Imperforate Hymen: A Comprehensive Systematic Review

Abstract

Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. 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. In this study, a literature search of PubMed databases was performed for sources published up to 3 July 2018 for English-language studies with the term “imperforate hymen”. The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. 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.

Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation

“…1 The diagnosis is usually become delay due to late presenting symptoms like delayed menarche, pressure symptoms with pain and mass, and bulging hymenal membrane. 2 The timing of surgery is controversial . Some authorities believe that hymenotomy is simple and can be done even in newborns 7 .…”

“…It is treatable and does not cause significant morbidity. 2 The most common age of presentation is peri-pubertal age or incidentally during the newborn period and childhood. 3 Imperforate hymen usually presents with cyclical abdominal pain and delayed menstruation due to hematocolpus.…”

Teenage Girl With a Vaginal Mass

“…1 Its incidence rate is 0.01% to 0.1%. 1,2 This congenital obstructive vaginal abnormality occurs as a result of incomplete degeneration of the central portion of the hymen. The catamenial blood accumulation manifests clinically with symptoms of amenorrhea, pelvic pain, hematocolpos, and urinary retention.…”

“…The catamenial blood accumulation manifests clinically with symptoms of amenorrhea, pelvic pain, hematocolpos, and urinary retention. 2,3 This condition can be diagnosed on the basis of careful history taking and physical examination, with ultrasonographic confirmation. Early detection and surgical treatment can prevent ascending genitourinary infection, endometriosis, and infertility.…”

“…Early detection and surgical treatment can prevent ascending genitourinary infection, endometriosis, and infertility. 2,3 The patient underwent hymenotomy, and 400 mL of coagulated blood was drained from the vagina and the uterus. She was discharged a day after the procedure, without complications.…”