A woman aged 35 presented to our outpatient clinic with a complaint of something coming out per vaginum. She had undergone investigations in past for primary amenorrhoea and had been diagnosed to have Mullerian agenesis or Meyer Rokitansky Kuster Hauser syndrome. She had been advised vaginoplasty by he gynecologist at that time, but she did not undergo that procedure. Notes of her previous clinical and endoscopic evaluation were not available. She was single. We found her to have 3 cm eversion of thevestibular epithelium, lateral limits of which had medial aspects of the labia minora included in the eversion. She had no visceroptosis. It was possible that she had been sexually active and the chronic penile pressure had developed the vagina. However she refused having had any sexual activity. The lateral attachments of the vagina were also lost, besides loss of support to its vault.
We planned to perform sacrospinous suspension of the vault. However her ligament was quite small and there was no space in the pelvis to place the suspensory suture without risk of injury to the pudendal or sciatic nerve. We performed iliococcygeus suspension of the vault on theleft side. She withstood the procedure well and was found to have adequate elevation and suspension of the vagina at follow-up examination.
