ORIGINAL ARTICLE
Journal of International Surgery and Clinical Medicine (JISCM) 2026.
Volume 6.
Number 1: 1-4
E-ISSN: 2807-7008
Proximal Transverse Vaginal Septum In Women With Primary Infertility : A Rare Case Report Rauzatul Jannah1*.
Yusra Septivera2.
Rusnaidi Rusnaidi3.
Sarah Nainggolan4 Published By :
Surgical Residency Program
Universitas Syiah Kuala
ABSTRACT
Department of Obstetrics and Gynecology.
Faculty of Medicine.
Universitas Syiah Kuala.
Indonesia Dr.
Zainal Abidin Regional Public Hospital.
Banda Aceh *Corresponding author:
Rauzatul Jannah.
Department of Obstetrics and Gynecology.
Faculty of Medicine.
Universitas Syiah Kuala.
Indonesia.
rauzatuljannah2392@gmail.
Received: 2026-01-15 Accepted: 2026-04-07 Published: 2026-05-04 Introduction: A transverse vaginal septum (TVS) represents an uncommon congenital malformation of female genital structures resulting from incomplete canalization where the urogenital sinus meets the distal portion of Myllerian ducts.
This condition occurs in approximately 1 per 2,100 to 1 per 72,000 female live births.
TVS manifests as either obstructive or non-obstructive variants and frequently correlates with infertility and painful intercourse.
Surgical intervention is necessary to reestablish normal vaginal structure and enhance fertility potential.
Case Description: This report details a 28-year-old female presenting with inability to conceive following 18 months of consistent unprotected marital relations.
Her complaints included painful sexual activity, reduced menstrual flow, and menstrual cramping.
Physical examination identified a dense transverse membrane in the proximal vaginal third, measuring roughly 2 cm in thickness, positioned 5 cm beyond the introitus, containing a tiny opening that obscured cervical observation.
Sonographic evaluation demonstrated unremarkable uterine and adnexal structures.
Hysterosalpingography could not be completed due to septal blockage.
Surgical management included vaginal septal excision combined with diagnostic laparoscopy and chromopertubation, demonstrating normal reproductive organs with open fallopian tubes and endometrial implants on the uterine surface that underwent ablation.
Patient recovery proceeded without complications.
Conclusion: A transverse vaginal septum constitutes a rare congenital malformation potentially presenting with fertility difficulties and dyspareunia during reproductive years.
Surgical removal with vaginal restoration represents the preferred therapeutic approach to reestablish normal anatomy and maximize reproductive potential.
Continued postoperative surveillance is crucial for detecting complications and assessing fertility outcomes.
Keywords: Vaginal septum, infertility, dyspareunia.
Cite This Article: Jannah.
Septivera.
Rusnaidi.
Nainggolan.
Proximal Transverse Vaginal Septum In Women With Primary Infertility : A Rare Case Report.
Journal of International Surgery and Clinical Medicine 6.
: 1-4.
DOI : 10.
INTRODUCTION
Congenital malformations represent significant risk factors contributing to elevated morbidity and mortality rates among newborns, as well as developmental challenges during childhood.
1 Certain undetected until adolescence, while others persist as ongoing concerns throughout adolescent and pubertal Vaginal malformations comprise approximately 10% of all female reproductive system anomalies.
2 TVS
represents an uncommon congenital defect of Myllerian duct development.
While precise occurrence rates remain uncertain, estimates range from 1 in 2,100 to 1 in 72,000 births.
3 The underlying cause of this embryological defect remains unclear, with no identified genetic basis.
During normal development, sinovaginal bulbs extend from the urogenital sinus, connecting with the Myllerian tuberculum at the distal end of Myllerian ducts, forming the vaginal plate that subsequently canalizes to create the lower vaginal portion.
5 TVS is believed to arise from unsuccessful vaginal plate canalization at the junction where the urogenital sinus meets Myllerian ducts.
Associated abnormalities may involve systems, including imperforate anus, intestinal malrotation, ectopic ureter hydronephrosis, vesicovaginal fistula, and bicornuate uterus.
7 Less common associations include musculoskeletal defects, aortic coarctation, and atrial septal abnormalities.
8 TVS may develop at any vaginal location, though the proximal vagina .
unction between vaginal plate and fused Myllerian duct.
represents the most frequent site.
