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PubMed1995

Prenatal diagnosis of congenital imperforate hymen.

BACKGROUND: 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. CASE: 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. CONCLUSION: 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.

Abnormalities, Multiple↗

PubMed2005

Spontaneous closure of the hymen during pregnancy.

Imperforate hymen is a rare disorder that is usually discovered at the onset of menstruation. In the literature, secondary closure of the hymen has been reported in 2 cases, both of which occurred subsequent to surgical procedures that involved the hymen. We report an interesting case of the spontaneous formation of an imperforate hymen during pregnancy in the absence of previous surgical procedures. Electron microscopic findings indicate hymenal tissue reorganization.

Adult↗

PubMed1998

Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature.

Since tampon availability has become ubiquitous, several authors have opined about their effect on the virginal hymen, but only one paper has scientifically addressed the subject of tampon use and clefts in the hymens of never-sexually-active adolescent girls. It naturally has become an authority used by the courts. The Emans et al. (1994) study asserts that 'for physicians testifying in court about sexual assault cases, complete clefts in adolescents cannot be attributed to prior tampon use'. On closer inspection, however, it appears that the authors have interpreted their statistical finding using a strict scientific convention (chi 2, P = 0.06 as not having statistical significance) that may mislead in a clinical or legal situation. Indeed, there is a definite possibility that tampon use compared to not having used tampons in their never-sexually-active sample was associated with an increased percentage of complete hymenal clefts (14% vs. 6%; P = 0.06). Nevertheless, clefts were found in both the sexually active and the never-active groups: 20 of their 200 never-sexually-active subjects possessed complete hymenal clefts, as did only 84 of their 100 sexually active subjects. Caution should be used by all physicians asked to testify in courts regarding possible causes of a hymenal cleft.

Adolescent↗

PubMed2002

A longitudinal study of hymenal development from 3 to 9 years of age.

PURPOSE: To document hymenal characteristics associated with normal development in girls between 3 and 9 years of age. STUDY DESIGN: The hymens of 93 children without a history of sexual abuse were examined and photographed at 3 and 5 years of age; 80 children were reexamined at 7 and 61 at 9 years of age. Hymenal features recorded included periurethral and vestibular bands, notches, transections, longitudinal intravaginal ridges, external ridges, mounds, and tags. Transhymenal diameters were measured as well as the tissue at 3, 6, and 9 o'clock positions. Changes in hymenal measurements over time were analyzed using the general estimating equation approach to repeated measures. RESULTS: Crescentic configuration became more common as the children aged (P <.01). The number of mounds and intravaginal ridges observed per child as well as the size of the transhymenal diameter increased as the sample aged. The mean amount of tissue at the 6 o'clock position significantly changed over time (P <.01). However, no significant changes were observed in the number of tags, periurethral or vestibular bands, notches, external ridges, or amount of tissue present at the 3 or 9 o'clock position. CONCLUSIONS: Few changes occur in the morphologic features of the hymen between 3 and 9 years of age.

Anthropometry↗

PubMed2003

Nurses' and midwives' views on approaches to hymen examination.

Premarital sexual relations are unacceptable for women within Turkish society's understanding and perception of honour. If there is any suspicion about virginity, young girls are forced to undergo hymen examination against their will, which frequently results in attemped suicide. The most frequent cause of suicide in young Turkish girls is hymen examination. Nurses and midwives are always involve in this procedure. The purpose of this study was to determine the views of and approaches to hymen examination by nurses and midwives. Of those who participated in this study, 80.2% had been present during a hymen examination, 40.4% indicated that virginity had a special significance in the society owing to social pressures, and 37.5% indicated that they agreed with the view that the idea of virginity puts restraints on a woman's sexual life, whereas sexual activity is a physiological need. They also indicated their opposition to hymen examination imposed without the individual's consent. They agreed that stopping this practice depended more on the social structural changes required than on legal measures.

Adolescent↗

PubMed1993

The configuration of prepubertal hymen in Turkish population and its clinical aspect.

The importance of the hymenal configuration lies in the fact that it is accepted as an important sign of the virginity in many countries and also it needs a clearcut definition for the forensic evaluation of child abuse and rape. To improve understanding of configuration of the normal hymen we studied 100 prepubertal hymens. In addition to the most commonly seen types we found the fimbriated hymen at a high rate especially in adolescents. There was another configuration the appearance of which differed on each half of the vaginal orifice; one half had a labium while the other had fimbriae. The tagged type hymen was also encountered.

