Article

Long-term follow-up of women who underwent surgical correction for imperforate hymen

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Abstract

The aim of this study was to demonstrate the clinical results of postoperative evaluation for a consecutive series of cases of imperforate hymen presenting at a tertiary medical center during an over 14-year period. We retrospectively reviewed the clinical records of 15 patients with imperforate hymen that had undergone hymenectomy between 1987 and 1998. After completing a questionnaire via a telephone interview regarding sexuality, fertility, menstrual problems, micturition and defecation after surgical correction, those patients were persuaded to come back to the hospital for further gynecological surveys during 2002. The mean postoperative follow-up was 8.5 years (range, 4-14 years). The mean age at diagnosis was 13.2 years (range, 11-16). The most common clinical symptom was cryptomenorrhea (15), followed by pelvic pain (11), palpable abdominal mass (9), urinary retention and other voiding problems (8) and problems of defecation (4). None admitted intercourse attempts before. Two patients also had uterine anomalies, but none had urinary tract or bowel anomalies. During the follow-up period, we found that the majority of patients had irregular menstrual cycles and were worried about their future fertility. Six patients suffered from dysmenorrhea; of 11 patients who began having intercourse two later delivered babies, and none complained of sexual dysfunction. After hymenectomy, the women with imperforate hymen were markedly relieved of cryptomenorrhea, and problems of micturition and defecation also greatly improved. Although complaints of irregular menstruation and dysmenorrhea gradually evolved as the center of attention during follow-up, most patients fared well in terms of fertility and sexual function.

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... Imperforate hymen is the commonest female genital tract malformation and is noted in approximately 1 in 2000 females. 1 Although the most common age of presentation is around puberty 2,3 diagnosis in utero [4][5][6] and during the new born period and childhood 4,7 are also reported. We report two cases of imperforated hymen with different symptoms of presentation. ...
... The age of presentation (mean, range) is 12 and 10-15 years respectively according to Lui et al. 10 and 13.2 and 11-16 years respectively according to Liang et al. 5 The common mode of presentation of imperforate hymen includes-I. Amenorrhea, which may be primary due to accumulation of blood behind the imperforate hymen 3,4,7 or secondary which can occur following spontaneous closure of previously perforate hymen. ...
... 1 The outcome of surgical hymenotomy is good and the recurrences are rare. 5 ...
... Imperforate hymen, despite being the commonest female genital tract malformation [1], is a rare occurrence with a prevalence of 0.014-0.1% [1][2][3]. It mostly presents during puberty [1,4] although diagnoses in utero [3,5,6] and during the new born period and childhood [3,7] are also documented. ...
... Imperforate hymen is a layer of connective tissue that forms a transverse septum and obstructs the vaginal opening at the level of the introitus [5]. Usually, the hymen is a membrane that embryologically develops through the fusion of the caudal end of the paramesonephric ducts and the urogenital sinus [4,5,7,8]. ...
... Imperforate hymen is a layer of connective tissue that forms a transverse septum and obstructs the vaginal opening at the level of the introitus [5]. Usually, the hymen is a membrane that embryologically develops through the fusion of the caudal end of the paramesonephric ducts and the urogenital sinus [4,5,7,8]. The central portion of this membrane perforates through the degeneration of its epithelial cells [5]. ...
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Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for hematocolpometra, having presented with abdominal pains and tenesmus.
... Em consequência da obstrução causada pela ausência de perfuração himenial, o sangue catamenial acumulase na vagina (hematocolpos) e na cavidade uterina (hematometra) 3,5,7 . Este processo patológico pode refl ectirse em efeitos mecânicos sobre a uretra, bexiga, intestino ou vasos sanguíneos pélvicos que podem resultar em retenção urinária (37-60%), obstipação (27%) e, em certos casos, edema dos membros inferiores 6,[15][16][17] . Ocasionalmente, a irritação de raízes nervosas do plexo sagrado pode originar dor lombar (38-40%) 15 . ...
... O prognóstico é excelente e, embora descrita, a recorrência é pontual. No entanto, se a obstrução vaginal é causada por um septo plano médio transversal ou atresia vaginal, o prognóstico depende da presença e gravidade de outras perturbações associadas 17,18 . De acordo com a ESHRE/ ESGE classifi cation system of female genital anomalies 19 , o hímen imperfurado é classifi cado como U0C0V3 (U0= normal uterus; C0= normal cérvix; V3= transverse vaginal septum and/or imperforate hymen). ...
Article
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Introduction: Imperforate hymen occurs in approximately 1 in 1,000 females. It can be found incidentally on physical examination, it is treatable and does not cause significant morbidity. If it is not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and symptoms of urinary retention due to hematocolpos.
... Em consequência da obstrução causada pela ausência de perfuração himenial, o sangue catamenial acumulase na vagina (hematocolpos) e na cavidade uterina (hematometra) 3,5,7 . Este processo patológico pode refl ectirse em efeitos mecânicos sobre a uretra, bexiga, intestino ou vasos sanguíneos pélvicos que podem resultar em retenção urinária (37-60%), obstipação (27%) e, em certos casos, edema dos membros inferiores 6,[15][16][17] . Ocasionalmente, a irritação de raízes nervosas do plexo sagrado pode originar dor lombar (38-40%) 15 . ...
... O prognóstico é excelente e, embora descrita, a recorrência é pontual. No entanto, se a obstrução vaginal é causada por um septo plano médio transversal ou atresia vaginal, o prognóstico depende da presença e gravidade de outras perturbações associadas 17,18 . De acordo com a ESHRE/ ESGE classifi cation system of female genital anomalies 19 , o hímen imperfurado é classifi cado como U0C0V3 (U0= normal uterus; C0= normal cérvix; V3= transverse vaginal septum and/or imperforate hymen). ...
