A 34-year-old woman visited our gynecology clinic seeking treatment for a cervical polyp. She was in good health and took a combined oral contraceptive pill (OCP) along with ibuprofen to manage heavy menstrual bleeding and dysmenorrhea. Despite experiencing occasional dyschezia, the patient was not sexually active and had normal previous Pap tests.
Upon examination, we discovered several polypoid growths in the right posterior vaginal fornix that did not involve the cervix. After performing a wide local excision in the operating room, we received confirmation from pathology that the growths were vaginal polypoid endometriosis. Our focused ultrasonography revealed an anteverted, anteflexed uterus with diffuse global adenomyosis, along with “kissing ovaries” relocated to the posterior cervix in the midline.
Endometriosis, defined as the presence of endometrial-like glands and stroma outside the uterine cavity, affects 10-15% of reproductive-age women and can cause pelvic pain and infertility. Polypoid endometriosis is a rare variant that presents as large masses in the ovaries, colon, or vagina. Postcoital spotting and hemorrhage are common symptoms.
Treatment options for vaginal polypoid endometriosis are similar to those for pelvic endometriosis, with a focus on symptom control using progestin- or estrogen-suppressive therapies. In this case, the patient opted to transition to a lower-dose OCP containing norethindrone acetate and ethinyl estradiol for targeted endometriosis suppression, and her symptoms improved significantly.
Patients with deep endometriosis involving pelvic structures, the bowel, and the vagina may require surgical intervention if medical management fails. As clinicians, it’s important to choose clinical images that are both clear and educational, as well as to obtain written consent from patients before publishing any findings.
