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Severe atrophic vaginitis causing vaginal synechiae and hematocolpos at menopause

Segal, Saya MD1; Harvie, Heidi S. MD, MBA, MSCE2; Siegelman, Evan MD3; Arya, Lily A. MD, MS1

doi: 10.1097/gme.0b013e3181f3285a
Case Report
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Objective: Vaginal atrophy caused by decreased levels of ovarian estrogen production is common at menopause. Atrophic vaginitis severe enough to result in vaginal stricture of the upper two thirds of the vagina and subsequent hematocolpos is unusual.

Methods: A 53-year-old woman presented with nonvisualization of the cervix at the time of her annual examination.

Results Pelvic ultrasound reported a "vaginal cyst," and the final diagnosis of hematocolpos was made by magnetic resonance imaging. The woman was managed with surgical excision of vaginal synechiae followed by local vaginal estrogen therapy and dilators, with satisfactory results.

Conclusions: Untreated severe atrophic vaginitis at menopause can result in a shortened vagina and hematocolpos. Magnetic resonance imaging is useful to characterize vaginal pathology in postmenopausal women.

From the 1Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Chestnut Hill Health System, Philadelphia, PA; and 3Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Received May 20, 2010; revised and accepted July 21, 2010.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Saya Segal, MD, Hospital of the University of Pennsylvania, Department of Obstetrics and Gynecology, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104. E-mail: saya.segal@uphs.upenn.edu

©2011The North American Menopause Society