Virginity-sparing management of hematocolpos with imperforate hymen: case report and literature review

Abstract

Imperforate hymen results from failure of the endoderm of the urogenital sinus to completely canalize and has an incidence of 0.01% to 0.05%. This sometimes presents as a pelvic mass that compresses the bladder causing acute urinary retention. A 13-year-old girl was referred to our department with a history of primary amenorrhea, cyclic lower abdominal pain, abdominal-pelvic mass, constipation and acute urinary retention. She had an ultrasonography misdiagnosis of a huge ovarian mass before referral to our unit. On examination, the vagina was bulging and compressing the rectum. Repeat abdominal ultrasonography confirmed the diagnosis of hematometrocolpos. She underwent X-shaped hymenotomy with a favorable outcome. Diagnosis of imperforate hymen requires high suspicion index. Virginity-sparing surgery constitutes a good treatment option for cultural and religious reasons.

Case Report of a 12-Year-Old Girl with Imperforate Hymen—Review of the Literature on Incision Techniques and Further Treatment of Patients

“…In our case, as it was also reported in other articles [2] [16] an X-shaped incision was chosen combined with the insertion of a Foley catheter in the urethra so as to stent it. This method protects the integrity of the urethra [2].…”

“…A cross-shaped incision of the hymen, with or without the use of a Foley catheter to stent the urethra, seems to be the incision of choice [1] [11]. Other types of incision include: a star-incision so as to protect the Bartholin's glands [9], vertical midline incision (<1 cm) [12], annular incision with [4] or without [6] [10] [13] placement of a Foley catheter in the opening of the hymen and an elliptical incision [16]. The annular incision is claimed to have the least effect on the hymen's architecture and thus appears to be the preferred choice among cultures and religions where a girl's virginity is of great importance [4] [6].…”

Retenção Urinária Como Manifestação de Hematocolpos

“…Optou-se por fazer uma incisão cruciforme, uma vez que tem a vantagem de reduzir o risco de lesão na uretra, seguida de uma excisão central circular para manter um hímen anular intacto. 6,11 A fixação da mucosa vaginal ao intróito evita a reestenose e resulta em pós-operatório sem complicações. 2,5 Contudo, neste caso, devido à espessura do hímen, optou-se por não se realizar a fixação.…”

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

“…This case proves that clinical sign of bulge imperforated hymen is an isolated genital tract anomaly that rarely associates with other female genitourinary tract anomalies or genetic disorders. 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 .…”

“…The imperforated hymen is one of the common obstructive congenital anomalies of the female genital tract with a prevalence of 0.01%-0.05%. 1 It arises as a result of failure to canalize the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. Imperforate hymen prevents the passage of blood causing accumulation of menstrual products in the vagina or uterus.…”