Vaginal Septum

　　The occurrence of vaginal septum is caused by teratogenic factors during the embryonic period. The specific etiology and pathogenesis are described as follows.

　　1. Etiology

　　During the embryonic period, the precursor of the female reproductive tract, the Müllerian duct, is a bilaterally symmetrical duct. Through a series of steps such as fusion along the midline and absorption of the septum, it eventually forms a single uterus, cervix, and vagina along the midline, while still maintaining a pair of fallopian tubes on each side. This process begins around the 5th week of embryogenesis and is completed by the 16th week. During this period, if the progress of the above process is hindered by teratogenic factors, it can lead to varying degrees of bicornuate uterus, bicornuate cervix, and vaginal malformations.

　　2. Pathogenesis

　　The specific mechanism of the occurrence of the asymmetric malformation of vaginal diaphragm is not yet clear. The occurrence of the Müllerian duct and the mesonephric duct is closely related, the development of the Müllerian duct depends on the development of the mesonephric duct, if the development of the mesonephric duct is obstructed, the development of the Müllerian duct will also be abnormal, thus forming a series of asymmetric malformations in the development of kidneys, ureters, and vagina. The lesions of vaginal diaphragm are divided into the following three types:

　　Type I imperforate diaphragm, there is no hole on the diaphragm.

　　Type II perforated diaphragm, there is a small hole on the diaphragm, often with poor drainage of the posterior fornix cavity. It has the highest incidence opportunity, accounting for about 50%.

　　Type III imperforate diaphragm with cervical fistula, there is a fistula between the two cervixes or between the posterior fornix cavity and the opposite cervix, and there may also be poor drainage.

　　Vaginal diaphragm can be complicated with pelvic infection and endometriosis, and the specific complications are described as follows.

　　1. Pelvic infection:Common in type II and III patients, due to long-term pus accumulation in the posterior fornix cavity, it can cause acute inflammation and pelvic abscess when the resistance decreases.

　　2. Endometriosis:It is more common in type I patients, causing endometriosis due to retrograde menstruation.

　　The clinical manifestations of vaginal diaphragm that should be noted are dysmenorrhea, in addition, there may be symptoms of vaginal discharge and infection. The specific clinical symptoms and signs are described as follows.

　　1. Symptoms:Adolescents, with an average time of 1.7 years from menarche to the onset of major clinical symptoms. Type I patients seek medical attention earlier, most are unmarried and childless, dysmenorrhea is the main clinical symptom, which is a severe pain,坠胀,憋闷的痛经, in addition, there may be symptoms of vaginal discharge and infection.

　　2. Signs:Generally, patients are virgins and vaginal examination is rarely performed. Generally, if a vaginal examination is performed, a small hole on one side of the vagina can be seen, with pus flowing out, and a mass in the vaginal wall can be palpated. Such masses are generally located lower, different from common pelvic masses, fixed on one side of the vaginal wall and fornix.

　　The occurrence of vaginal diaphragm is related to teratogenic factors to which pregnant women are exposed, therefore pregnant women should avoid teratogenic factors to prevent the occurrence of this disease. In addition, regular physical examinations should be done to achieve early detection, early diagnosis, and early treatment.

　　The examination of vaginal diaphragm includes vaginal secretion examination, CA125 examination, and other auxiliary examinations. The methods of auxiliary examination are described as follows.

　　1. Ultrasound examination:It can suggest bicornuate uterus and unilateral uterine hematocolpos with cervical dilation, which is very helpful for diagnosis and can also simultaneously suggest the absence of one kidney.

　　2. Iodine oil contrast study:Type I hysterosalpingography shows a unicorne uterus and unicornuate fallopian tube deformity. Type II hysterosalpingography shows the same unicorne uterus and unilateral fallopian tube, but if the posterior fornix cavity can be seen through the oblique septal orifice, the posterior fornix uterus is generally difficult to visualize. Type III can visualize the ipsilateral uterus and the opposite posterior fornix cavity connected to it from the cervix.

　　3. Laparoscopic examination:A bicornuate uterus was found.

　　4. Urological imaging examination:An absence of one kidney and ureter was found.

　　The diet and nutrition after surgery for patients with vaginal septum has a great relationship with the body's recovery. Eating too early can cause complications such as abdominal distension, but eating too late is also harmful. If the postoperative trauma does not receive sufficient nutrition, the speed of wound repair will slow down, and thirst, hunger, and other symptoms will torment the patient. For patients with local anesthesia and minor surgery, there is no anesthetic drug reaction, and normal food can be given after 6 hours. For patients with general anesthesia but not gastrointestinal surgery, if there is no nausea or vomiting reaction after 6 hours, they can start with liquid food, and then semi-liquid or regular food can be given according to the situation.

　　One, Nutritional Principles

　　Generally speaking, surgery will always bring some damage to the human body, which is easy to cause hypermetabolism. The general dietary principle after surgery is light, easy to digest, high in protein, balanced in meat and vegetables, and small and frequent meals. According to traditional Chinese medicine theory, surgery 'damages the flesh and blood, injures the vital energy', so it is suitable to eat more foods with the effects of tonifying the body, nourishing the body, and invigorating the Qi and nourishing the blood.

　　Two, Suitable Foods

　　1, Selection of Starches:Glutinous rice, glutinous rice, sorghum, purple glutinous rice, black glutinous rice, etc.

　　2, Selection of Meat, Eggs, and Milk:Black-bone chicken, turtle, pork, beef, pigeon, perch, etc.

　　3, Vegetable Selection:Yam, potato, pumpkin, spinach, cabbage, carrot, tomato, etc.

　　4, Fruit Selection:Longan, jujube, apricot, pomegranate, apple, etc.

　　5, Other:Eat more dried fruits such as walnuts and peanuts. In the recovery period, you can add some tonifying herbs to make medicinal food, such as ginseng, Astragalus membranaceus, Angelica sinensis, Rehmannia glutinosa, etc.

　　Three, One-Day Reference Diet

　　Breakfast: milk, yam, lamb, eggs, etc., such as yam milk porridge, boiled eggs; lunch: glutinous rice, millet, beef, mushrooms, rapeseed hearts, etc., such as two-millet congee, beef stewed mushrooms, rapeseed heart soup; dinner: purple glutinous rice, glutinous rice, stone ear, pigeons, etc., such as purple glutinous rice congee, stone ear stewed pigeon.

　　The only effective method for treating vaginal septum is surgery. There are reports that although the removal of one uterus through laparotomy can alleviate symptoms, the surgery has a large trauma and sacrifices one normal functional uterus, which is no longer used. The most ideal surgical treatment is to incise the vaginal septum and drain it.