A modification of the fenton's technique as a vaginal reconstructive surgery in the correction of congenital partial vaginal atresia

Sexual function is an important aspect of an individual's well being. The inability to have sexual intercourse for any reason, when one chooses to, is a concern that will cause distress. It's the kind that does not only affect the individual who is unable to, but also the partner who is able to. Dyspareunia is one reason for this. The pain during coitus may be severe enough, and thus cause frustration everytime it is attempted. Reported here is a 31 year old nulligravid who has an incomplete form of congenital atresia of the outer third of the vagina on which a modified Fenton's procedure was done. The Fenton's surgical technique was originally conceptualized to "widen a tight vagina" in patients with postpartum dyspareunia caused by scar tissue formation and contacture after an episiorrapy. The above mentioned congenital defect, its incidence, embryogenesis, presentation and management are discussed in this case report. The innovation in surgical intervention is also described.

A second - look hysteroscopy after treatment of genital tuberculosis in an amenorrheic woman

A 32 year old G2P1 (1011) presented with amenorrhea of 2 years duration. Both sister and grandfather were diagnosed with Pulmonary Tuberculosis 10 years ago and adequately treated for 9 months with quadruple anti-Koch`s medications. Patient presented with no sign nor symptoms highly suspicious for tuberculosis. Physical and Pelvic examinations, complete endocrinologic investigations, chest X-ray and transvaginal ultrasound all revealed normal results. Progesterone challenge test failed to elicit withdrawal bleeding. Hyteroscopy showed a globularly fibrotic endometrial cavity, while endometrial biopsy revealed chronic granulomatous inflammation with Langhan`s giant cell typical of genital tuberculosis. She was subsequently started on anti-Koch`s medications for 6 months, with prompt resumption of menses after treatment. Second-look hysteroscopy on readmission showed normal, healthy-looking endometrium with no areas of fibrosis. Repeat endomentrial biopsy revealed benign secretory phase endometrium, with absolutely no evidence of chronic granulomatous inflammation. This paper aimed to underscore the value of hysteroscopy as a vital tool in the work-up amenorrhea, and to demonstrate, using second look hysteroscopy, the efficacy of anti-tuberculosis treatment on the uterine cavity in an amenorrheic woman diagnosed with genital tuberculosis.