Article
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Resumo Introdução: Hímen imperfurado ocorre em aproximadamente 1 em cada 1.000 mulhe-res. Pode ser diagnosticado incidentalmente ao exame físico e é tratável, não causando habitualmente morbilidade signifi cativa. Se não for rastreado e tratado precocemente, as pacientes apresentam uma menarca associada a história de dor pélvica ou abdominal cíclica e sintomas de retenção urinária associada a hematocolpos. Caso clínico: 12 anos, sexo feminino, pré-menarca, recorreu ao serviço de urgência por dor abdominal cíclica e polaquiúria, com 6 meses de evolução. Sem antecedentes médi-cos relevantes, sem história de menstruação ou início da actividade sexual até à data. O exame do períneo revelou um hímen imperfurado e saliente ao nível do introito. Foi efectuada uma incisão em Y no hímen imperfurado e durante a himenectomia foi dre-nado 500 mL de sangue castanho (viscoso, cor de chocolate). A doente teve alta no 2º dia pós-operatório. Na consulta de follow-up (aos 52 dias), a doente relatou resolução completa dos sintomas. Conclusão: Apesar de rara, a imperfuração do hímen associada a menstruação retrógra-da, é causa de dilatação da vagina e do útero, isto é, hematocolpometra. É um diagnósti-co diferencial, facilmente confi rmado, importante a ter em consideração em meninas na pré-menarca com dor abdominal, frequentemente associado a sintomas urinários. Abstract Introduction: Imperforate hymen occurs in approximately 1 in 1,000 females. It can be found incidentally on physical examination, it is treatable and does not cause signifi cant morbidity. If it is not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and symptoms of urinary retention due to hematocolpos. KEYWORDS Abdominal pain; Haematocolpos; Hymenotomy; Imperforate hymen Documento descarregado de http://www.elsevier.pt el 25/10/2014. Cópia para uso pessoal, está totalmente proibida a transmissão deste documento por qualquer meio ou forma.
... Em consequência da obstrução causada pela ausência de perfuração himenial, o sangue catamenial acumulase na vagina (hematocolpos) e na cavidade uterina (hematometra) 3,5,7 . Este processo patológico pode refl ectirse em efeitos mecânicos sobre a uretra, bexiga, intestino ou vasos sanguíneos pélvicos que podem resultar em retenção urinária (37-60%), obstipação (27%) e, em certos casos, edema dos membros inferiores 6,[15][16][17] . Ocasionalmente, a irritação de raízes nervosas do plexo sagrado pode originar dor lombar (38-40%) 15 . ...
... O prognóstico é excelente e, embora descrita, a recorrência é pontual. No entanto, se a obstrução vaginal é causada por um septo plano médio transversal ou atresia vaginal, o prognóstico depende da presença e gravidade de outras perturbações associadas 17,18 . De acordo com a ESHRE/ ESGE classifi cation system of female genital anomalies 19 , o hímen imperfurado é classifi cado como U0C0V3 (U0= normal uterus; C0= normal cérvix; V3= transverse vaginal septum and/or imperforate hymen). ...
Article
Full-text available
Resumo Introdução: Hímen imperfurado ocorre em aproximadamente 1 em cada 1.000 mulhe-res. Pode ser diagnosticado incidentalmente ao exame físico e é tratável, não causando habitualmente morbilidade signifi cativa. Se não for rastreado e tratado precocemente, as pacientes apresentam uma menarca associada a história de dor pélvica ou abdominal cíclica e sintomas de retenção urinária associada a hematocolpos. Caso clínico: 12 anos, sexo feminino, pré-menarca, recorreu ao serviço de urgência por dor abdominal cíclica e polaquiúria, com 6 meses de evolução. Sem antecedentes médi-cos relevantes, sem história de menstruação ou início da actividade sexual até à data. O exame do períneo revelou um hímen imperfurado e saliente ao nível do introito. Foi efectuada uma incisão em Y no hímen imperfurado e durante a himenectomia foi dre-nado 500 mL de sangue castanho (viscoso, cor de chocolate). A doente teve alta no 2º dia pós-operatório. Na consulta de follow-up (aos 52 dias), a doente relatou resolução completa dos sintomas. Conclusão: Apesar de rara, a imperfuração do hímen associada a menstruação retrógra-da, é causa de dilatação da vagina e do útero, isto é, hematocolpometra. É um diagnósti-co diferencial, facilmente confi rmado, importante a ter em consideração em meninas na pré-menarca com dor abdominal, frequentemente associado a sintomas urinários. Abstract Introduction: Imperforate hymen occurs in approximately 1 in 1,000 females. It can be found incidentally on physical examination, it is treatable and does not cause signifi cant morbidity. If it is not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and symptoms of urinary retention due to hematocolpos. KEYWORDS Abdominal pain; Haematocolpos; Hymenotomy; Imperforate hymen Documento descarregado de http://www.elsevier.pt el 25/10/2014. Cópia para uso pessoal, está totalmente proibida a transmissão deste documento por qualquer meio ou forma.
... At outpatient review six weeks following surgery, she reported a resolution of her dysmenorrhoea with the menstrual cycle experienced postoperatively. On occasion, antenatal ultrasound can detect an imperforate hymen due to the presence of hydrocolpos in the fetus in response to maternal oestrogens [11]. Imperforate hymen can also be identified on examination of the newborn, and if it is asymptomatic at this time, the recommendation is to delay surgical management until puberty, when the Oestrogenization improves elasticity and healing. ...
... Only one paper reviewed the long term outcome of late diagnoses of imperforate hymen. It reported the persistence of menstrual dysfunction even after hymenectomy, with 60% demonstrating abnormal menstruation and 40% with ongoing dysmenorrhea [11]. Furthermore, the data assessing fertility in these patients is sparse but encouraging. ...
Article
Full-text available
Objective. Imperforate hymen represents the extreme in the spectrum of hymenal embryological variations. The archetypal presentation in the adolescent patient is that of cyclical abdominopelvic pain in the presence of amenorrhoea. We reported a rare event of imperforate hymen presenting as a cause of tuboovarian abscess (TOA). Case Study. A 14-year-old girl presented to the emergency department complaining of severe left iliac fossa pain. It was her first episode of heavy bleeding per vagina, and she had a history of cyclical pelvic pain. She was clinically unwell, and an external genital examination demonstrated a partially perforated hymen. A transabdominal ultrasound showed grossly dilated serpiginous fallopian tubes. The upper part of the vagina was filled with homogeneous echogenic substance. Magnetic resonance imaging (MRI) demonstrated complex right adnexa mass with bilateral pyo-haemato-salpinges, haematometra, and haematocolpos. In theatre, the imperforate hymen was opened via cruciate incision and blood was drained from the vagina. At laparoscopy, dense purulent material was evacuated prior to an incision and drainage of the persistent right TOA. Conclusion. Ideally identification of imperforate hymen should occur during neonatal examination to prevent symptomatic presentation. Our case highlights the risks of late recognition resulting in the development of sepsis and TOA.
