VAGINAL SYNECHIAE PRESENTING AS PRIMARY INFERTILITY: A CASE REPORT

Problem statement: This is a case of a 29-year-old nulligravid who presented with primary infertility, complaints of intermenstrual spotting and dyspareunia. On transvaginal ultrasound, a hypoechoic band with a small opening was noted at the lower third of the vagina 1.3 cm away from the hymenal ring. This hypoechoic band was considered a vaginal synechiae probably secondary to genital tract injury accrued from a vehicular accident.
Methods: Ultrasound-guided lysis of the vaginal synechiae was done to restore normal anatomy and postoperative insertion of vaginal dilators to prevent recurrence of synechiae and maintain the caliber of the vagina.
Results: The patient was able to resume sexual activities with no complaints and had regular menses. She has then conceived ten months after the procedure.
Conclusion: This case highlights the importance of careful evaluation of all primary infertile young couples, because an undocumented acquired, rare and asymptomatic reproductive tract defect could underlie the infertility necessitating surgical intervention.