From the Guidelines
An imperforate hymen typically causes symptoms when a girl reaches puberty and begins menstruation, primarily presenting with cyclical lower abdominal or pelvic pain and absent menstrual bleeding. The symptoms of an imperforate hymen can be identified through a thorough examination and patient history, as outlined in the American Academy of Pediatrics clinical report 1. Key symptoms include:
- Cyclical lower abdominal or pelvic pain that occurs monthly but without visible menstrual bleeding
- A bulging hymen that may appear bluish or purplish in color due to trapped blood
- Urinary retention or difficulty urinating
- Back pain
- Constipation due to pressure on surrounding organs
- Abdominal distension
- Nausea or vomiting
It is crucial to refer a pubertal female with an imperforate hymen promptly to a gynecologist to prevent accumulation of blood in the vagina and upper genital tract, as recommended by the American Academy of Pediatrics 1. A saline-soaked cotton swab can be gently inserted to demonstrate patency of the vagina if there are any questions about it. The presence of any blood coming from the vagina, vaginal discharge, and signs of trauma or infection should also be noted during the examination 1. Treatment typically involves a minor surgical procedure to create an opening, allowing the trapped blood to drain and preventing future accumulation.
From the Research
Symptoms of Imperforate Hymen
The symptoms of an imperforate hymen can vary, but common presentations include:
- Cyclic lower abdominal pain 2, 3, 4
- Amenorrhea or primary amenorrhea 2, 3, 4
- Urine retention 2
- Chronic lower back pain 5
- Abdominal mass or pelvic mass 3, 6
- Hematometrocolpos secondary to an imperforate hymen 5
- Leaking hematosalpinx into the peritoneum, mimicking acute appendicitis 6
Diagnostic Challenges
Imperforate hymen can pose diagnostic challenges due to its low incidence and often atypical presentation 3. Delayed diagnosis can lead to potentially irreversible and life-changing sequelae, including infertility, endometriosis, and renal failure 3.
Importance of Early Identification
Early identification of imperforate hymen reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions 3, 6. A meticulous clinical examination and appropriate imaging techniques, such as ultrasound, can aid in diagnosis 2, 6.