The spontaneous development of total vaginal occlusion as the result of postmenopausal atrophy is unusual. This poorly described entity may give rise to diagnostic confusion, as the site of vaginal occlusion resembles an atrophic cervix flush with the top of a stenotic vaginal vault. Fluid collections above this site of occlusion may produce pelvic masses with a characteristic physical sign. The absence of any history of vaginal injury or disease distinguishes these cases from other types of acquired vaginal occlusion.