Perinatology.  2019 Mar;30(1):36-39. 10.14734/PN.2019.30.1.36.

Postpartum Gynetresia

• Park Y
• Im E

• KMID: 2443175
• DOI: http://doi.org/10.14734/PN.2019.30.1.36

Abstract

Vaginal stenosis, or gynetresia, commonly results from a congenital defect, while acquired gynetresia is a rare condition. Reported contributors to acquired gynetresia include chronic graft-versus-host reaction, radiotherapy for gynecologic malignancies, female genital mutilation, postpartum foreign body insertion, or chemical insertion. We report a case of postpartum gynetresia, that was attributed to neither a foreign body nor chemicals. A 33-year-old Korean primigravid woman was referred to our hospital in hypovolemic shock due to postpartum bleeding caused by an actively bleeding vaginal laceration identified on pelvic examination. Primary repair of the vaginal laceration followed by embolization were performed. Four weeks later, postpartum gynetresia was identified on the pelvic examination. Adhesiolysis by blunt finger dissection was performed and a vaginal mold was inserted along with vaginal estrogen capsules. The vaginal mucosa was healed in four weeks.

Keyword

Postpartum period; Genitalia; Vagina; Constriction; Pathologic

MeSH Terms

Adult
Capsules
Congenital Abnormalities
Constriction
Constriction, Pathologic
Estrogens
Female
Fingers
Foreign Bodies
Fungi
Genitalia
Gynecological Examination
Hemorrhage
Humans
Lacerations
Mucous Membrane
Postpartum Period*
Radiotherapy
Shock
Vagina
Capsules
Estrogens

Figure

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  Fig. 1. A vaginal obstruction is identified on pelvic examination. (A) No specific findings are seen on the external genitalia. (B, C) The vaginal canal is completely obstructed at 10 mm from the vaginal orifice.

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  Fig. 2. A gynecologic ultrasound shows the gross anatomical configuration. Gynecological ultrasonography shows postpartum ischemic changes in the myometrium of the uterine body (yellow pointer) and a thin, but intact endometrium; however, the vaginal cavity cannot be identified because the uterine body has caused it to collapse (white arrow).

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  Fig. 3. An intact cervix and inner vaginal cavity are visible after adhesiolysis. (A, B) The inner vaginal canal and uterine cervix are intact, although an adherent lesion with an erosion is present.

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  Fig. 4. A vaginal mold is inserted into the vaginal canal. (A) The temporary vaginal mold is crafted from a 30 mL syringe covered by Vaseline gauze. (B) The mold is inserted into the vaginal cavity.

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  Fig. 5. A pelvic examination is performed at 4 weeks after the adhesiolysis. (A) The vaginal lumen shows no obstruction. (B) The vaginal mucosa shows an erosion (white arrow) with mild fibrotic changes in the posterior vaginal wall.

Reference

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