ABNORMALITAS PADA VAGINA DAN VULVA

Dr.Rahmanita Sinaga,MKed(OG),SpOG
Himen imperforata
• yaitu selaput dara yang tidak menunjukkan lubang
(hiatus himenalis) sama sekali.
• Kemungkinan besar tidak diketahui sebelum menarche
• Darah terkumpul di dalam vagina dan menyebabkan
himen
• tampak kebiru-biruan dan menonjol keluar 
Hematokolpos
Hematometra (uterus terisi dengan darah haid)
Hematosalpinks (tuba kiri dan kanan terisi darah haid)
 dapat diraba dari luar sebagai tumor kistik di kanan dan
kiri atas simfisis
• Pengobatan  Himenektomi
Ciri khas Hematokolpos

Himenektomi
SEPTUM VAGINA

• Adanya sekat sagital di vagina yang ditemukan

di bagian atas vagina
• Sering ditemukan dengan kelainan pada uterus
adanya gangguan dalam fusi atau kanalisasi
kedua duktus Mulleri
• Pada umumnya tidak menimbulkan keluhan
• Ditemukan pada pemeriksaan ginekologik
• Darah haid keluar secara normal
Septum vagina
Vaginal Corpus Alienum

CHILD ADULT
may insert a Psychiatric
foreign body disorders

Unusual
Sexual
abuse sexual
practice
What to do ?
• Common cause of vaginal discharge, which may appear
purulent or bloody

• Visualize the foreign body  nasal speculum /vaginal speculum

• Pediatric patients knee-chest position  rectal examination,

 expell the foreign body from the vagina by pushing with the
examining finger in the rectum.

• Friable foreign bodies such as wads of toilet paper may be

flushed out using warm water, an infant feeding tube, and a
standard syringe.

• Lost or forgotten tampons can be removed with vaginal forceps.

What to do ?
• In difficult cases  general anesthesia
• empty her bladder and lie in stirrups in the
lithotomy position.
• Insert a Foley catheter to break any suction
between the foreign body and the vaginal
mucosa.
• Reserve x rays for radio-opaque foreign bodies
concealed in the bladder or urethra.
• Do not forget to ask about possible sexual abuse
and consult with protective services if it cannot
be ruled out.
• Diambil dari : Berek,SJ, Benign Disease of the Female
Reproductive2007.Gynecology.Fourteen edition.Lippincott Williams Wilkins.
Kista bartholin
• Obstruction of the distal Bartholin’s duct may result in
the retention of secretions and the formation of a cyst.

• The process is
usually unilateral
and occurs in up to
2% of women.

• Bartholinitis 
acute pain,
tenderness,
and dyspareunia.
Bartholin abcess
• The cyst may become infected, and an abscess may
develop in the gland.
• Infectious organisms (often Neisseria gonorrhoeae with
secondary streptococci, staphylococci, or Escherichia
coli) become pocketed within the passage to form an
abscess
• A Bartholin’s duct cyst does not necessarily have to be
present before a gland abscess develops.
• Abscess (+)  incision and drainage +broad spectrum
antibiotic
GARTNER’S DUCT CYSTS
• Gartner’s duct cysts are remnants of the mesonephric ducts of
the Wolffi an system.
• Found most commonly in the anterior lateral aspects of the
upper part of the vagina.
• Most are asymptomatic.
• Patients may present in adolescence with dyspareunia or difficulty
inserting a tampon.
• These cysts are typically treated by excision
• When removal is necessary, an IVP and cystoscopy should be
performed preoperatively to locate the position of the bladder and
ureters relative to the cyst.
• Urethral diverticula, ectopic ureters, and vaginal and cervical
cancer should be ruled out.
Kista gartner
 Nabothian cysts
• These are caused by intermittent blockage of an endocervical gland
and usually expand to no more than 1 cm in diameter.
• Nabothian cysts are more commonly found in menstruating women
and are usually asymptomatic.
• discovered on routine gynecologic examination and require no
treatment.

Nabothian cysts of the cervix.

