From the Guidelines
Imperforate hymen management requires prompt referral to a gynecologist to prevent accumulation of blood in the vagina and upper genital tract 1.
Key Considerations
- A pubertal female with an imperforate hymen should be referred promptly to a gynecologist for further evaluation and treatment 1.
- The gynecologist may perform a physical examination, including a gentle insertion of a saline-soaked cotton swab to demonstrate patency of the vagina, if there are any questions about patency 1.
- Surgical intervention, such as a hymenectomy, may be necessary to excise the imperforate hymen and create a vaginal opening.
Important Aspects of Care
- Patients with an imperforate hymen may also have other genital tract anomalies, such as a vertical or transverse vaginal septum, which would require further evaluation 1.
- The presence of any blood coming from the vagina, vaginal discharge, or other signs of trauma or infection should be noted and addressed promptly 1.
- A multidisciplinary approach, including surgical intervention and potential pre- and post-operative care, may be necessary to manage imperforate hymen effectively.
From the Research
Management of Imperforate Hymen
The management of imperforate hymen typically involves surgical intervention to relieve obstruction and reduce the risk of secondary complications such as endometriosis and renal failure.
- Surgical techniques for imperforate hymen include:
- Hymenectomy: a procedure where the hymen is completely removed 2, 3, 4
- Hymenotomy: a procedure where an incision is made in the hymen to create an opening 3, 5, 4
- Interdigitating Y-flap technique: a newer technique that may reduce the risk of postoperative complications such as stenosis and ascending infection 2
- The choice of surgical technique may depend on the individual patient's needs and preferences, as well as the surgeon's expertise and experience.
- In some cases, hymen-sparing surgery may be an option, where a simple vertical incision is made and a few oblique sutures are used to prevent refusion 4
- Prophylactic antibiotics may be used in some cases to reduce the risk of infection 3
- Vaginal molding may be considered to prevent hymen re-closure due to lack of estrogenization of genital tissue 5
Treatment Outcomes
- Most patients who undergo surgical treatment for imperforate hymen experience improvement in symptoms and quality of life 3
- Complications such as vaginal adhesion and stricture are relatively rare, occurring in around 6.6% of patients 3
- Early diagnosis and treatment are important to reduce the risk of adverse complications and avoid unnecessary interventions 3, 6