriksaan MRI didapatkan agenesis uterus dan agenesis adnexa. Pemeriksaan analisa hormonal, LH 9,81 mIU/mL, FSH 6,87 mIU/mL, progesteron 0,51 ng/mL, estradiol 46,4 pg/mL, testosteron 60,45 mg/dl, TSH 1,216 mIU/L, T4 11 ug/dl, serta analisa kromosom 46XX. Pasien direncanakan untuk dilakukan vaginoplasti.Kata kunci : sindrom MRKH, anomali duktus Mulleri, vaginoplastiAbstract. Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) is a syndrome characterized by uterine, cervix, and the two third of upper vagina aplasia which is the cause of incomplete development of the Müllerian duct. Reported a case of woman 26 years old, patient has not menstruated until now. The phenotype of the patient appears to be female, and with normal stature. Breast, axilla dan pubic hair distribution, fatty in buttocks and thigh developed normally. Fallopian tubes, uterine and 2/3 upper part of vagina were not formed. On gynecological clinical examination, found vaginal introitus with a vaginal sonde was 2 cm. On abdominal ultrasound examination, the uterus was seen as a line and both ovaries were difficult to assess. MRI examination obtained theresults as uterine and adnexa agenesis. Hormonal analysis showing LH 9.81 mIU/mL, FSH 6.87 mIU/mL, progesteron 0.51 ng/mL, estradiol 46.4 pg/mL, testosterone 60.45 mg/dl, TSH 1.216 mIU/L, T4 11 ug/dl, and chromosome examination is 46 XX. Patient are planned for vaginoplasty. Key words: MRKH syndrome, mullerian duct anomalies, vaginoplasty

Endometrial cancer with implantation metastasis to vagina: a case report

Authors present a case of vaginal implantation metastasis following a diagnosis of endometrial cancer. A 58-year-old lady presented with postmenopausal bleeding and was later diagnosed to have endometrial cancer. She underwent an extra-fascial hysterectomy and bilateral salpingo-oophrorectomy with pelvic lymphadenectomy for Stage 3A endometrioid adenocarcinoma of the endometrium. The lymph nodes and cervix were free from the disease and no lymphovascular invasion was seen on the pathological specimen. She defaulted adjuvant radiotherapy and was lost to follow up. Six months later she had a tumour recurrence at the vaginal introitus just below the urethral orifice and awal from the vaginal vault with similar histopathological findings as previous cancer. This case highlights the rare occurrence of implantation metastasis of endometrial cancer.

Recurrence of low-risk vaginal embryonal rhabdomyosarcoma: A case report and literature review

Background Low-risk vaginal embryonal rhabdomyosarcoma (ERMS) requires no radiotherapy (RT) for local control. Case summary A 32-month-old girl presented with an exophytic vaginal botryoid mass, which was confirmed of be ERMS. She was given two courses of vincristine, topotecan, and cyclophosphamide (VAC) as neoadjuvant therapy, after which she underwent a hysteroscopy and conservative resection of the vaginal lesion with a negative margin. She was diagnosed with low-risk ERMS (stage I, subgroup A and Group I) and was discharged after another four courses of VAS. However, twenty-eight months after the last treatment, she presented with a giant mass protruding through the vaginal introitus, which was confirmed to be a recurrence of ERMS. Despite multiple rounds of therapy, the patient died 39 months after her diagnosis, at 5 years of age. Conclusion When making the decision to eliminate RT for low-risk vaginal ERMS patients, the risk of local recurrence should be considered and emphasized.