... 2,3 The presence of primary amenorrhea in an adolescent girl with cyclical abdominal pain, urinary retention, constipation and/or lower abdominal mass is suggestive of the condition. 4 Imperforate hymen could be confused with other obstructive malformations OHVIRA (obstructed hemivagina and ipsilateral renal agenesis) syndrome. 5,6 Hymenectomy after a cruciate, plus or X-shaped hymenotomy is the standard surgical treatment of imperforate hymen. ...
... 5,6 Hymenectomy after a cruciate, plus or X-shaped hymenotomy is the standard surgical treatment of imperforate hymen. 4,7 Late discovery of imperforate hymen may lead to pain, infection, hydronephrosis, endometriosis and infertility. 8,9 We are presenting a case of imperforate hymen managed at the Douala General Hospital, Cameroon. ...
Article
Full-text available
Imperforate hymen results from failure of the endoderm of the urogenital sinus to completely canalize and has an incidence of 0.01% to 0.05%. This sometimes presents as a pelvic mass that compresses the bladder causing acute urinary retention. A 13-year-old girl was referred to our department with a history of primary amenorrhea, cyclic lower abdominal pain, abdominal–pelvic mass, constipation and acute urinary retention. She had an ultrasonography misdiagnosis of a huge ovarian mass before referral to our unit. On examination, the vagina was bulging and compressing the rectum. Repeat abdominal ultrasonography confirmed the diagnosis of hematometrocolpos. She underwent X-shaped hymenotomy with a favorable outcome. Diagnosis of imperforate hymen requires high suspicion index. Virginity-sparing surgery constitutes a good treatment option for cultural and religious reasons.
... [11] Hymenectomy results are often good, and there is very less chance of recurrences. [12] The most common complications of needle aspiration in cases of hematocolpos or hydrocolpos are pyocolpos formation and infection therefore needle aspiration should be avoided in such cases. [8] In very rare cases, vaginal reclosure and adhesions have been reported after surgical intervention, only 6.6% of cases have been noticed so far. ...
Article
Full-text available
In postpubertal age, one of the most common genital tract malformations is imperforate hymen and the patient usually presents with abdominal pain of cyclical nature with palpable abdominal mass and increased frequency of micturition. We report an unusual case of a 15‑year‑old girl who had a history of hematocolpos for which she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract, 2 months later, she again developed similar complaints of increased frequency of micturition and some palpable masses in the lower abdomen. On further investigation, magnetic resonance imaging showed recurrent hematocolpos but with a transverse vaginal septum. For which she again underwent hymenotomy and septal excision with Z‑plasty. Imperforate hymen is a rare congenital malformation of the vagina that can be treated and diagnosed easily. An adequate early management requires proper knowledge and clinical history of pain with amenorrhea in young girls for diagnosis.
... The hymen is a membrane located in the vaginal opening at the level of the introitus and is composed of urogenital sinus epithelial connective tissue [1] [2] [3] [4] [5]. During the final weeks of the embryologic development, a canal is created between the vaginal plate and the urogenital sinus [ [12] or urinary tract anomalies [3] [9]. ...
... This may lead to mechanical effects on the urethra, bladder, intestines or pelvic blood vessels which can result in urinary retention, obstipation or edema of the legs [9,11,12]. Irritation of the sacral plexus or nerve roots can cause lower back pain [13]. Problems with intercourse are rarely mentioned, probably because most of the patients are still sexually inactive [14]. ...
... 1,12 Hematocolpos can lead to urinary retention, constipation, low back pain and rarely in lower limb edema. 2,6,13 Laboratory and imaging tests are generally not necessary for the imperforate hymen classic forms diagnosis. However, ultrasound can be a useful tool in cases of doubt. ...
Article
Full-text available
The imperforate hymen is one of the most common obstructive lesions of the female genital system, with a prevalence from 1: 1000 to 1: 10000. Anomalies of the hymen are due to incomplete degeneration of the hymen central portion. It can be diagnosed at physical examination from birth and treated surgically. The most common clinical presentation is cyclic pelvic abdominal pain, urinary retention and hematocolpos. 12-year-old girl, premenarche who appealed to the Emergency department with abdominal pain and bilateral lumbar irradiation, over 2 weeks of evolution. Physical examination showed abdominal tumefaction in the hypogastric region, painful to palpation and under tension. Gynecological examination revealed an imperforate hymen, protruding from the introitus. Rectal ultrasonography performed at the emergency room showed vaginal distension with a hypoechoic content of 16 cm, larger diameter. Surgical hymenectomy was performed as treatment. On the 58th postoperative day, the patient was asymptomatic.The authors present a clinical case of imperforate hymen diagnosed at menarche, an anomaly diagnosed increasingly early due to the earlier physical examination that involves observation of the external genitalia of the new-born and the pre-pubertal child.
... Congenital transverse vaginal septum is a rare anomaly, with an unknown prevalence ranging from 1/2,100 to 1/84,000 people. [3][4][5] It occurs in adolescents with a median age of 13.2 years (11-16 years ) [6] or 2.5-4 years after the menarche. [7] Family history has been reported as the cause in few cases. ...
Article
Full-text available
Obstructing lesions of vagina, such as transverse vaginal septum, are rare anomalies. In this paper, we report a case of posttraumatic transverse vaginal septum. The patient was a 14-year-old girl who had a transverse vaginal septum because of repaired perineal trauma happened during earthquake that hit Bam city of Iran, when she was three years old. Post-traumatic vaginal septum had resulted in development of a massive hematometra. To our knowledge, this is the first report of urinary incontinence due to massive hematometra, which resulted from a posttraumatic vaginal septum. The rareness and diversity of clinical presentations of vaginal obstructing lesions can lead to misdiagnosis. The patient might refer to different medical and surgical specialists. So, knowing the symptoms is necessary for its early diagnosis. The probability of vaginal obstructing lesions in peripubertal girls with lower urinary tract symptoms should always be considered. Keywords: Urinary incontinence; urinary retention; vaginal septum.
... [1] Even though cases of IH diagnoses in utero and newborn period were reported, most cases are diagnosed in adolescence. [2][3][4][5] This is probably due to the occurrence of symptoms related to blood and menstrual products entrapment in the vagina or uterus. [6] Most of the cases with IH are brought to the hospital or clinic with symptoms of lower abdominal pain, dysuria and rarely with acute urinary retention. ...
