Content area
Full Text
Background
Acquired vaginal stenosis or gynatresia is a rare problem in the developed world but common and grossly under-reported in the developing world where it may be the result of intervention by untrained health workers, quacks or as a result of infection. In the Arab world, rock salt was inserted everyday in a postpartum woman to restore the vagina to a nulliparous state resulting in complications like sepsis, vaginal stenosis, haematocolpos, haematometra, etc. 1 The other part of the world where acquired gynatresia is common is Africa and especially Nigeria, where incidence is reported to be around 7/1000 2 women, with the commonest cause being insertion of caustic vaginal pessaries, birth injury and also as a complication of vesicovaginal fistula repair. 3 In the developed world, it has been reported to be associated with chronic graft-versus-host reaction 4 or after radiotherapy. Here we report two cases, one with postpartum total vaginal stenosis secondary to negligence by a healthcare worker and another case secondary to chemical vaginal burns.
Case presentation
Case 1
A 30-year-old woman para 1 with no live issues reported to the outpatient department (OPD) of our hospital with secondary infertility, dyspareunia and dysmenorrhoea for past 10 years. Except for the dysmenorrhoea her menses were regular. According to the patient, she had delivered vaginally, a live full-term female baby 10 years back after a prolonged labour at a primary health centre (PHC). The baby expired soon after birth. According to the patient, she received an episiotomy which was sutured, soon after which she was discharged. Post delivery, according to the patient, she developed vaginal discomfort and discharge and on follow-up at the same PHC 2 weeks after delivery, a neglected gauze swab inserted at the time of delivery was removed from the vagina. The patient was discharged with the advice of abstinence for 2 months. After 2 months, when the patient attempted intercourse she had severe dyspareunia and penetration was impossible. On examination, there was severe vaginal stenosis and even a small paediatric Sim's speculum could not be inserted. A per vaginam examination was not possible due to intense pain. The patient was posted for examination under anaesthesia (EUA) with vaginal adhesiolysis. EUA revealed a cicatrised vagina half an inch in length and a...