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A case of hematocolpos with imperforate hymen in a 16-year-old, well-developed African girl is reported. Diagnosis was established by the presence of an abdominopelvic doughy mass, a boggy mass filling the vagina and an imperforate, bulging hymen, and cryptomenorrhea despite the presence of characteristics of pubescence.
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.
At the Sexual Dysfunction Clinic at Keesler USAF Medical Center, 17 women complaining of dyspareunia with painful hymen and demonstrable vaginismus were managed by surgical removal of hymenal remnants followed by directive sexual therapy and progressive vaginal dilatation. All patients were pain free within 8 weeks of the surgical procedures. It is believed that a combined approach is best to break the cycle of pain, fear, vaginismus, and more pain that these women have established.
BACKGROUND: 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. CASE: 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. CONCLUSION: 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.
We report on two adolescent girls with imperforate hymen that had presented clinically as urinary retention. In the second case described herein, hydrocolpos could have resulted from the imperforate hymen and might have caused the congenital hydronephrosis incorrectly diagnosed during the neonatal period and childhood as such.
About one among 2000 girls have hymen imperforatus. Some are recognized because of mucocolpos at birth, but the diagnosis is usually not detected before puberty. Menstrual blood will accumulate behind the imperforate hymen, and result in abdominal pain, distension of the lower abdomen and often in acute urinary retention. The diagnosis and treatment is easy, but many patients have seen several doctors before the diagnosis is clear.
OBJECTIVE: To study the relationship between anatomic changes in the peripubertal female and sex hormonal maturation. STUDY DESIGN: Medical records were reviewed on virginal females whose first gynecologic examination occurred between ages 9 and 20 and who were examined at least twice by the same gynecologist. Speculum sizes at each visit were surrogate measures of circumferential hymenal elasticity, the anatomic change of interest. RESULTS: Mean ages at the two visits for the 35 patients were 14.6 and 16.7 years, respectively, with substantial overlap in ages between visits. Average Tanner breast and pubic hair stages and speculum sizes were greater at the second visit (P < .001). At first visit, age, Tanner breast and pubic hair stages, and time elapsed from menarche, thelarche and pubarche correlated positively with larger speculum sizes (P < .10). Change in speculum size between visits was associated with younger age and lower Tanner pubic hair stages at first visit and with increases between visits in age, body mass index and Tanner pubic hair stages. Larger changes were associated with shorter elapsed time between the first visit and menarche, thelarche and pubarche. CONCLUSION: Circumferential hymenal elasticity increases during adolescence. This anatomic change, the surrogate measure of which is specula diameter, can be used along with Tanner staging as a measure of physiologic maturity in adolescent women.
Human papillomavirus (HPV) type 18 DNA was found in an aggressively invasive adenocarcinoma tumor from a woman who had an intact hymen and denied any prior sexual intercourse. The viral DNA was detected within the tumor tissue by polymerase chain reaction (PCR) using consensus primers for the L1 region of oncogenic high-risk genital HPVs. In order to determine mutations within the tumor suppressor gene p53, the gene exons were amplified by PCR followed by single-stranded conformation polymorphism (SSCP) analysis. The appearance of a mutation in exon 8 of the p53 gene suggested by SSCP was directly confirmed by DNA sequencing of the exon. The sequencing showed a single base deletion that may truncate the protein by introducing a early stop codon in the messenger RNA. This early truncation could be expected to affect the proper oligomerization of the p53 protein and hence its DNA-binding activity. The results show that genital oncogenic human papillomaviruses may be passed by nonsexual routes and suggest that the virus may work in concert with p53 mutations to help the infected tissue progress toward invasive cancer.
Unusual hymenal perforation created a diagnostic problem when persistence of the urogenital sinus was suspected. However, the vagina was found to communicate with the exterior through what appeared to be Skene's ducts.
Adenocarcinomas of the lower genital tract are rare diseases, and most of them arise from the Bartholin glands. Villoglandular adenocarcinoma of intestinal type is a very uncommon neoplasm of unknown origin with only few cases described on the vulva and in the vagina. It is characterized by villoglandular architecture, mucinous-type epithelium with intestinal differentiation (goblet cells), and direct apposition of the tumor with the surface epithelium. We report a case that developed on the hymen of a 64-year-old woman and discuss its possible origin as arising de novo from the squamous epithelium.
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.
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.
OBJECTIVE: Although it is detectable at all ages through inspection of the external genitalia, imperforate hymen (IH) is a diagnosis that is missed commonly. We hypothesized that children with late diagnoses (predefined as > or =8 years of age, chosen to reflect the timing of normal menarche) would be more likely to be symptomatic, undergo more diagnostic testing, and lack appropriate documentation in their medical records, compared with children with earlier diagnoses (ie, <8 years of age). METHODS: All patients with IH were identified through searches of 3 hospital databases with International Classification of Diseases, Ninth Revision, codes. The medical records of eligible subjects were reviewed by a single, blinded researcher. Comparisons were made between children diagnosed at younger versus older ages. RESULTS: A bimodal distribution of age at diagnosis was demonstrated; 43% (n = 10) of girls were diagnosed at <8 years of age, and 57% (n = 13) were diagnosed at > or =8 years of age. Among older girls, 100% were symptomatic (abdominal pain and/or urinary symptoms; duration of symptoms: 1-120 days), whereas 90% of cases in the younger group were detected incidentally. Documentation was lacking for breast development (77%), pubic hair development (69%), and menstrual history (46%) among the older girls. Older children were more likely to present symptomatically (odds ratio: 42.0; 95% confidence interval: 3.1-1965.7) and to undergo ancillary testing (odds ratio: 20.3; 95% confidence interval: 1.6-983.1). CONCLUSIONS: Two distinct populations of girls with IH exist, ie, those diagnosed without symptoms at a young age and those not diagnosed until >8 years of age. By incorporating an examination of the external genitalia into their routine practice, clinicians caring for children can prevent the significant delays in diagnosis, misdiagnosis, and morbidity associated with the latter group.
Diffuse vaginal adenosis is a rare disease presenting severe symptoms and difficult to treat. It has not previously been described in the Scandinavian literature. Three typical cases are reported, two in children of 14 years and one in a women of 20 years, who were all treated for imperforate hymen and haematocolpos. None of the patients had been subjected to oestrogen treatment in utero. The colposcopic findings are very characteristic and are described in relation to the histological examination. The pathogenesis, treatment and risk of malignant transformation are discussed.
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.
In a 14-year-old girl who suffered from anuria and abdominal pain, atresia of the hymen was diagnosed.
A clinical case of imperforate hymen is presented. The echography rule is emphasized.
Imperforate hymen is a malformation that is easy to diagnose, even in countries with limited health care coverage. Unrecognized at birth, it becomes evident at puberty because of the development of a hematocolpos, which requires surgical intervention. This situation can be avoided with a complete examination of the infant at birth. This case report describes four patients whom we saw from 1995 through 2001 at the Bangui (Central African Republic) Pediatric Center and Community Hospital.