Article
Full-text available
Imperforate Hymen (IH) is a hereditary malformation that obstructs the female genital tract. It is found in 1 in 2000 female births. Hymenectomy or hymenotomy is the for IH treatment of choice. In some cultures and religions, preserving of the hymen is very crucial as a sign of virginity, therefore virginity-sparing surgery is recommended.
... Persistence of symptoms after surgical intervention has been reported as 40% (13). Rock et al. reported an 86% pregnancy rate within 2 years on follow up of women after surgical correction of imperforate hymen. ...
... This may lead to mechanical effects on the urethra, bladder, intestines or pelvic blood vessels which can lead to urinary retention, constipation or pedal edema [7][8][9] . Irritation of the sacral plexus or nerve roots can cause lower back ache [10] . ...
... The outcome of the surgery is excellent and recurrence is rare. 13 ...
Article
Full-text available
Imperforate hymen is a rare obstructive congenital anomaly of the female genital tract which arises as a result of complete failure of canalisation of the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. Its prevalence is 0.05%-0.1%. We are presenting a case of 14 years old girl who came with complaints of lower abdominal pain since 10 days not associated with nausea, vomiting and diarrhoea. She had not attained menarche but her secondary sexual characters were developed with breast, pubic and axillary hair in tanner stage 4. MRI revealed hematocolpos and hematometra with imperforate hymen. Hymenotomy was performed and 300-400 ml of thick tarry colour blood was drained. Her postoperative period was uneventful, and patient was discharged in satisfactory condition. On follow up after 1 month, patient resumed normal menses.
... Sepsis leading to death can occur secondary to either urinary tract infection or rupture and secondary peritonitis. 7,8 These complications can be managed by simple hymen incision and drainage of the collection. Therefore, a thorough newborn examination is essential to screen for an imperforate hymen. ...
Article
Full-text available
Imperforate hymen, though a congenital anomaly, usually presents late in puberty as lower abdominal pain, primary amenorrhea, and cyclical pain. Blood collects in vagina and uterus, proximal to imperforate hymen leading to their distention. Its presentation at infancy is a rare entity. We report such a rare case of symptomatic imperforate hymen in infancy, who presented with acute retention of urine, chills and rigor. Abdominal examination revealed an intra-abdominal mass in the lower abdomen and pelvis with the absence of vaginal opening on perineal examination. Contrast enhanced computed tomography abdomen showed large abdominopelvic cystic lesion posterior to the urinary bladder and anterior to the rectum consistent with a highly distended vagina. She was managed by the incision of the imperforate hymen and drainage of the pus. A high index of suspicion is necessary whenever a female infant presents with abdomino-pelvic mass with symptoms of fever or urinary retention.
... There can be abnormal menstruation or problems in micturition and defecation even after adequate surgical hymenectomy. [7,8] conclusIon Hematocolpometra a result of imperforate hymen is an unusual congenital anomaly which presents at prepubertal age with a history of noninitiation of menstruation and monthly abdominal pain. A thorough examination and a detailed history give a clue to the diagnosis. ...
... The mass effect can also result in other symptoms like back pain, constipation, and tenesmus. If not treated in time, patients might develop endometriosis by the retrograde blood flow through the uterus and the fallopian tube affecting fertility [9]. ...
Article
Full-text available
Imperforate hymen is an uncommon congenital anomaly of the female genital tract and can lead to the collection of blood in the vagina and the uterus. Most patients are not diagnosed until menarche when they present with symptoms such as cyclic abdominal and pelvic pain, constipation, tenesmus, back pain, and difficulties with urination in association with lack of menses. We discuss the case of an adolescent female who presented with the complaint of an increasing abdominal swelling along with the urgency and a sense of incomplete urination. She had not attained menarche. A diagnosis of hematometrocolpos was made based on computed tomography findings. Subsequent perineal examination revealed a bulging imperforate hymen. Hymenotomy was performed with complete resolution of the symptoms. This case highlights the importance of keeping a high index of suspicion for this condition in patients presenting with these symptoms and the importance of appropriate gynecologic examination.
... Whereas imperforate hymen is a problem that could be easily solved by a minor operation without sequela [9], even though rare [7], any accompanying uterine anomaly like bicornuate uterus as in this case could potentially have a long lasting impact on fertility [10]. ...
Article
Full-text available
A rare case of imperforate hymen associated with bicornuate uterus in an infant is presented as a cause of bilateral hydroureteronephrosis and pelvic mass in infancy. The importance of postoperative radiologic evaluation for diagnosis of accompanying uterine abnormalities is introduced. A 8-month-old girl with restlessness and intermittent fever was brought to the daily outpatient clinic by her parents. Ultrasound exam showed bilateral grade 4 hydroureteronephrosis and a large cystic pelvic mass. Magnetic resonance scan of the pelvis revealed marked hematocolpos. A cruciate incision was made over the hymen under general anesthesia. During a 6-month followup gradual resolution of bilateral hydroureteronephrosis was documented. Although the details of the uterine anomaly were obscured in preoperative imaging, postoperative US and MR demonstrated bicornuate uterus. Postoperative pelvic radiologic examination is highly recommended to verify the resolution of hematocolpos and to screen for any concomitant anomalies that can have long-term clinical significance.
... The blood is retained first in the vagina, then the uterus (hematometry) and possibly the tubes [18,19]. Its volume varies from patient to patient and can even reach 3 liters [20][21][22]. ...
... Retrograde menstrual fl ow can alter the fallopian tubes or lead to endometriosis lesions that can impair fertility later[23]. However, this is rare if the diagnosis is made early and fertility is usually maintained[24][25][26]. Clinical diagnosis of this malformation is usuallyeasy. ...
... There can be abnormal menstruation or problems in micturition and defecation even after adequate surgical hymenectomy. [7,8] conclusIon Hematocolpometra a result of imperforate hymen is an unusual congenital anomaly which presents at prepubertal age with a history of noninitiation of menstruation and monthly abdominal pain. A thorough examination and a detailed history give a clue to the diagnosis. ...
Article
Full-text available
Obstruction of the uterine or vaginal outlet causes hematometra or hematocolpos. The uterine or the vaginal cavity is distended with blood and its products causing abdominal pain, obstructive symptoms, and discomfort in adolescent patients. A proper diagnosis aids inadequate management through various surgical techniques and not only prevents any further complications but also preserves fertility in such individuals. In this article, we are presenting three cases of hematometra and hematocolpos, discussing their clinical presentations and imaging findings.Keywords: Abdominal pain, amenorrhea in adolescent, hematocolpos, hematometra, imperforate hymen, magnetic resonance imaging.
