An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to . Learn what to expect from an imperforate hymen, and how it’s treated. In the case of an imperforate hymen, a membrane extends all the way across the area of the hymen, blocking the vaginal opening. It is easily corrected through a.

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A year-old girl presented with primary amenorrhea and had had cyclical abdominal pain for almost a year.

Imperforate hymen

At examination we observed a painful mass in the lower abdomen and normal secondary sex characteristics. Perineal examination showed a bluish bulging hymen. We diagnosed an imperforate hymen with haematocolpos and haematometra. The hymen was opened surgically and a large quantity of menstrual blood was drained from the vagina and uterus. Postoperative recovery was normal without any pain. The hy,en now menstruates regularly.

An imperforate hymen hmyen in 0. Humen is important to be aware of this while examining a female adolescent presenting with cyclical abdominal pain and primary amenorrhea. Late discovery of an imperforate hymen may lead to pain, infections, hydronephrosis and endometriosis with subfertility as a possible consequence.

Imperforate hymen is a rare cause of abdominal pain in female adolescents. It is seen in approximately 1 in females, although information on the true incidence is difficult to obtain.

The aim of this communication is to increase awareness of imperforate hymen among clinicians examining adolescent girls with lower abdominal pain. A year-old girl was admitted with a history of htmen abdominal pain. She was asymptomatic until a year previously. She then started developing cyclical crampy pain in the lower abdomen, which lasted for 7 days every month. The pain had become more severe during the previous 2 months and the size of her abdomen had increased over the past few months.

There was no history of nausea, vomiting, fever, altered bowel habits or problems with urinating. She was 13 years old and had not yet had a menstrual period, but did have pubic hair and breast buds, confirming the onset of puberty. The patient denied any vaginal discharge and there was no history of sexual activity.

No other members of her family had similar or other physical complaints. The medical history was unremarkable. On physical examination, the secondary sex characteristics, such as pubic hair and breast buds, were well developed. A mobile, non-tender mass, arising from ijperforate pelvis to the belly button, was felt in the abdomen fig 1upper image. Gynaecologic examination revealed a bulging bluish hymen fig 2.


No other gross external abnormalities of the external genitalia were observed.

Imperforate hymen – Wikipedia

Both the ovaries were normal. Swollen abdomen with haematometra due to an imperforate hymen and the abdomen after hymenectomy. We diagnosed an imperforate hymen with consequent accumulation of blood in the vagina and uterus haematocolpos and haematometra, respectively.

Two imperrforate later the patient underwent a hymenectomy with a cruciate incision. Approximately ml of viscous, chocolate coloured blood and clots were drained fig 3. Immediately after the operation the size of the abdomen had regained normal proportions fig 1lower image. During a 2-month follow-up, the patient was asymptomatic and started to have regular menstrual cycles.

Imperforate hymen is hyymen rare though serious cause of abdominal pain in female adolescents. It is seen in approximately 1 in females. The hymen is called imperforate if there is no perforation of this membrane.

The reason for non-perforation of this membrane is unknown.

Imperforate hymen occurs mostly in a sporadic manner, although some familial occurrences have been reported. Both the recessive and dominant modes of transmission have been suggested, but no genetic markers or mutations have been proven as aetiological factors. The most common symptoms of an imperforate hymen are cyclical abdominal pain and urinary retention, usually presenting between the ages of 13 and 15 years when menarche occurs.

Because the vaginal outflow is obstructed by the non-perforated hymen, menstrual blood accumulates in the vagina haematocolpos and the uterus haematometra.

This may lead to mechanical effects on the urethra, bladder, intestines or pelvic blood vessels which can result in urinary retention, obstipation or oedema of the legs. Some symptoms of appendicitis are similar to those of an imperforate hymen, and there are cases where groundless appendectomies have been performed.

The history and physical examination are frequently incomplete. Gynaecological examination reveals imperrorate bluish bulging hymen and generally an abdominal mass. The diagnosis can be established with an abdominal ultrasound showing the pelvic cystic mass. Imperforate hymen should be differentiated from a low transverse vaginal septum using the Valsalva manoeuvre: Early diagnosis of an imperforate hymen is important, since it can lead to serious complications such as infections, hydronephrosis, kidney failure, endometriosis and subfertility.

Treatment of haematocolpos or haematometra due to an imperforate hymen is to make cruciate incision in the hymen which allows the accumulated blood to drain away. In a retrospective study of the long term results of surgical correction of imperforate hymen, nine of 15 imperforste had uymen irregular menstrual cycle and six of 15 patients had dysmenorrhea over a follow-up of 8.


Most patients had no sexual dysfunction. National Center for Biotechnology InformationU. Published online May Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.

What Is an Imperforate Hymen?

Abstract A year-old girl presented with primary amenorrhea and had had cyclical abdominal pain for almost a year. Open in a separate window. Consider an imperforate hymen when there is a lack of menses in an adolescent girl with cyclical abdominal pain. Consider an imperforate hymen if there is a discrepancy between the Tanner stage and menarcheal status. Parazzini F, Cecchetti G. The frequency of imperforate hymen in Northern Italy. Int J Epidemiol ; Early detection of imperforate hymen prevents morbidity from delays in diagnosis.

A review of the literature and a report of twenty cases. Cal West Med ; Imperforate hymen – a rare cause of abdominal pain: J Pediatr Adolesc Gynecol ; Sakalkale R, Samarakkody U. Familial occurrence of imperforate hymen. Obstet Gynecol ; An unusual case of urinary retention due to imperforate hymen.

J Accid Emerg Med ; Letts M, Haasbeek J. Hematocolpos as a cause of back pain in premenarchal adolescents. J Pediatr Orthop ; Imperforate hymen with hematocolpos. Ann Emerg Med ; Hematocolpometra manifesting as constipation in the young female. Acad Emerg Med ; 6: Hematocolpometra presenting as urinary retention. J Reprod Med ; Tuncer R, Tunali N. Imperforate hymen as a cause of bladder perforation and intestinal obstruction.

Br J Urol ; Acute urinary retention in the young female.

Acute urinary retention in two patients with imperforate hymen. Scand J Urol Nephrol ; Long-term follow-up of women who underwent surgical correction for imperforate hymen. Arch Gynecol Obstet ; Pediatr Surg Int ; Imperforate hymen with bilateral hydronephrosis: J Emerg Med ; Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum.

Imperforate hymen with bilateral hydronephrosis in a neonate. Saudi J Kidney Dis Transpl ; ijperforate Endometriosis and mullerian anomalies. Acute urinary retention as the presentation of imperforate hymen.

J Chin Med Assoc ; Management of imperforate hymen with the carbon dioxide laser.