Acquired Vaginal Atresia, Rare and Catastrophic Complication of Vaginal Delivery: Report of Two Cases and Literature Review
Okbu Frezgi*, Dawit Sereke, Hailemichael Gebremariam and Berhe Tesfai
ABSTRACT
Introduction: Gynaetresia usually follows a poorly managed vaginal delivery that causes soft tissue injuries, and interventions by unskilled health workers were identified as causes. Here, we report two primiparous women with acquired vaginal atresia after experiencing difficulty during delivery.
Case Reports: The first case came with a history of difficulty engaging in sexual activity and 15 years of infertility. Her only stillbirth delivery was at home by a traditional birth attendant. On examination, the vaginal opening was almost completely occluded with a pin-point opening near the ureteral meatus. Successful vaginal recanalization was performed, and during follow-up, her dysmenorrhea and dyspareunia were improved. The second case came with a complaint of dyspareunia and an abnormally closed vaginal opening six months after delivery. Her delivery was in a health facility, and an episiotomy was performed to ease the delivery. There was extensive soft tissue injury with profuse bleeding during delivery, and the repair was amid to stop bleeding. Vaginal opening was completely occluded, and recanalization was achieved to a depth of 6 cm, but the cervix was not identified. She was followed by applying dilators, and the depth of the vaginal canal narrowing again, and she was advised to go abroad for possible vaginoplasty.
Conclusion: Improperly approximated or unrecognized perianal injury after delivery can lead to vaginal stenosis or atresia. Routine episiotomy during delivery should be avoided, and if indicated, it should be performed by experienced clinicians, and follow-up is recommended
