Surgical Management
Examination under general anaesthesia was performed in a lithotomy position. Thick labial adhesions made identification of dissection planes challenging. A finger was placed in the rectum to delineate its relative position and avoid inadvertent injury. A mixture of blunt and sharp dissection with gentle probing using a Size 3 Hegar dilator was utilised to first open the vestibule [Figure 2]. Once the urethra was revealed, it was cannulated with a two-way 16 french Foley catheter [Figure 3]. The vaginal orifice was then opened and stretched with two parallel Sims speculums to a width of 4cm, releasing accumulated cervico-vaginal secretions. The cervix was visualised and cannulated with Hegar dilators to demonstrate uterovaginal continuity and endometrial curettage was performed to exclude intrauterine pathology. An anti-adhesion gel consisting of sodium hyaluronate and sodium carboxymethylcellulose [Guardix SolĀ®, Genewal Co, South Korea] was applied to the raw surfaces of the introitus. A vaginal mould was fashioned using sterile foam obtained from a negative pressure wound therapy set. This was sheathed by 2 condoms to give it shape [Figure 4]. This was also covered in the same antiadhesion gel and secured with a gamgee tissue for three days before being removed prior to inpatient discharge.