Question

Teenage patient with transverse vaginal septum with dysmennorhea & chronic pelvic pain. Diagnosis?

• A. Endometriosis
• B. Tubovarian abscess
• C. Dermoid cyst
• D. Theca lutein cyst

Answer 1

The Correct Option is A

The patient scenario described involves a teenage patient with a transverse vaginal septum who experiences dysmenorrhea (painful menstruation) and chronic pelvic pain. The presence of a transverse vaginal septum can obstruct menstrual flow, compounding issues like pain and potentially promoting retrograde menstruation. This retrograde menstruation can lead to endometrial tissue implanting outside the uterus, a key characteristic of endometriosis.

Endometriosis is a condition where endometrial-like tissue grows outside the uterus, causing pain and possibly infertility. Symptoms often include pelvic pain, typically correlated with the menstrual cycle, and can worsen over time. Particularly, when menstrual flow is obstructed or instead directed backwards, such as across a transverse vaginal septum, there is a heightened risk of endometriosis, as menstrual blood and endometrial tissue may implant elsewhere in the pelvis.

The incorrect options each have distinctive features that do not align as completely with the patient's presentation:

• Tubovarian abscess: Generally associated with infections like pelvic inflammatory disease (PID) and present with fever, acute pain, and adnexal mass, which do not align fully with chronic pain description.
• Dermoid cyst: A type of ovarian cyst containing different tissue types, rarely directly associated with dysmenorrhea or pelvic pain unless it leads to complications like torsion.
• Theca lutein cyst: Often develops in response to elevated levels of the hormone human chorionic gonadotropin (hCG), common in certain pregnancy conditions, but typically asymptomatic until they grow large.

Based on the patient's symptoms and conditions, endometriosis is the most plausible diagnosis. Endometriosis explains the chronic pelvic pain associated with menstrual obstruction due to the transverse vaginal septum.

Diagnosis: Endometriosis