A female with an imperforate hymen is normally asymptomatic before puberty. However, at birth, accumulations of vaginal secretions may lead to swelling of the introitus with spontaneous resolution.
On perineal exam, the vulva can present as a tense, bulging, bluish membrane. This occurs due to hematocolpos (vagina filling with blood preventing release) as the bluish mass pushes the labia open on pelvic examination. Additionally, due to the retention of blood, there can possibly be a palpable lower abdominal mass.
Primary amenorrhea (failure of menses by age 13 without secondary sex characteristics or age 15 with secondary sex characteristics) can be seen in patients with an imperforate hymen along with periodic lower abdominal pain.
Imperforate hymen can also present with lower abdominal pain along with dysuria, frequency, and urinary retention. These symptoms could be related to the elongation of the urethra due to the distended vagina.
Imperforate hymen is primarily diagnosed by clinical impression but a pelvic exam and/or imaging can be performed in order to rule out other conditions (e.g. transverse vaginal septum).
Surgical intervention is required to correct the imperforate hymen. Specifically, the excision of the imperforate hymen, known as a hymenectomy, is performed.
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