Background: Perforated transverse vaginal septum is a rare condition which has no currently standard management guidelines. This case report outlines the new technique for diagnosis and treatment at Thammasat University Hospital.
Case Report: A 23 years old, nulliparous, Thai female was admitted to the hospital due to acute pelvic pain with normal female sexual characteristics, hematocolpos and hematometra. A transabdominal ultrasound guided vaginoscope with loop electrocauterization was the investigation and treatment of choice in this case according to the location, type, visualization and pain limitation. Six weeks after the operation, the width and the thickness of septum remained the same width and thickness, as an excellent result of surgery. This was considered adequate to maintain menstrual blood flow and penetrative function in the future. Self-digital dilation was advised for preventing recurrence.
Conclusion: Combine ultrasound guided- digital examination and vaginoscopy for diagnosis and resection of vaginal septum and continuous self-digital dilatation of vagina is a safe and simple technique for management of transverse vaginal septum with splendid results.

Keywords: Transverse vaginal septum, Vaginoscopy, Amenorrhea, Hematocolpos