... The blood is retained first in the vagina, then the uterus (hematometry) and possibly the tubes [18,19]. Its volume varies from patient to patient and can even reach 3 liters [20][21][22]. ...
... It should be noted that females with hematometra and hematocolpos are prone to pelvic inflammatory disease (PID), perineal abscess and susceptible to antibiotic drug abuse as a result of stored menstrual blood and obvious hymenal tissue-barrier defect [18][19][20]. As reported by Liang et al [21] optimal caution must be exercised during hymenotomy under anesthesia to avoid injury to the urethra. A simple imperforate hymen is usually not associated with other birth defects / congenital anomalies. ...
Article
Full-text available
Background: Imperforate hymen is an uncommon obstructive congenital anomaly of the female external reproductive channel due to lack of canalization (lower) vaginal plate between the vaginal and urogenital sinus; with a prevalence rate of less < 0.1%. Hematocolpos / imperforate hymen with heamatometra often presents as a pelvic mass that compresses the urinary bladder causing acute urine retention and pain. Case presentation: A 14-year-old presented with lower abdominal pain for 5 months. Patient physical examination revealed normal secondary sexual characteristics with a thickened than normal hymen. She presented with delayed menarche; a physician earlier prescribed analgesic and anthelmintic medication for pain management. After conservative hymenotomy about 360ml of dark-tan haem (blood) was drained in few minutes. Postoperative recovery was uneventful; normal menstruation occurred after 4 weeks. Conclusion: Diagnosis through physical examination and ultrasound requires vigilance and a high degree of suspicion; virginity sparing is a viable treatment option due to social reasons and religious beliefs.
... Mais certaines complications rares peuvent être observées. Liang [11] note dans son étude des complications à type de récidive, de dyspareunies et de dysménorrhées. ...
Article
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Hydrocolpos and hematocolpos are defined as vaginal retention cervical and vaginal secretions (hydrocolpos), in newborns and infants, or menstrual blood (hematocolpos) unadolescents at puberty. The commonest etilogi is an imperforate hymen. It is a rare pathology and thus aim was be to report on the clinical, paraclinical, therapeutic and evolutionary characteristics as well as the difficulties encountered, especially in case of hydrocolpos. It was a retrospective and descriptive study carried out the pediatric surgery department of the Teaching Hospital of Treichville, over a period of 10 years, from January 2008 to December 2017. It concerned all patients diagnosed with hydro or hematocolpos. Studied variables were clinical, paraclinical, therapeutic and outcom. We recorded 11 cases including 5 cases of hydrocolpos and 6 cases of hematocolpos. Themean age was 12.4 daysfor hydrocolpos and 13.83years for hematocolpos ones. The presenting complaint was acute urine retention in 8 cases (72.72%), abdominal distention in 2 cases. Cyclic pelvic pain was found in all adolescents, with in hematocolpos, associated with an absence of menses in all cases. The diagnosis of imperforate hymen was done late in 3 patients. Ultrasound was performed in 100% of cases. Surgical treatment consisted of a hymenotomy in all patients with laparotomy and vaginal opening to the skin in 3 and 2 cases, respectively. The outcom was simple in 9 cases (81.82%). The complications recorded incloded a recurrence of hydrocolpos that required another hymenotomy and intestinal occlusion by adhesions. Imperforate hymen is a rare and benign malformation of the female genital tract. The diagnosis especially in the newborn and infant is delayed because of the ignorance of practitioners. it should be considered in case of any urinary disorder, it and confirmed by examination of the vulva. Keywords: hydrocolpos, hematocolpos, imperforate hymen, hymenotomy
... If patient or parents refuse genital exam evaluation, imaging studies can greatly help with diagnosis. According to Lui et al. [6] mean age of presentation is 12 years and 13.2 years by Liang et al. [7]. ...
Article
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Background: Imperforate hymen though most common female genital tract malformation, remains an uncommon cause of acute urinary retention and abdominal pain in children. Case Report: We present a case of 13 year old pre-menarchal female who presented with acute urinary cyclical suprapubic pain and a lump in abdomen in emergency department. Foleys catheterization was done to relief her urinary retention. On detail examination, she was diagnosed with imperforate hymen and palpable lump in abdomen. Ultrasonography showed it to be hematometrocolpos. Patient underwent hymenotomy and passive drainage of collected menstrual blood. Discussion: Imperforate hymen presents as amenorrhea, recurrent cyclical lower abdominal/pelvic pains, acute urinary retention or palpable lump due to hematometrocolpos. Conclusion: It is a diagnosis that can easily be overlooked in the fast paced setting of the Emergency Department. It must be included, particularly, in the differential diagnosis of every pre-pubertal young female with abdominal pain or acute urinary retention.
Article
Imperforate hymen occurs in approximately 1 out of every 2000 females. This entity is the most common congenital cause of genital outflow obstruction and does not usually cause symptoms until puberty.We present the case of a 13-year-old girl who attended the emergency department complaining of abdominal pain and metrorrhagia. Physical examination revealed an imperforate and bulging hymen beginning to drain dark blood. Transabdominal ultrasonography was suggestive of hematocolpos and hematometra. The patient was treated surgically and the postoperative outcome was favorable.
Article
Imperforate hymen is a relatively rare congenital anomaly. However, it is not an uncommon cause of lower abdominal pain presenting in teenage girls. Without careful history taking and thorough examination, the condition can be missed easily. We report an imperforate hymen presenting as abdominal pain in three teenage girls aged 12, 12 and 13 years, respectively, within a six-month period. The presentation was reviewed and the various types of hymenotomy were discussed.
