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PubMed2005

Familial occurrence of imperforate hymen.

Imperforate hymen is uncommon, occurring in 0.1 % of newborn females. Non-syndromic familial occurrence of imperforate hymen is extremely rare and has been reported only three times in the English literature. The authors describe two cases in a family across two generations, one presenting with chronic cyclical abdominal pain and the other acutely. There were no other significant reproductive or systemic abnormalities in either case. Imperforate hymen occurs mostly in a sporadic manner, although rare familial cases do occur. Both the recessive and the dominant modes of transmission have been suggested. However, no genetic markers or mutations have been proven as etiological factors. Evaluating all female relatives of the affected patients at an early age can lead to early diagnosis and treatment in an asymptomatic case.

Abdominal Pain↗
PubMed1994

Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity.

We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women.

Adolescent↗
PubMedDate not supplied

[Forensic-medical evaluation of the histologic structure of the hymen].

Variants of microscopic structure of the hymen are described and its histological classification based on the stromal component structure is offered. Hypotheses on the hymen histogenesis under different conditions are formulated. Histological analysis and histological classification of the hymen are needed for objective solution of questions arising during expert evaluation of virginity and its violation, probability or improbability of coitus without defloration.

Adolescent↗
PubMed1989

[A case of atresia hymen with urinary retention].

A case of atresia hymen with urinary retention was reported. The patient was a 13-year-old female, who visited our clinic complaining of urinary retention and constipation. Examination of the external genitalia revealed atresia hymen . Intravenous pyelography showed hydronephrosis was not present. The symptoms disappeared completely after a hymenal incision was made. This case indicates necessity for caution concerning urological symptoms in females.

Adolescent↗
PubMed1989

Management of imperforate hymen with the carbon dioxide laser.

A method for the management of imperforate hymen using carbon dioxide laser is described. In four patients presenting with imperforate hymen, the hymen was excised by CO2 laser under local anesthesia. No bleeding or wound infection occurred, and healing was prompt and satisfactory. Two out of four patients became sexually active and experienced no introital dyspareunia. We conclude that the CO2 laser may be an alternative method of treatment for this rare congenital abnormality.

Adolescent↗
PubMed1986

Laser ablation of hymenal fissures.

Four patients presented with linear ulcers (hymenal fissures) that had not responded to conventional local therapy or oral antibiotics. These sexually active women had experienced dyspareunia for 8-24 months. Cultures for venereal agents were negative. One patient had two linear ulcers, and the others had only one; all the ulcers were restricted to the hymenal ring at either the 4 or 8 o'clock position. The lesions usually were obscured when the hymen was collapsed, but they were obvious when the ring was expanded. The lesions varied in length from 0.5 to 2 cm and were very shallow, generally 1 mm deep. The ulcers were linear streaks that could be stretched to 3-4 mm wide. Laser ablation of the lesions to a depth of at least 5 mm resulted in complete resolution of the ulcer in two cases. A third patient had almost complete resolution of the lesion after two laser treatments. The fourth patient failed treatment and refused additional treatment. The underlying nature of this recalcitrant condition may be as much an enigma as that of the anal fissure. Laser treatment seems the best approach at present.

Adult↗
PubMed1996

Nevermore: the hymen and the loss of virginity.

A major milestone in a woman's life is the loss of virginity, "defloration," with the breaking of the hymen. Psychoanalysis has paid little attention to the meaning of defloration to either women or men, and virtually none to the hymen as a part of the female genitalia. The reasons for this disregard or avoidance are explored. Utilizing the few psychoanalytic writings, mythology, literature, and anthropological studies in addition to numerous clinical examples, the authors find that the unconscious meanings of the loss of virginity and the hymen emerge clearly. The common theme is that of negation, never, never again, never seen, known or named. Theoretical considerations regarding female sexuality are discussed. Technical implications for analyst-patient are presented.

Adult↗
PubMed2002

Vaginal stones with a pinpoint hymenal opening.

Primary vaginal stones are a rarely reported complication of a congenital vaginal septum, an imperforated hymen, vaginal scarring or female circumcision. We report a woman who had vaginal stones with a microperforate hymen.

Adult↗
PubMed2006

Congenital imperforate hymen and its life-threatening consequences in the neonatal period.

