Transverse vaginal septae: management and long-term outcomes

ObjectiveTo examine the management and long-term outcomes of transverse vaginal septae. DesignObservational study with cross-sectional and retrospective arms. SettingTertiary referral centre specialising in Mullerian anomalies. PopulationForty-six girls and women with a transverse vaginal septum. MethodsData from medical records of all cases (1998-2013) of transverse vaginal septae were collected and reviewed. Patients over 16years of age also completed a questionnaire. Main outcome measuresPresentation, examination findings, investigations, surgery, and long-term reproductive outcomes. ResultsThe septae in the study were described as follows: 61% (95%CI0.46-0.74) were imperforate, and presented with obstructed menstruation; 39% (95%CI0.26-0.54) were perforate, and presented with a variety of concerns; 72% (95%CI0.57-0.83) were low, 22% (95%CI0.12-0.36) were mid-vaginal, and 6% (95%CI0.02-0.18) were high; 33% were managed via an abdominoperineal approach, 59% were managed via a vaginal approach, and 6% had laparoscopic resection (one patient did not have surgery); 11% (95%CI0.05-0.23) of patients presented with reobstruction, all following abdominoperineal vaginoplasty; 7% presented with vaginal stenosis, two following vaginal resection and one following the abdominoperineal approach; 61% of questionnaires were returned. These results showed that 22/23 patients were menstruating and one had a hysterectomy, 74% had been sexually active, 35% had dyspareunia, and 36% complained of dysmenorrhoea. There were seven pregnancies, with one termination and six live births, all following the vaginal excision of a transverse vaginal septum. ConclusionsTransverse vaginal septae resected vaginally or laparoscopically have low complication rates and good long-term outcomes. Complex septae require more extensive surgery, with an increased risk of complications.