(33) Contrast-Enhanced Ultrasound for Evaluation of Vaginal Stenosis

Background: Contrast-Enhanced ultrasound (CEUS) and contrast-enhanced genitosonography (ceGS) have been used to assess anomalies and abnormalities in the bladder, urethra, and uterus. There is existing evidence on using CEUS to characterize urogenital anomalies and cloaca in pediatric patients for surgical planning. We present a novel use of CEUS in the evaluation of vaginal stenosis after vaginoplasty for distal vaginal agenesis.

Case: Patient is a 20yo female with history of distal vaginal agenesis status post colonic vaginoplasty complicated by vaginal stenosis at the anastomosis between native and neovagina. This was managed by a revision surgery in January 2023. She reported that her vaginal stenosis was limiting the depth of penetrative vaginal intercourse she could have and she experienced recurrent vaginal lacerations. She reported regular monthly menses. An MRI was performed with a vaginal tampon in place that was unable to fully appreciate the area of stenosis and did not demonstrate any additional abnormal distension of the neovagina or uterus. After multi-disciplinary discussion, radiology recommended attempting a contrast-enhanced pelvic ultrasound to further characterize the area of vaginal stenosis.

A 24 French Foley catheter was inserted into the vagina past the introitus and the balloon was inflated to occlude the vagina. Approximately 50mL of LUMASON contrast was instilled into the vagina. A trans-abdominal and trans-perineal pelvic ultrasound was performed. Contrast opacified the vaginal vault and endometrial cavity indicating patency of the vagina. The area of stenosis was identified at the upper vagina, likely representing the anastomosis between the native vagina and the colonic vaginoplasty. The stenotic segment was found to be 6mm in length. The native upper vagina measured 1.8 cm and the colonic vaginoplasty approximately 6 cm in length.

After this procedure was performed, the patient was counseled about options for management of vaginal stenosis. Given the location in the upper vagina and risk for recurrent stenosis, the decision was made to focus on non-surgical management with vaginal dilation. She was also counseled about penile-bumpers which can be used to moderate the depth of penetration during intercourse.

Comments: Contrast-enhanced ultrasound is a minimally invasive, low risk, and inexpensive imaging modality that can effectively characterize vaginal stenosis to aid in counseling about non-surgical and surgical management options. Future studies are needed to assess the effectiveness of contrast ultrasound to evaluate other vaginal anomalies.