Abstract As anomalias Müllerianas têm uma baixa prevalência na população geral, mas um impacto marcado nos desfechos reprodutivos. O septo uterino é a malformação mais frequente, no entanto, mantém-se a ausência de consenso das sociedades médicas internacionais quanto aos critérios diagnósticos e orientação clínica. Embora menos frequente, a agenesia da vagina interfere de forma significativa na identidade feminina. Independentemente da técnica de neovaginoplastia escolhida, é fulcral tentar normalizar a função sexual.

Resumo Müllerian anomalies have a low prevalence in the general population, but a marked impact on reproductive outcomes. The uterine septum is the most common malformation, however, there remains a lack of consensus from international medical societies regarding diagnostic criteria and clinical guidance. Although less common, vaginal agenesis significantly interferes with female identity. Regardless of the neovaginoplasty technique chosen, it is essential to try to normalize sexual function.

Abstract A female adolescent presented with recurrent pelvic pain, severe dysmenorrhea, and catamenial diarrhea for 2 years. Ultrasound and magnetic resonance imaging suggested a hemi-uterus with a non-communicating rudimentary cavity. Hysteroscopy revealed a normal vagina and cervix, and one tubular uterine cavity with only the left tubal ostium. During laparoscopy, a left hemi-uterus was observed with a normal left ovary and tube, and a non-communicating rudimentary cavity on the right side with normal adnexa (ESHRE/ESGE U4aC0V0). Blood and endometriotic lesions were present at the pouch of Douglas. Excision of the rudimentary cavity, tube, and endometriotic lesions was performed.

Resumo Adolescente do sexo feminino observada na urgência de ginecologia por dor pélvica crónica, dismenorreia grave e diarreia catamenial desde há 2 anos. Realizou ecografia e ressonância magnética com visualização de hemi-útero com uma cavidade rudimentar não comunicante. À histeroscopia com vagina e colo normais, uma cavidade uterina tubular com um único óstio tubário esquerdo. Na laparoscopia, observado hemi-útero esquerdo com ovário e trompa esquerdos normais e uma cavidade rudimentar não comunicante à direita com anexos normais (ESHRE/ESGE U4aC0V0). Apresentava também sangue no fundo de saco de Douglas e lesões endometrióticas. Foi realizada a excisão da cavidade rudimentar, da trompa e das lesões endometrióticas por via laparoscópica.

Abstract Objective Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Methods Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. Results A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Conclusion Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.