Teen patient complains of vaginal discomfort

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I had been working as a women's health nurse practitioner for about 10 years when I saw a 17-year-old patient who came into the clinic complaining of vaginal pain and bleeding after vaginal intercourse. The patient had had sex for the first time at age 14. She had had three different male sex partners but had been with the current one for 18 months.

The patient currently was pain free, and there was no bleeding. After asking her if the sex had been rougher than usual or in a different position — both of which she denied — I had her undress and get on the table. Externally there was nothing remarkable: no lesions or bleeding.

I then told the patient that I would need to insert a speculum to visualize what the problem might be, but I first wanted to do a digital exam. As I stood and inserted one finger, there was no problem. But as I inserted the second finger, she clearly became uncomfortable. I withdrew my fingers and told her I wanted to take a better look with the light.

I adjusted the light and sat as low as I could on the exam stool. As I inserted the tip of one finger and gently plied the introitus to my left, I could see a piece of vaginal tissue. I then told her I wanted to insert a long Q-tip. When I inserted the Q-tip to the right of my finger, it was clear that the two were in separate channels.

The patient had a longitudinal septum, which for some reason had torn for the first time two days earlier. She was referred to a gynecologist who removed the septum. This is the first time I had seen vaginal septum, but I have seen two more since.
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