Imperforate hymen is most commonly an isolated finding and usually remains asymptomatic until puberty. Rarely, symptoms of imperforate hymen manifest antenatally as well as in the neonatal period, requiring surgical correction for life-threatening consequences. We report a 5-day-old infant with a large hydrometrocolpos causing severe renal compromise and abdominal ascites, successfully surgically treated in the neonatal period. Associated polydactyly suggested McKusick-Kaufman syndrome.

Adult↗
PubMed1999

Distal mucocolpos and proximal hematocolpos secondary to concurrent imperforate hymen and transverse vaginal septum.

A 12-year-old girl had cruciate incision of imperforate hymen draining a large mucocolpos. Her symptoms did not abate thereafter, and 3 months later a transverse vaginal septum was diagnosed. This was perforated and dilated under ultrasound (US) guidance draining a large hematocolpos. Results of examination under anesthesia after 3 months was satisfactory, and she has had normal periods in follow-up for 9 months. Imperforate hymen and transverse vaginal septum are known causes of mucocolpos and hematocolpos. However, the concurrent occurrence of the two abnormalities is unique.

Child, Preschool↗
PubMed1985

Imperforate hymen with hematocolpos.

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.

Abdomen↗
PubMed1997

Function of the human hymen.

The few existing hypotheses for the function of the human hymen are weak. These are briefly reviewed, and a new hypothesis is proposed. We suggest that the appearance of the juvenile human hymen is based on 'premature' birth, following which infant helplessness and a subsequent advantage for vaginal protection from external sources of infection allowed natural selection to increase its persistence well into juvenile life.

Embryonic and Fetal Development↗
PubMed1999

Imperforate hymen and ruptured hematosalpinx: a case report with a review of the literature.

The imperforate hymen is a common genital disorder, but a ruptured hematosalpinx is a fairly rare complication. This article presents one case with an imperforate hymen as well as a bilateral hematosalpinx, with unilateral ruptured hematosalpinx, giving a picture of acute abdomen. The pathology, diagnosis, treatment, and complications of these rare cases are discussed. The most important factor for the clinician to remember is the history; a simple inspection provides the diagnostic clue.

Adolescent↗
PubMed2006

Imperforate hymen complicated with pyocolpos and lobar nephronia.

An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by physicians. Lobar nephronia is a rare condition in pediatric patients that can be screened by ultrasound or computed tomography to distinguish it from a renal abscess. Treatment for lobar nephronia requires at least 14 days of antimicrobial therapy and a follow-up assessment by renal ultrasonography or dimercaptosuccinic acid scan. We report an unusual case of a 2-year-old girl with an imperforate hymen and pyocolpos. The pyocolpos compressed the left lower ureter to cause hydroureter, hydronephrosis, and nephronia. Partial hymenotomy was performed to drain the pus, and antibiotics were administered for a total of 3 weeks. There was a good outcome. This case demonstrates the need to perform a full physical examination, particularly a genital examination, in newborns. Further, if gynecologic pathology is suspected, then urologic screening studies are recommended to rule out potential associated anomalies.

Bacterial Infections↗
PubMed1981

Hymenal colposcopic examination in sexual offenses.

Colposcopy, a method of more detailed examination of the cervix, widely used in the world but the application of this technique to forensic examinations is not. This presentation offers the benefits of the use of colposcopy in the examination of sexual assaults on women in a city in Brazil by a Medical Examiner of Mogi das Cruzes in the State of São Paulo near the megapolis of the same name. In 11.80%, or 59 of the 500 cases examined by the author, this technique has been of value to determine unsuspected trauma, fringed hymen, infantile hymen, healing, and accurate information in questionable cases.

Adolescent↗
PubMed2001

Imperforate hymen: congenital or acquired from sexual abuse?

Imperforate hymen diagnosed beyond the newborn period may present a dilemma for the physician. Three case studies are reviewed in which children with the diagnoses of imperforate hymen presented for evaluation of suspected sexual abuse. Clear descriptions of genital anatomy documented at well-child visits may be critical to later interpretations of findings encountered during examinations for suspected sexual abuse.

Child↗
PubMedDate not supplied

Imperforate hymen presenting with chronic constipation and lumbago: report of one case.

A history of unexplained low back pain associated with chronic constipation in an adolescent girl of menarchal age or in an obviously postmenarchal girl should make one consider an imperforate hymen with hematocolpos. This is a particular important differential diagnosis in the work-up of an adolescent who denies ever having had menses or sexual activity. The case of a girl with an imperforate hymen presenting with a six-month history of chronic constipation and intermittent low back pain is described.

Adolescent↗