When to see your doctor What is an imperforate hymen Imperforate hymen is the most common type of blockage of the vagina. Imperforate hymen is something a girl is born with. No one knows why this happens. There is nothing that the mother did to cause it. The hymen is a thin membrane, a layer of connective tissue that forms a transverse septum and obstructs the vaginal opening 1. The hymen is an embryological remnant of mesodermal tissue that normally perforates during the later stages of embryo development.
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Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. The literature review identified citations and articles case reports, 12 case series containing patients who were finally included two papers were not written in English.
Among postnatal patients, the mean age of the patients was Abdominal pain Most patients diagnosed with the condition underwent surgical treatment There were no differences in outcomes between two surgical methods. In addition, Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus.
In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection. Keywords: imperforate hymen, abdominal pain, genitourinary symptoms, hymenectomy, hymenotomy, improvement, systematic review 1.
Introduction Imperforate hymen IH is an uncommon congenital anomaly of the female genital tract, in which the hymen completely obstructs the vaginal opening, with an approximate incidence of 0.
IH obstructs uterine and vaginal secretions also called hematocolpos , causing amenorrhea and cyclic pelvic pain [ 2 ]. There have been rare cases of familial IH occurrence; most cases are thought to occur sporadically and no genetic mutations have been identified [ 5 ]. IH is often diagnosed in adolescent girls after menarche, mainly presenting with amenorrhea and lower abdominal pain or urinary retention [ 6 ].
Most young girls with IH are asymptomatic and diagnosed incidentally until menarche. IH can be diagnosed by inspecting the external genitalia, which presents a bulging, bluish hymenal membrane [ 1 ], but an abdominal ultrasound may accurately show a pelvic cystic mass [ 1 ].
Although IH is a benign congenital disorder, late detection and diagnosis may result in severe morbidity and requirement of additional interventions [ 2 ]. Without proper management, IH can cause infections, subfertility, endometriosis, or hydronephrosis and renal failure in rare cases [ 8 ]. The treatment of choice is based on cruciate incision or excision of the hymen [ 1 ]. In contrast to hymenectomy with X, T, cross, or crucial incision, and resection of excess tissues, hymen-preserving surgeries, such as a simple vertical incision and annular hymenotomy, can be an option for patients desiring virginity [ 9 , 10 ].
Alternative treatments include a carbon dioxide laser or insertion of a Foley catheter [ 11 , 12 ]. Therefore, when adolescent girls present with abdominal pain or acute urinary retention, clinicians must suspect IH and conduct thorough abdominal and gynecological examinations. Although there have been many case reviews and reports, no systematic review on IH has been reported.
Therefore, we searched cases of IH and reviewed the epidemiology, symptoms, treatment options, and clinical outcomes. We also aimed to raise awareness among clinicians by discussing several cases of IH with severe complications.
Methods 2. We included studies if they met the following criteria: I published in a peer-reviewed journal with accessible full-length content in English, II included patients with IH, III presented symptoms or imaging findings, IV evaluated treatment, and V reported on relevant outcomes. Finally, eligible articles case reports, 12 case series were identified for the systematic review of IH. We reorganized the eligible articles into two groups: 1 articles with postnatal patients articles, cases, Supplementary Table S2 ; and 2 articles with prenatal diagnosis 17 articles, 17 cases, Supplementary Table S3.
Two case series are not belonged to either postnatal or prenatal groups, not containing detailed patient information Supplementary Table S4. Articles in each group were reviewed and analyzed entirely.
Details of the selection process are presented in Figure 1.
What You Should Know About an Imperforate Hymen
In some cases, a doctor may suspect an imperforate hymen following a routine newborn checkup. In this case, surgery to produce an opening to the hymen may be recommended, but some parents prefer to wait until their daughters are older. In older girls, painful symptoms often bring them to the doctor. A doctor may also spot visual cues of an imperforate hymen when doing a pelvic exam.
Imperforate Hymen: A Comprehensive Systematic Review