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.

Low-dose gonadotropin releasing hormone agonist (Leuprorelin acetate) in the postoperative treatment of endometriosis-associated pain

Background: Gonadotropin-releasing hormone agonist (GnHRa) is used postoperatively for pain eradication and recurrence prevention in patients with endometriosis. However, the hypoestrogenic state induced by these agents limits its acceptability and safety. Objective: To know the effect of 1.88 mg monthly injection of GnHRa therapy for post-operative treatment of endometriosis-associated pain. Methodology: Prospective longitudinal study conducted between May 2010-February 2011. Six patients with endometriosis-associated pain were given 1.88 mg GnHRa SC every 4 weeks for 12 weeks. Endometriosis-associated pain was graded using the Biberoglu and Behrman scale. Serum estradiol is measured and adverse symptoms were recorded. Results: Mean pelvic pain scores during treatment were significantly lower than before treatment at all time points. Serum estradiol levels after the 2nd dose were within the therapeutic window (20-50 pg/ml) and remained so during the treatment period. Conclusion: Half-dose GnHRa maintained therapeutic effectiveness is postoperative patients with enmetriosis-associated pain. Favorable levels of plasma estradiol were maintained wihtin therapeutic window. No adverse events were recorded.