Office vaginoscopic resection of a large prolapsed longitudinal vaginal septum diagnosed in adulthood after previous vaginal delivery: A case report

Longitudinal vaginal septum is an uncommon Müllerian developmental anomaly caused by incomplete fusion or resorption of the Müllerian ducts. It is frequently associated with uterine malformations, whereas isolated forms are rare. Clinical presentation ranges from asymptomatic findings to dyspareunia, dysmenorrhea, infertility, or obstetric complications. Diagnosis is usually made during adolescence or reproductive evaluation and is unusual after prior vaginal delivery. A 36-year-old woman with one previous spontaneous vaginal delivery presented with dyspareunia. Pelvic examination revealed a thick longitudinal vaginal septum protruding externally beyond the vulvar introitus. The septum extended from the cervix to the lower third of the vagina and measured more than 2 cm in thickness. A single cervix was identified. Imaging studies excluded associated uterine or urinary tract anomalies, confirming an isolated longitudinal vaginal septum. The patient underwent office-based vaginoscopic resection using a 5-mm bipolar energy device. The septum was coagulated and excised under direct visualization without intraoperative complications. At 6-month follow-up, vaginal anatomy was normal, with no stenosis or residual tissue. The patient reported complete resolution of dyspareunia and satisfactory sexual function. This case highlights the possibility of late diagnosis of isolated longitudinal vaginal septum even after vaginal childbirth and supports minimally invasive office vaginoscopic management as a safe and effective therapeutic approach. • Isolated longitudinal vaginal septum can remain undiagnosed until adulthood. • Diagnosis after previous vaginal delivery is an unusual clinical scenario. • Vaginoscopic resection allows minimally invasive outpatient treatment. • Bipolar energy devices enable safe excision of thick vaginal septa. • Office management can achieve excellent anatomical and functional outcomes.