(From Bickley LS, Szilagyi P. Bates’ Guide to Physical Examination and History Taking, 8th
ed. Philadelphia, PA: Lippincott Williams &Wilkins; 2003.)
BYPASS INCONTINENCE (URINARY FISTULA)

• Bypass incontinence
(continuous urinary incontinence)
 the result of a urinary fistula
formed between the bladder and the
vagina (vesicovaginal fistula), or
between the urethra and the vagina
(urethrovaginal fistula) or the ureter
and the vagina (ureterovaginal fi
stula).
• A urinary fistula will result in extra
urethral leakage of urine, which is usually
reported by the patient as continuous
incontinence.

• Pelvic radiation and pelvic surgery account

for more than 95% of urinary fistula
incontinence cases in the United States.

• In particular, simple abdominal

hysterectomy and vaginal hysterectomy
alone account for more than 50%of
vesicovaginal fistulas.
Urethrovaginal fistula

Urethrovaginal fistulas may also occur as complications

of surgery for urethral diverticula,anterior vaginal wall
prolapse, or stress urinary incontinence.
 Ureterovaginal fistulas, as seen after 1% to 2% of radical
hysterectomies, are usually due to devascularization rather than
direct injury.
• Obstetric injuries associated with
operative vaginal deliveries
(forceps, vacuum) were once the
leading cause of urinary fistulas

• In many developing nations,

urinary fistula often results from
birth trauma and obstructed labor,
untrained birthattendants,
inadequate pelvic dimensions
 HISTORY

• Painless and continuous loss of urine

• Usually after pelvic surgery, pelvic radiation, or
obstetric trauma.
• Fistulas due to surgery usually become clinically
apparent within 14 postoperative days.
 DIAGNOSTIC EVALUATION

• Methylene blue or indigo carmine instilled into the bladder in a retrograde

fashion can be visualized leaking through the fistula into the vagina.
• If the fistula is very small and difficult to visualize, a tampon can be placed in
the vagina following the instillation of dye; the blue dye will stain the tampon
if a vesicovaginal fistula is present.

• To diagnose a ureterovaginal fistula, indigo carmine is given intravenously.

• As the compound is filtered through the kidneys and passes through the
ureters, it will stain the tampon. If a ureterovaginal fistula is present, the
retrograde dye test will be negative and the IV dye test will be positive.
• Cystourethroscopy and the voiding cystourethrogram (VCUG) can
then be used to identify the number and location of the fistulas.
• Intravenous pyelogram (IVP) and retrograde pyelogram may also be used to
localize urinary fistulas as well.
 TREATMENT

• Surgery is the primary treatment for urinary

fistulas.
• It is typical to wait 3 to 6 months before
attempting to repair postsurgical fistulas. This
waiting period allows inflammation to decrease
and vascularity and pliability of the area to
increase.
• Antibiotics for urinary infection and estrogen
for postmenopausal women are also used during
this period.
RECTOVAGINAL FISTULA
• Rectovaginal fistulas are abnormal epithelial-
lined connections between the rectum and
vagina.
Etiology

• Fistulas can be the result of congenital malformations or

acquired etiologies
• Prolonged labor with necrosis of the rectovaginal septum
or obstetric injury with a third- or fourth-degree perineal
tear or episiotomy can lead to rectovaginal fistula.
• Malignancies 
• Operative trauma
• Infectious processes
• sexual assault
Evaluation

• passage of flatus or liquid stool per vagina. 

• malodorous vaginal discharge and recurrent vaginitis
• Endorectal and transvaginal ultrasounds may be used to
identify low fistula
• Alternatively  a vaginal tampon can be inserted
followed by instillation of a methylene blue enema. The
tampon is removed after retaining the enema for 15 to 20
minutes. If there is no staining, the diagnosis of
rectovaginal fistula is highly unlikely. More proximal
fistulas are best diagnosed with vaginography or
computed tomography with rectal contrast
TREATMENT

• Conservative Management
A small subset of patients may respond to medical
optimization.  regulating bowel function and controlling
diarrhea  patients with rectovaginal fistula of obstetric origin
may experience fistula healing with this regimen..

• Antibiotic therapy or immunosuppressive medications play

an important role for surgical preparation. A recommended
period of 3 to 6 months for medical therapy has been
suggested

• Operative