Article
To report the clinical characteristics of 14 patients with imperforate hymen and their levels of tumor markers (CA 19-9 and CA 125). Fourteen patients with imperforate hymen who followed-up between September 2006 and September 2010 in the Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey, were evaluated retrospectively. The clinical features and the management of the patients are discussed. The mean age of the patients was 13.8 years. All patients had primary amenorrhea and pelvic pain. The most common clinical symptoms were cryptomenorrhea in 14 patients, pelvic pain in 11, palpable abdominal mass in 6, voiding difficulties in 7, and defecation problems in 2. In 6 patients with palpable pelvic mass, the mean + standard deviation values of tumor markers were as follows: CA 125, 84.0 +/- 23.7 and CA 19-9, 162 +/- 189. One week after surgery we measured CA 125 and CA 19-9 levels once again. The postoperative mean CA 125 level was 13.8 +/- 3.6, and the mean postoperative CA 19-9 level was 17.5 +/- 3.5. Preoperative levels of CA 125 and CA 19-9 were significantly higher than those of the postoperative period (p < 0.001 for both comparisons). Six patients were treated by T-shaped incision and 8 patients by a central surgical incision through the hymenal membrane. Diagnosis of imperforate hymen is very important before undergoing surgery in a different clinic. Many patients have seen several doctors before receiving a clear diagnosis and have had tumor markers evaluated because the presence of pelvic mass in patients suggests the possibility of a gynecologic malignancy. Imperforate hymen is one of the benign conditions that increase serum CA 125 and CA 19-9 levels and which is not listed in the classical medical textbooks. These markers are not needed for the diagnosis.
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Background: A genital outflow tract obstruction is an uncommon cause of primary amenorrhea. If ovula-tion occurs, menstrual bleeding is prevented. Patients typically present with abdominal/pelvic pain due to hematocolpos. Absence of significant hematocolpos could indicate a secondary source of primary amenor-rhea and be challenging to the clinical diagnosis. Case: 17 year-old patient with primary amenorrhea, ap-propriate Tanner staging secondary sex characteris-tics, and transverse vaginal septum presents with virtual absence of hematocolpos. After vaginal sep-tum resection, the patient began menstruating, al-though only evidenced by two cycles of vaginal spot-ting. Conclusion: Significant hematocolpos is an ex-pected sequella of distal outlet obstruction when col-lated with secondary sexual characteristics. Absence of such along with suboptimal return of menstruation reflects pathophysiology which may be attributed to a coexistent disorder of the hypothalamus or higher central nervous system function.
Article
A 16-year-old girl presented with primary amenorrhea and had had cyclical abdominal pain for almost a year. At examination we observed a painful mass in the lower abdomen and normal secondary sex characteristics. Perineal examination showed a bluish bulging hymen. Transabdominal ultrasonography revealed a dense mass in the pelvis measuring about 12×11 cm. 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 patient now menstruates regularly. An imperforate hymen occurs in 0.05% of women. It 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.
Article
The rare finding of both a didelphic uterus and imperforate hymen is described in this case. Imperforate hymen is an important cause of abdominal pain in female adolescents, which can usually be diagnosed by thorough clinical history and physical examination. Further investigation may be necessary to exclude other genital tract anomalies.
Chapter
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The hymen is named after the God of marriage “Hymenaios” in classical Greek mythology; the word “hymen” is usually synonymous with virgin membrane. Human female is the only primate member to possess a hymen. Variants in hymenal configuration are often seen varying from hymen semilunaris, anularis, cribriformis, septus, fimbriatus, navicularis. Estrogen withdrawal at an older age may convert some of the annular types into this crescentric-shaped configuration. Hymen imperforatus is an external congenital genital anomaly when a nonperforated membrane of the hymenal tissue covers the entrance into the vagina, the membrane composed of vaginal epithelium and epithelium of the urogenital sinus interposed by mesoderm. Imperforation of hymenal tissue may also be present in variations as microperforate, septate, stenotic, or cribriform hymen. In hydrocolpos, the newborn may present with a whitish bulging mass filling the introitus (hydrocolpos or mucocolpos); rarely, the vaginal content may be infected, and the neonate may present with a distended vagina and uterus with pure pus; especially if a fistula with the urogenital sinus is present, this is called pyocolpos; neonatal hydrometrocolpos is a hydrocolpos with extensive retained fluid resulting in gross distension of the uterus and vagina with fluid due to congenital vaginal outflow obstruction. Hematocolpos is defined as an accumulation of menstrual blood above an imperforate hymen leading subsequently to the distention of the vagina to a variable degree; usually, it is presented after the age of menarche when the young girl presents with cyclic abdominal pain. Transverse vaginal septa (TVS) may occur at any level above the hymen. It results from incomplete fusion between the vaginal components of the Mullerian ducts and the urogenital sinus. Hymenal tag is a normal redundant hymenal tissue protruding from the floor of the vagina during the first weeks after birth. It eventually disappears without treatment, but hymenal polyps are an elongated projection of hymenal tissue protruding beyond the hymenal rim or extending from the rim itself.
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We report the case of a 14-year-old girl who visited the emergency room because of suprapubic discomfort and sudden acute urinary retention. She did not have any significant medical and surgical history, and her neurological examinations were all normal. Urinary catheterization led to the passage of 500 mL urine. Abdominal ultrasonography showed a hematocolpos that was compressing the urinary bladder. Gynecologic history taking revealed that the patient has not had menarche yet. Therefore, a cruciate incision was performed and her urination became normal. As the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, the diagnosis of imperforate hymen is important. However, this condition is easily missed in the clinic because the first physician visited by the patient rarely takes a detailed gynecologic history or performs appropriate physical examinations. Although rare, imperforate hymen should be considered as a cause of acute urinary retention in the adolescence period. If an adolescent girl presents with abdominal pain and voiding dysfunction, a detailed gynecologic history and appropriate physical examinations of the genital introitus should be performed. Key words: Imperforate hymen, Hematocolpos, Urinary retention
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Imperforate hymen is a rare congenital vaginal outflow obstruction with an estimated incidence of 1 in 2000 girls. We present the case of a 13-year-old girl with acute lower abdominal pain and palpable lower abdominal mass which turned out to be an imperforate hymen with hematocolpos. Appropriate treatment is usually simple and consists in a cruciate excision of the hymenal membrane. In general, it is important to hold in mind this uncommon entity in female amenorrheic adolescents presenting with acute lower abdominal pain.
Article
Imperforate hymen is a rare congenital vaginal outflow obstruction with an estimated incidence of 1 in 2000 girls. We present the case of a 13-year-old girl with acute lower abdominal pain and palpable lower abdominal mass which turned out to be an imperforate hymen with hematocolpos. Appropriate treatment is usually simple and consists in a cruciate excision of the hymenal membrane. In general, it is important to hold in mind this uncommon entity in female amenorrheic adolescents presenting with acute lower abdominal pain.
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A case of transverse vaginal septum in the lower third of the vagina in a patient presenting at 24 years of age for evaluation of primary infertility. The patient was treated surgically. The finding of transverse vaginal septum in an asymptomatic infertility patient is highly unusual. We report the MR findings of transverse vaginal septum, and revisit the embryonic origin of vaginal malformation.
