Recurrent transverse vaginal septum presenting as lactational amenorrhea: a rare presentation of a rare anomaly

Transverse vaginal septum is a rare congenital Mullerian duct developmental anomaly with varied presentations in different age groups. Depending on its location in vagina, it can be a high, middle or low transverse vaginal septum, thus causing hematometra with or without hematocolpos. Diagnosis of transverse vaginal septum in female with symptoms of obstructive vaginal pathology is usually made with a careful gynaecological examination and USG. MRI may also be considered particularly in women with recurrence to know septal thickness and any distortion in anatomy from previous surgery. We report case of a 22-year-old lactating mother presenting as lactation amenorrhea and lower abdominal pain. She was diagnosed as a case of recurrent low transverse vaginal septum with hematocolpos and hematometra. She underwent Y-V plasty with drainage of hematometra and hematocolpos with mould with drainage placement. On follow-up she resumed her menses and able to cohabitate normally after 3 months of surgery. In females with primary amenorrhea, differentiating imperforate hymen and transverse vaginal septum is important. Transverse vaginal septum is known for its high rate of recurrences after surgery and will require postop dilators and regular postop follow-up. Using Mould with drainage is suggested for allowing longer intervals for mould change particularly in patients with hematometra and hematosalpinx.