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𝐒𝐮𝐛𝐬𝐜𝐫𝐢𝐛𝐞 𝗙𝐨𝐫 𝗠𝐨𝐫𝐞 𝗜𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧 𝐨𝐧 𝗛𝐞𝐚𝐥𝐭𝐡 👩⚕ 𝐚𝐧𝐝 𝗠𝐞𝐝𝐢𝐜𝐢𝐧𝐞💉🩺💊 𝐘𝐨𝐮𝐭𝐮𝐛𝐞 : / @draishwaryakelkar 📌𝗙𝗮𝗰𝗲𝗯𝗼𝗼𝗸 : / draishwaryakelkar 📌𝗧𝘄𝗶𝘁𝘁𝗲𝗿: / aishwayadr 📌𝗜𝗻𝘀𝘁𝗮𝗴𝗿𝗮𝗺 : / clinical.learning 🌸 Lateral & Vertical Fusion Defects of the Vagina | USMLE Step 1/2 CK | Embryology, Imaging, Presentations & Management Master vaginal fusion defects the exam way by linking embryology to clinical patterns and first-line management. During normal development, the paired Müllerian ducts fuse in the midline to form the uterus, cervix, and upper two-thirds of the vagina, while the lower one-third arises from the urogenital sinus (vaginal plate) and must canalize upward to meet the Müllerian segment. Lateral fusion defects reflect failed ductal fusion or resorption along the midline and classically create a longitudinal (hemivaginal) septum, often accompanying uterine duplication anomalies (uterus didelphys or bicornuate). A high-yield variant is OHVIRA (Herlyn–Werner–Wunderlich) syndrome—uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis—presenting in teens with post-menarche cyclic unilateral pelvic pain, an enlarging mass, and eventual hematocolpos/hematometra with risk of endometriosis and infection. By contrast, vertical fusion (or canalization) defects involve failed union of the Müllerian upper vagina with the sinus-derived lower vagina or failed breakdown of the vaginal plate, producing transverse vaginal septum (at upper, mid, or lower vagina) or imperforate hymen. These lesions block egress of menses and present with primary amenorrhea, cyclic cramping, bulging bluish hymen (imperforate), urinary retention/constipation, or a mass effect; ultrasound shows hematocolpos ± hematometra, while MRI maps septum thickness and associated uterine anomalies for surgical planning. Diagnosis starts with a focused pelvic exam (when appropriate), pelvic ultrasound to identify obstructed blood collections, and MRI for precise anatomy (uterus/cervix configuration, septum level and thickness, renal tract survey). Differentiate obstructive anomalies from Müllerian agenesis (MRKH)—46,XX with normal ovaries but absent uterus/upper vagina—and from endocrine causes of amenorrhea. Management is anatomy-driven: longitudinal vaginal septum is treated with septoplasty (resection) to restore a single canal and relieve dyspareunia, tampon issues, or obstructed hemivagina; in OHVIRA, resection of the obstructing hemivaginal septum preserves both uteri/cervices and prevents endometriosis. Imperforate hymen requires cruciate hymenotomy or hymenectomy with controlled evacuation of retained blood. Transverse vaginal septum needs careful excision with mucosal mobilization (Z-plasty or end-to-end anastomosis) to prevent restenosis; postoperative dilators, topical estrogen (when appropriate), and close follow-up protect the new lumen. Counsel on fertility and pregnancy: many patients have normal reproductive outcomes after correction, but obstetric planning may be needed for associated uterine anomalies. On exams, remember the pattern: lateral fusion → longitudinal septum ± uterine duplication; vertical fusion/canalization → transverse septum or imperforate hymen. Presentations with primary amenorrhea + cyclic pain + pelvic mass are obstructive until proven otherwise—drain safely, image thoroughly, and correct the anatomic block to prevent long-term complications. #USMLEStep2CK #USMLEStep1 #VaginalSeptum #LongitudinalSeptum #TransverseVaginalSeptum #ImperforateHymen #OHVIRA #MullerianAnomalies #PrimaryAmenorrhea #Hematocolpos #PelvicMRI #Gynecology #OBGYN #PediatricAdolescentGyn #MedicalEducationUSA #USMLEPreparation #Step2CKPrep #Step1Prep