Design: Case report.

Setting: This case was performed at a tertiary academic children's hospital. In the OR, our patient was positioned in dorsal lithotomy in Yellowfin stirrups. The OR table height was adjusted so that both surgeons were able to comfortably operate while seated.

Patients or Participants: A single 15-year-old natal female, followed 3 months post-operatively.

Interventions: Examination under anesthesia, resection of transverse vaginal septum, pull-through vaginoplasty.

Measurements and Main Results: Following surgery, the patient was seen in clinic at 2 weeks and 3 months post-operatively. At these time points, vaginal exams were performed to evaluate surgical healing, and the patient was also interviewed. At her 2 week visit, her suture line remained appropriately at the level of the introitus without concern for dehiscence, and there was no evidence of stenosis with the introitus accommodating 1 finger breadth. At 3 months, her vagina was completely healed with no sutures or scarring noted. Her introitus accommodated 2 finger breadths. She reported easy compliance with vaginal estrogen and dilator use, with no pain.

Conclusion: The correct diagnosis of obstructive Mullerian anomalies, namely differentiating between imperforate hymen, transverse vaginal septum, and distal vaginal agenesis, is important for surgical planning. When performing surgical correction, surgeons should consider maintaining an intact septum in order to ensure the appropriate amount of vagina is mobilized to prevent introital stenosis or dehiscence of the suture line. Surgeons should consider post-operative dilator and topical estrogen use when there is concern for possible stenosis and/or retraction of the suture line, in order to prevent post-operative complications.