9 According to Rock et al.
approximately 46% of septa occur in the upper vagina, 35% in the middle portion, and 19% in the lower vagina.
TVS may be imperforate .
ompletely close.
, with thickness below 1 cm appearing prominent and bluish from accumulated menstrual .
ematocolpos/hematometr.
, with variable vaginal positioning.
transverse vaginal septum (TVS) variants include obstructive and non-obstructive forms, with obstructive types being more prevalent, typically imperforate and manifesting as absent menstruation, abdominal discomfort, and hematocolpos during adolescence.
3 Non-obstructive .
TVS typically presents with more diverse symptoms related to vaginal shortening, appearing during adolescence Published Open access:
by Surgical https://jiscm.
id/index.
php/JISCM/ Residency Program Universitas Syiah Kuala | JISCM 2026.
: 1-4 | DOI: 10.
51559/jiscm.
ORIGINAL ARTICLE
Figure 1.
Speculum examination revealed a proximal transverse vaginal septum with a hole.
or early adulthood.
Imperforate variants appear in adolescence with absent Conversely, females with non-obstructive septa frequently experience regular menstruation but encounter difficulties during sexual activity.
The septum may remain asymptomatic until adolescence, potentially presenting only with fertility issues, though no definitive theory explains this infertility, likely resulting from impaired sperm passage.
10 Diagnosis is considered when an abdominal or pelvic mass is palpable, or when vaginal narrowing prevents cervical 6 Physical reveals shortened vagina, with the cervix being non-palpable and invisible due to proximal septal closure or presence of a small opening.
11 When menstrual blood accumulates, the mass above the septum becomes palpable.
12 Diagnostic approaches include clinical examination, ultrasonography, and magnetic resonance imaging (MRI), with MRI being for determining septal thickness and 13 No standardized management protocols exist for TVS, though surgical approaches remain primary treatment Surgical septal resection with anastomosis of proximal and distal vaginal segments can be accomplished vaginally, laparoscopically, or through combined abdominoperineal approaches, depending on septal location and thickness.
14 Available medical literature provides limited guidance regarding TVS classification or Figure 2.
Post Operative Evaluation, .
After performing a proximal transverse vaginal septum excision, .
The uterus and both tubes appear within normal limits with the presence of endometriosis lesions surgical technique selection.
Additionally, published data on short-term and long-term outcomes following TVS resection remains scarce.
Postoperative complications include vaginal narrowing and reobstruction .
, painful intercourse, endometriosis, infertility, obstetric challenges, and psychological This case report aims to describe clinical presentation, evaluation, management, and outcomes in a patient with proximal transverse vaginal septum at RSUDZA.
Banda Aceh.
CASE DESCRIPTION
A 28-year-old female presented with concerns regarding absence of pregnancy 5 years of marriage with consistent unprotected sexual relations.
The consultations with an obstetrician at the outpatient department of RSUD dr.
Zainoel Abidin Banda Aceh.
She reported painful sexual intercourse.
Her menstrual cycles remained regular though flow was diminished, accompanied by menstrual Previous hysterosalpingography attempts were unsuccessful because speculum examination revealed a thickened septum preventing cervical Her husbandAos semen analysis demonstrated normal parameters.
Laboratory Speculum examination failed to visualize the cervix, revealing a septum in the upper vaginal third approximately 2 cm thick with partial closure containing a pinpoint opening, located approximately 5 cm from the vaginal opening.
Ultrasound examination showed normal gynecological structures.
The diagnosis was proximal transverse vaginal septum with primary infertility.
Planned management included septum resection and operative laparoscopy with Normal uterus and bilateral ovaries were identified with patent bilateral tubes.
Postoperative ward care proceeded smoothly, with discharge in satisfactory condition.
The procedure was performed in February 2025 with the patient positioned in lithotomy under epidural anesthesia, following aseptic preparation of the external genital region.
Upper and lower speculums were placed, revealing the septum in the distal vaginal A transverse incision was made on the septum to avoid urethral, bladder, or rectal injury, followed by combined sharp and blunt dissection cutting the septum until cervical visualization, ensuring hemostasis, then uniting vaginal mucosa with simple interrupted sutures using 2.
0 absorbable thread.
The procedure continued with operative laparoscopy, revealing normal uterus and bilateral tubes, with adhesions between transverse colon and peritoneal wall requiring adhesiolysis.