Adolescent↗

PubMed1992

Concave hymenal variations in suspected child sexual abuse victims.

The purpose of this study was to describe and analyze the characteristics of, and the clinical correlates to, concave hymenal variations in a large number of suspected child sexual abuse victims. Thirteen hundred eighty-three female child and adolescent suspected sexual abuse victims were comprehensively evaluated. Photocolposcopy was used for the anogenital examinations. Concave hymenal variations were found in 174 patients (12.6%). Sixty-one (35.1%) were anterior. Of these, 40 (65.6%) were curved and smooth, and 21 (34.4%) were angular and/or irregular. One hundred (57.5%) were posterior/lateral. Of these, 33 (33%) were curved and smooth, and 67 (67%) were angular and/or irregular. Thirteen patients (7.5%) had multiple hymenal concavities. Posterior/lateral location was associated with penile-vaginal contact (P = .004), penetration (P = .006), stranger perpetrator (P = .032), hymenal rim narrowing (P less than .001), and posterior fourchette abnormality (P = .049). Angular and/or irregular features were associated with penile contact (P = .005), vaginal contact (P = .035), penile-vaginal contact specifically (P less than .001), penetration (P = .046), abnormal general physical examination (P = .018), and hymenal rim narrowing (P less than .001). Logistic regression analysis demonstrated that age-specific prevalence trends for posterior/lateral (P less than .001) and angular and/or irregular (P = .011) concavities were consistent with acquired anatomic findings. An interobserver exercise with five "blinded" raters evaluating photographs of 49 patients showed significant agreement among observers in sorting posterior/lateral and angular concavities into the diagnostic categories "suggestive of trauma" and "trauma."(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

A longitudinal study of hymenal morphology in the first 3 years of life.

OBJECTIVE: To document the effects of aging on hymenal morphology during the first 3 years of life in a cohort of nonabused girls. METHODS: Using a longitudinal design, we examined and photographed the external genitalia of 134 girls at 2 months or less and near 3 years of age; 42 of these girls were also examined near 1 year of age. The prevalence of each hymenal characteristic was calculated at each time, and differences were analyzed using the z statistic and McNemar change tests. Measurements of transhymenal diameters and the inferior rims were compared using a paired t-test. RESULTS: Hymenal configuration in 65% (87 of 134) of the subjects changed between birth and 3 years, usually from annular or fimbriated to crescentic. External ridges observed at birth usually resolved by 3 years, whereas intravaginal ridges were observed more often in 3-year-olds (P = .00). Analysis by race showed that the prevalence of both superior and lateral notches decreased in whites, whereas the prevalence of intravaginal ridges changed only in blacks (P = .00). Sixty-eight percent (15 of 22) of the tags present at birth were not observed at 3 years, while nine tags formed during this period. Changes observed between 1 and 3 years included increases in the mean horizontal (P = .00) and vertical (P = .02) transhymenal diameters and in the prevalence of the crescentic configuration (P = .04). CONCLUSIONS: Changes in hymenal morphology, which may vary by race, occur in the first 3 years of life. Alterations are more pronounced in the first year than in years 2 and 3. Physicians should understand the effects of aging on the hymen's appearance to differentiate normal development from post-traumatic or infectious changes.

Aging↗

PubMedDate not supplied

Quantitative observations of hymens in prepubescent females selected for non-abuse.

The maximum hymenal opening was evaluated quantitatively in 111 prepubescent females during routine physical examinations in a pediatric subspecialty office. For comparison, an additional 53 females referred by child protective agencies were also examined. Analysis of data show "non-abused" groups may be separated statistically from "abused" groups on the basis of area of hymenal opening. The mean area for the "non-abused, non-masturbate" group was 6.4 mm2. The upper limit of area (mean + 3 S.D.) of hymenal opening in this group was 24.1 mm2. A child having a hymenal opening diameter of 6.94 mm or less has a 99% chance of being in the "non-abused" group. The area of hymenal opening for "non-abused" groups did not change with increasing age, height or weight. A skilled pediatrician knowledgeable in the area of sexual abuse may obtain clinically relevant information with ordinary office equipment and trained personnel. Regular and repeated observations of genitalia during routine health maintenance examinations are vital baseline measurements for the physical and mental health of young female patients.

Child↗

PubMed1987

Configuration of the prepubertal hymen.