Article
Imperforate hymen is a rare occurrence in younger women resulting in hydrocolpos and hydrometrocolpos. Although variations in hymen development occur, complete blockage by the hymen of the vaginal orifice is rare, occuring in approximately 0.05 % to 0.1% of female newborns. Most commonly, imperforate hymen is not detected until puberty with girls presenting at 13 to 15 years of age, when symptoms begin to appear but menstruation appears not to have begun. The symptoms after the on set of puberty are due to accumulation of menstrual blood within the vaginal outlet tract. We present a case of hematometra due to congenital imperformed hymen in an 18-year-old girl. The syptomps, the diagnostic methods and the treatment of the malformation are reported and discussed.
Article
Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis and infertility. The accepted surgical treatment for imperforated hymen as well as some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood. Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy. Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988–2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy. Results: During the study period, 56 out of 74 598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, caesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p = 0.01) as were infertility treatments (10.7 versus 4.4% p = 0.04) and dyspareunia (42.9 versus 0.2% p < 0.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26–4.93; p = 0.001). Conclusion: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.
Article
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Hematometrocolpo é a retenção de sangue na região uterina e no canal vaginal devido ao bloqueio do corrimento ginecológico, sendo o hímen imperfurado (HI) umas de suas causas. O HI é perceptível em qualquer período de vida pelo exame físico do aparelho genital externo, sendo notado frequentemente durante a puberdade, quando surgem sintomas acarretados pela obstrução. Desta forma, o objetivo deste trabalho foi relatar o caso uma adolescente com caracteres sexuais secundários adequados para a idade, em estágios M3/P3 de Tanner, ausência de sexarca e menarca, a qual manifestou clínica de abdomen agudo secundário ao hematocolpo pela imperfuração himenial.
Chapter
In diesem Kapitel wird das breite Spektrum der Kindergynäkologie anhand von ausgewählten Blickdiagnosen und Handlungsempfehlungen anschaulich präsentiert. Dazu gehören die angeborenen Fehlbildungen Hymenalatresie und der Ekstrophie-Epispadie-Komplex. Zudem werden praktische Empfehlungen für die häufige Labiensynechie und die Differenzialdiagnosen der genitalen Blutung vorgestellt. Die Ovarialtorsion ist immer ein Notfall und bedarf einer umgehenden chirurgischen Vorstellung. Ovarialzysten können ursächlich sein, aber auch Teratome kommen infrage. Abschließend wird das zunehmend präsente Krankheitsbild der femininen Beschneidung vorgestellt.
Article
Purpose of the study: The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period. Methods: A Foley's catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley's catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days. Results: The mean age of the patients at the time of this study was 28.3 ± 2.6 years, and the mean age at diagnosis was 13.2 ± 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus. Conclusion: A circular incision with insertion of Foley's catheter prevents many social problems by preserving the hymen's architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.
Article
Hematocolpos is a term given to a blood-filled dilated vagina due to menstrual blood. When there is concurrent uterine distention, the term hematometrocolpos is used. These conditions are mostly in the setting of an anatomical obstruction, usually an imperforate hymen. Usually, clinical presentation may be characterized by primary amenhorrea, recurrent abdominal or pelvic pain, urinary retention and dys-uria or constipation. Imaging techniques such as trans-abdominal ultrasound and nuclear magnetic res-onance are respectively the exam of choice and the “gold standard” exam for diagnosing hematocolpos. The paper reports the case of a 12-year-old girl with a sacral pain present for a month, not associated with other symptoms with a diagnosis of hematocolpos that became evident to the magnetic resonance.
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The paper reports the case of a 3-month girl presenting with “bruising of unknown origin”. Clinical findings sustained the diagnosis of “maltreatment”.
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Intervista al dott. Fulvio Gabbarini.
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Acute urinary retention (AUR) is unusual in children. We report for the first time a case of recurrent urinary retention due to massive hematocolpos resulting from an imperforate hymen in a 14-year-old girl. In case of AUR in adolescent girls, clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically, but follow-up is still necessary to ensure that there is no recurrence.
Article
Hydrocolpos, found chiefly in the new-born, characteristically presents as a mass in the lower abdomen associated with a cystic bulge at the introitus or an imperforate hymen. There is a membranous obstruction at the vaginal outlet in conjunction with excessive secretion of the glands of the infantile uterine cervix. A vaginogram made by injecting the cyst with radiopaque material helps to confirm the diagnosis. The best treatment is simple incision of the occluding vaginal diaphragm. In 6 of the 40 cases described in the literature since 1940, hysterocolpectomy was done, and the diagnosis was made only after examination of the removed surgical specimen. In 3 of the 4 cases reported by the author the condition occurred in newborn babies; in the fourth it became manifest at the age of 2 months.
Article
• Hydrohematometrocolpos anomalies denote the different types of accumulation of fluid and menstrual products in the vagina and the uterus. They are rare conditions due to an intact hymen, vaginal membrane, or vaginal atresla. They may present at different times during development. The method of presentation is variable, and the presence of other genitourinary abnormalities and anorectal anomalies makes prompt diagnosis and treatment necessary. Review of our experiences with these conditions for the last ten years reveals a total of ten cases. This study reports three cases in detail and describes the others in tabular form. (AJDC 1987;141:632-634)
Article
Although numerous etiologies for endometriosis have been proposed, it is clear that retrograde menstruation and cell-mediated lymphocytotoxicity each play a significant role in the disease's development. A comprehensive theory of pathogenesis of endometriosis holds that development of the disorder depends upon amount of retrograde menstruation and the ability of the immune response to remove the debris. To test this theory, 64 women with mullerian anomalies and intra-abdominal surgery were evaluated for the presence or absence of endometriosis, patency of tubes, hematocolpos or hematometra, and outflow obstruction. Results demonstrated that endometriosis was present in ten of 13 women with functioning endometrium, patent tubes, and outflow obstruction, whereas it could be identified in only 16 of 43 women with no obstruction (77 versus 37%, P less than .01). Similarly, eight of nine women with hematocolpos or hematometra had endometriosis, while only 18 of 47 with functioning endometrium but no hematometra/hematocolpos had it (89 versus 38%, P less than .01). None of the eight women without endometrium had endometriosis. These data support the concept that an increase in retrograde menstruation will increase the likelihood of endometriosis.
