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Imperforate Hymen

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An imperforate hymen is a congenital defect characterized by a hymen without an opening. It is often asymptomatic until puberty when menses begins. It can present as hematocolpos, primary amenorrhea, or lower abdominal pain. Diagnosis is made by clinical impression, and management involves surgically perforating the hymen.
6 KEY FACTS
CLINICAL FEATURES
Often Asymptomatic until Puberty
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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.

Hematocolpos
Bulging Blue Vulcan

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
(1) Wand with Amen-tampon

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.

Lower Abdominal Pain
Lower Abdominal Pain-bolts

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.

DIAGNOSIS
Diagnosis by Clinical Impression
Diagnostic-computer displaying Clinical Impression

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).

MANAGEMENT
Surgery
Surgeon

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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