What does this research mean for the field?

Late-onset OHVIRA syndrome can present in women as old as 49 years, and a minimally invasive surgical approach can effectively manage the condition. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This case reports on a rare presentation of OHVIRA syndrome in a middle-aged woman, focusing on diagnosis and treatment.

February 28, 2026Open Access

Late-onset OHVIRA syndrome in a 49-year-old woman with severe dysmenorrhea: a case report on vaginoscopic management

Key Points

This case reports on a rare presentation of OHVIRA syndrome in a middle-aged woman, focusing on diagnosis and treatment.
Detailed imaging studies including MRI to confirm diagnosis
Vaginoscopic and hysteroscopic resection of the vaginal septum performed
6-month follow-up to assess symptom resolution
Patient's severe dysmenorrhea and spotting completely resolved postoperatively
No recurrence of symptoms noted at 6-month follow-up
Highlights the importance of considering Müllerian anomalies in older populations

Abstract

OHVIRA syndrome is a rare Müllerian duct anomaly characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Although typically diagnosed in adolescence, it can rarely present later in life. We present the case of a 49-year-old woman who presented with severe dysmenorrhea and intermittent spotting. Imaging studies, particularly MRI, confirmed the diagnosis of OHVIRA syndrome by revealing a didelphic uterus with hematometra and hematocolpos secondary to a right-sided obstructed hemivagina, along with right renal agenesis. The patient was successfully managed with vaginoscopic and hysteroscopic resection of the vaginal septum. Postoperatively, her symptoms resolved completely, with no recurrence observed at 6-month follow-up. This case contributes to the literature by documenting one of the latest known presentations of OHVIRA syndrome, reinforcing that a high index of suspicion for Müllerian anomalies must be maintained regardless of patient age. It demonstrates that a partially draining orifice can mask classic symptoms for decades and confirms the long-term efficacy of a minimally invasive surgical approach for both diagnosis and treatment.

Bookmark

View Full Paper