Severe Vaginal Stenosis Simulating a Transverse Septum with Huge Hematocolpos in an Hiv-patient: How to Make a Break in the Wall?

Introduction: Vaginal infections are the most commonly reported condition among women with HIV/AIDS and such infections often represent the most common initial manifestation of the illness. As a consequence, post-infective early and late complications are frequently reported in these patients. Vaginal stenosis has been reported as a rare late complication of severe vaginal infections. The vaginoscopic treatment with miniaturized instruments of a severe vaginal stenosis with huge hematocolpos in a HIV-infected woman is here reported. Case presentation: A 38 year-old HIV-infected woman was referred to our Emergency Unit because of severe pelvic pain, increasing over time, beginning a week before, after a sexual intercourse. At physical and ultrasonographic examination, complete vaginal stenosis up to the vaginal vestibule (miming a transversal vaginal septum) with a giant haematocolpos was diagnosed. She was scheduled for traditional surgical treatment in the operating room with Hegar dilatators but the procedure was unsuccessful. The patient was then scheduled for an operative vaginoscopy in office setting by means of a 5mm oval-profile hysteroscope. The use of 5Fr bipolar electrode and mechanical instruments allowed to make a break in the “wall”, thus allowing the complete drainage of the haematocolpos without any significant complication. Conclusion: Vaginoscopy with miniaturized instruments represent a safe, convenient, and efficient therapeutic modality that can be used in patients with a restrictive vaginal opening or narrow vaginal canal.