23. Transverse Vaginal Septa: A Survey of Current Provider Practices

• Published in: Journal of pediatric & adolescent gynecology 2023-04, Vol.36 (2), p.183-183
• Main Authors: Justice, Tara D., Nelson, Kayla, McQuillan, Sarah
• Format: Article
• Language: English
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2023.01.111

Transverse vaginal septa (TVS) are rare congenital abnormalities of the vagina that are typically managed by experienced Pediatric & Adolescent Gynecologists (PAG). Debate often exists on the preoperative management, timing of surgery, surgical management, and postoperative care for these patients. Given the rarity of the condition, the published literature on the surgical management of TVS is scarce and poorly described, which is not ideal for a condition that carries high levels of surgical risk. This exploratory cross-sectional study served to add to the limited existing literature and create consensus among NASPAG providers on how to best care for these patients. We hypothesize that providers have varied preoperative and postoperative practices, but that most providers are delaying surgery until the patient is older and can fully participate in their care. An electronic survey was distributed through REDCap to all members of the NASPAG listserv on two occasions. The survey consisted of up to 47 questions, with the number of questions for a given individual determined by their level of involvement in the care of patients with TVS. Questions explored the full breadth of care, including practices at the time of diagnosis, decision making regarding timing of surgery, use of menstrual suppression, and perioperative management. Ethics approval was obtained. Forty-three members of NASPAG responded to the survey. The majority were trained in PAG (90.6%) and felt comfortable with the surgical management of TVS (90.6%). There was heterogeneity with respect to whether surgeons would operate at the time of diagnosis, with 11.6% of respondents always operating, 20.9% never operating, and 66.4% operating in select circumstances. A variety of forms of menstrual suppression are used, with only 15.7% of respondents using a GnRH agonist despite it being one of the more effective methods of menstrual suppression. With respect to dilatation, 64% of providers consider pre-operative vaginal dilatation while 95% of providers consider using a post-operative vaginal stent or dilatation. Pre-operative antibiotics are not routine, with only 56.4% of surgeons using antibiotics at the time of surgery with cefazolin as the antibiotic of choice. Despite the close-knit nature of the PAG community, there is remarkable heterogeneity in the management of patients with TVS. Our study highlighted the significant variation in the timing of surgery as well as the preoperative, intraoperativ