Article
Presented are two cases of imperforate hymen with hematocolpos seen in a pediatric emergency department (ED) during a seven-month period. The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. The diagnosis was not made on the initial presentation. The patient was seen a second time, and final diagnosis was not made until a third visit to the pediatric outpatient clinic. The second case presented with syncope and bilateral lower abdominal pain. Ultrasound and subsequent surgery confirmed the physical findings in the ED of imperforate hymen and hematocolpos. Both patients underwent hymenectomy, and they have experienced no further symptoms.
Article
Screening for sexual problems should be part of the medical assessment, but there is controversy on the best method to use. This study compared the yield of a simple questionnaire with that of a more detailed interview. Ninety-eight sexually active women (out of a total of 110) admitted on an elective basis to general gynecology wards were studied. Forty-six patients presented with a sexual complaint and 33 (33%) of these requested medical attention for the problem. In all cases, the simple questionnaire was as effective as the detailed inquiry in detecting a sexual problem. It is concluded that a simple questionnaire can be used effectively by all physicians as a screening test for sexual dysfunction with regard to heterosexual coital activity. Further research is required to confirm this hypothesis in other conditions of medical practice.
Article
The presenting features and associated abnormalities of imperforate hymen and vaginal atresia were studied in 24 girls under the age of 16 years. Hydrocolpos or hydrometrocolpos occurred in 8 infants, 13 older girls developed haematocolpos, but 3 of the girls had no distension of the genital tract. Seven of the older girls were diagnosed as having appendicitis. Anorectal anomalies were present in 9 of the children. Intravenous pyelography was performed on 16 girls and was normal in only one. Urinary tract investigations are indicated in all girls with vaginal outlet obstruction, and the vaginal orifice should be inspected in all girls with anorectal abnormalities.
Article
Of 254 patients with vaginal malformations, 167 had total vaginal agenesis and 87 had lesser defects. Incidence, embryogenesis, etiology, and associated anomalies are described. Improvements in surgical management have diminished complications and improved results. Preoperative investigation and preparation of the patient and prolonged postoperative supervision and support are critical.
Article
Pregnancy success was evaluated in 48 women following surgical correction of a vaginal obstruction due to imperforate hymen (N = 22) or to a complete transverse vaginal septum (N = 26). Pregnancy success was more likely to occur following surgical correction of imperforate hymen (P less than .05). Patients with a complete transverse septum in the middle or upper vagina were less likely to conceive than were patients with a septum in the lower vagina. Prompt diagnosis and surgical correction to drain accumulated blood may preserve preserve fertility possibly through the prevention of endometriosis.
Article
Imperforate hymen is a rare diagnosis to make in the emergency department and important to treat immediately. Hydronephrosis is a known but rare complication of an imperforate hymen. We present the case of a premenstrual adolescent with an undiagnosed imperforate hymen complaining of increasing abdominal pain. The article discusses the history, physical examination, evaluation, differential diagnosis, ultrasound findings, complications, and prompt surgical treatment necessary.
Article
Congenital imperforate hymen is an external urogenital anomaly that has a small differential diagnosis. With careful antenatal sonographic evaluation of the female perineum, identification of a thin protruding membrane consistent with imperforate hymen can be made. We report a case in which an imperforate hymen was diagnosed in a fetus at 25 weeks' gestation. It appeared as a thin membrane that distended the vagina and spread the labia majora because of retained secretions. An associated renal abnormality was present, representing either a right multicystic dysplastic kidney or cystic dysplasia. Imperforate hymen and hydrocolpos can be diagnosed as early as the second trimester. Because of the additional renal anomaly in this case, it is suggested that the presence of prenatally diagnosed imperforate hymen warrants a careful survey of the remaining fetal anatomy to rule out associated abnormalities. The possibility of a familial occurrence should be considered, and the appropriate history should be obtained.
Article
The imperforate hymen is a rare gynecologic abnormality that may not be detected until the onset of menses, when hematocolpos causes symptoms due to an expanding pelvic mass. A 19-year-old woman had primary amenorrhea, originally misdiagnosed as müllerian agenesis. Because of a combination of late onset of menses, vaginal dilation, and sexual intercourse, her hematocolpos remained relatively asymptomatic. Proper diagnosis of the imperforate hymen could have been made earlier by contrasting the ultrasound findings with the absence of associated genitourinary and skeletal anomalies. Magnetic resonance imaging can detect a uterus not previously seen on ultrasound. An early imaging study may further prevent the misdiagnosis of congenital absence of the uterus.
Article
Acute urinary retention in two adolescent girls with hematometrocolpos caused by imperforate hymen are reported. The accumulation of the menstrual blood in the vagina and uterus may form a mechanical effect on the urethra and bladder and lead to the obstructive urinary symptoms. Hymenotomy created individually by CO2 laser and cruciate incision was performed. The two patients were discharged on the same day after operation and made an uneventful recovery.
Article
Acute urinary retention is a symptom that often accompanies hematocolpometra. The imperforate hymen is a rare gynecologic abnormality that can be easily diagnosed on initial presentation. We report on a 14-year-old white girl with hematocolpometra and imperforate hymen. The symptoms, operative findings and postoperative involution of internal genitalia are described.
Article
A 15 year old girl presented to the accident and emergency (A&E) department with a 24 hour history of lower abdominal pain, and was found to have acute urinary retention. She was discovered to have an imperforate hymen with associated haematocolpos and haematometrium. This is rare and is hence a very unusual presentation to the A&E department. Patients presenting with retention of urine should be carefully assessed for the cause.
Article
1. 1. Congenital hydrocolpos is caused by a combination of vaginal obstruction and fetal cervical gland secretion caused by stimulus of the maternal hormones. 2. 2. The vaginal obstruction may be caused by atresia, imperforate hymen, or possibly by a congenital fold of tissue which causes a valvelike obstruction in a partially stenotic vagina. 3. 3. The most important factor in treatment of this anomaly is the establishment of a correct preoperative diagnosis. 4. 4. When the correct diagnosis is made, most of these patients will be cured by a relatively simple transperineal drainage procedure. 5. 5. Long-term follow-up is essential since the distended, hypertrophic vagina and the associated hydronephrosis tend to develop intercurrent infection during their slow return to normal.
Endometriosis. In: Novak's gy-necology
  • D Hooghe
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D'Hooghe TM, Hill JA (1996) Endometriosis. In: Novak's gy-necology, 12th edn. Williams and Wilkins, Hong Kong, pp 887–905