Anatomically descriptive terms are required when one is asked to comment on the hymen of the sexually abused prepubertal child. Action descriptive terms such as virginal or ruptured relay no objective information. Biologic hymenal configurations can be loosely categorized by the amount and distribution of hymenal tissue surrounding the vaginal introitus: The terms fimbriated, circumferential, and posterior rim are proposed. Descriptions of 124 prepubertal hymens are presented, with discussion focusing on biologic configurations and the impact of trauma and hormones.

Aging↗

PubMed2003

Imperforate hymen: report of an unusual familial occurrence.

Imperforate hymen is an uncommon obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. Although it is usually sporadic, four cases of familial occurrence of imperforate hymen have been reported so far. Imperforate hymen is seldom associated with complications if it is detected early. In view of the possible familial occurrence, it is important to have a high index of suspicion in women who present with imperforate hymen. A detailed menstrual history of other female family members is necessary to enable early detection.

Adolescent↗

PubMed1998

What is an 'intact' hymen? A critique of the literature.

The purpose of this study was to establish medico-legal guidelines based upon medical findings which support or refute allegations of sexual penetration, taking into account non-sexual explanations for positive physical findings. A review of the literature was undertaken to examine what has been determined about the range of usual findings which can be expected if the hymen has been penetrated. While a large body of literature is available on the topic, some findings are ambiguous, and further research is required to advance and clarify our knowledge base in these areas. In only a minority of non-acute cases can definitive statements be made as to whether an alleged molestation has occurred. A non-scarred hymen that will not admit a finger is 'intact'; a hymenal opening accommodating two fingers or a vaginal speculum, with evidence of a deficit or scarring at the lower pole, indicates past sexual or, possibly, non-sexual penetration. Other findings are not definitive and, at best, can estimate only relative probability of occurrence of penetration. Findings within the normal range should be presented as 'neither confirm nor deny abuse', not 'consistent with abuse'. Often, it is impossible to establish whether a hymen is 'intact' in regard to past sexual intercourse.

Adolescent↗

PubMed2001

A case of a bitch with imperforate hymen and hydrocolpos.

A 38-month-old female Golden retriever was presented with dysuria and dyschezia. It was difficult to visualize the vagina by vaginoscopy due to a cystic polyp on the hymen. The polyp was 2 x 3 cm in diameter, round, and pink in color. From clinical and imaging evaluations the original diagnosis was mucometra or pyometra. From endoscopic examination of the vagina an imperforate hymen was finally diagnosed. The ovaries, uterus, and half of the vagina were removed through a median abdominal incision. The vagina contained about 1.5 liters of fluid, but the uterus and ovaries appeared normal. This is a rare case with imperforate hymen and hydrocolpos with a polyp on the hymenal membrane in bitch.

Animals↗

PubMed1993

Imperforate hymen: report of an unusual familial occurrence.

BACKGROUND: Although imperforate hymen occurs in approximately 0.1% of female newborns, familial occurrence of imperforate hymen has been reported only once. CASES: We report two families in which imperforate hymen was diagnosed in three siblings of each family. One family is described in detail; the patients were two postmenarchal young women and one premenarchal girl. CONCLUSION: Imperforate hymen usually occurs sporadically but can be familial. We advise screening all female newborns and children for vaginal patency, especially family members of an affected child. Identification of other families with a similar problem might point to a specific mode of inheritance.

Adolescent↗

PubMed1996

13-year-old female with imperforate hymen.

Imperforate hymen is a rare occurrence in younger women resulting in hydrocolpos and hydrometrocolpos. Though imperforate hymen may be diagnosed in infancy, females ages 9-15 years most often present with the problem. Imperforate hymen usually is a congenital anomaly, but has been reported as a result of sexual abuse. This case report reviews the presentation and treatment of a 13-year-old female with imperforate hymen.

Abdominal Pain↗

PubMed2002

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

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.

Adolescent↗

PubMed2000

Microperforate hymen at 27 years of age diagnosed with withdrawal bleeding and hysterofiberscopy.

Microperforate hymen is a congenital obstructive vaginal membrane with a tiny opening. It is usually detected long before menarche because of recurring vulvovaginitis and urinary tract infection. We report a case of microperforate hymen in a 27-year-old women presenting oligomenorrhea, in whom the location of the tiny opening on the hymenal membrane was detected by withdrawal bleeding without anesthesia, and definitively diagnosed preoperatively by using hysterofiberscopy.

Adult↗

PubMedDate not supplied

Imperforate hymen with bilateral hydronephrosis: an unusual emergency department diagnosis.

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.

Adolescent↗