A Case of Distal Vaginal Scarring following Cloacal Repair

Background: Newborns with severe cloacal malformations must undergo surgical reconstruction in infancy. Further surgical management during adulthood is often needed to restore specific functions. Case: A 17 year old female presented with inability to engage in vaginal intercourse. She had undergone cloacal reconstruction in infancy. Pelvic exam revealed normal labia, a vaginal-urethral common opening <5mm and a fibrous scar at the distal vagina. Diagnostic evaluation included pelvic hydrosonovaginogram, Voiding Cystourethrogram (VCUG), MRI and Examination Under Anesthesia (EUA) with cystoscopy and vaginoscopy. Surgical repair consisted of a perineal flap vaginoplasty. Summary and Conclusion: This report describes the importance of a thorough preoperative evaluation when managing gynecologic complications of a rare cloacal malformation. Vaginoplasty was performed without compromising bowel or bladder function.