Further exploration identified endometriotic lesions on the uterine fundus requiring ablation, followed by chromopertubation confirming bilateral tubal patency.
The procedure was completed successfully.
Published by Surgical Residency Program Universitas Syiah Kuala | JISCM 2026.
: 1-4 | DOI: 10.
51559/jiscm.
ORIGINAL ARTICLE
DISCUSSION
Williams et al.
A classified vaginal septa according to location .
easured from vaginal opening to distal septal end: low location under 3cm, moderate 3-6 cm, high exceeding 6 c.
, septal thickness .
easured via MRI: thin under 1 cm, thick 1 cm or mor.
, and perforation status .
erforate versus imperforat.
The European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) developed a revised classification of Myllerian duct anomalies, categorizing TVS under subclass U3, representing a uterus with two distinct horns .
but a single cervix.
TVS is typically diagnosed when patients reach adulthood, are married, and remain childless .
despite cohabitation and regular sexual Infertility represents a coupleAos inability to achieve pregnancy following at least 12 months of regular unprotected intercourse, commonly termed primary TVS results from lateral and vertical fusion failures of the urogenital sinus and Myllerian ducts.
Unsuccessful vertical fusion between Myllerian ducts and urogenital sinus disrupts genitalia canalization, forming transverse septa.
Clinical presentations of non-obstructive .
septa include asymptomatic cases, with patients reporting painful and diagnosis during gynecological In pre-pubertal patients, hydrocolpos may occur from obstructed genital secretion discharge produced by reproductive gland hypersecretion responding to maternal hormone TVS and imperforate hymen can be differentiated through physical examination findings.
In TVS, suprapubic pressure does not produce distention or mass protrusion in the perineal region.
Septal thickness and location prove difficult to assess clinically unless patients consent to internal examination .
peculum, rectal examinatio.
, which can be supplemented by abdominal, transperineal, transrectal ultrasonography or MRI to evaluate septal location and thickness before management.
Imperforate hymen appears as bluish mass protrusion between labia minora with visible distention changes when suprapubic pressure is applied.
TVS management goals include restoring vaginal function and achieving pregnancy.
Some vaginal septa can be conservatively managed with monitoring, while cases associated with pain, infertility, or hematometra require surgical reconstruction and vaginal Three different surgical approaches exist for TVS management:
abdomino-perineal vaginoplasty, simple vaginal resection, and laparoscopic vaginal wall resection.
In this case, simple vaginal resection was performed by incising the septum and resuturing proximal to distal vaginal septal wall portions, with patient education regarding regular coitus after recovery to prevent recurrence and reobstruction.
For this patient, the abdominoperineal approach is recommended.
Abdominoperineal procedures often involve complex surgical reconstruction, consequently leading to more frequent long-term complications such as reobstruction and 14 The only available data comes from retrospective studies of obstructive vaginal This study contained only three TVS patients .
ow and moderate location, all imperforate, thickness not describe.
Results showed two of three septa developed vaginal stenosis requiring reexcision.
Batu et al.
explained significantly following TVS resection compared to imperforate hymen, with middle and high location TVS having lower fertilization chances compared to low location TVS, potentially caused by vaginal stenosis and 15 General endometriosis incidence approximates 10%, increasing significantly in obstructive Myllerian duct anomalies, considered secondary to retrograde menstruation.
16 Previous studies demonstrated that TVS patients have higher endometriosis incidence compared to middle and low location TVS.
17 Literature incidence in thick septa and shorter This condition causes obstructed menstrual blood, increasing retrograde menstruation possibility.
Vaginal dilation is recommended following vaginal reconstruction surgery to prevent stenosis or reobstruction, though supporting evidence remains limited.
Dilation is recommended for all patients undergoing surgery via vaginal approach using skin grafts or with significant scar tissue.
Dilation should commence within several days postoperatively.
CONCLUSION
Proximal transverse vaginal septum remains an uncommon congenital This case report demonstrates septum is appropriate for simple prevaginal septum resection approach considering postoperative stenosis risk and other complications.
Additional long-term investigations are needed to comprehensively evaluate longterm reproductive outcomes following transverse vaginal septum resection.
DISCLOSURES
FUNDING
The authors received no financial support for this research.
CONFLICT OF INTEREST
During this research, the authors had no conflicts of interest related to the research.
REFERENCES