UMEM Educational Pearls

Title: Imperforate hymen

Category: Pediatrics

Keywords: Female GU, abdominal pain, missed period (PubMed Search)

Posted: 8/21/2020 by Jenny Guyther, MD
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Definition: Congenital anomaly where the hymen is completely obstructing the vaginal opening

Demographic: Incidence 0.05-0.1% of females

History:  Most are asymptomatic and diagnosed on physical exam or incidentally when there is lack of menarche. Symptoms in adolescents can include: Abdominal pain (50%), urinary retention (20%), abnormal menstruation (14%), dysuria (10%), frequency, renal failure, UTI and back pain.

Physical exam: bulging, blueish hymenal membrane

Complications: Late detection can lead to infections, fertility problems, endometriosis, hydronephrosis, and rarely renal failure

ED treatment: If abdominal pain is significant or there is urinary obstruction, a urinary foley can be placed.  GYN should be consulted.

Definitive treatment: Hymenectomy, hymenotomy, carbon dioxide laser treatments or foley insertion through the hymen (done by a specialist).

References

Lee K, Hong J, Jung H et al.  Imperforate Hymen: A Comprehensive Systematic Review.  J Clin Med 2019; 8(56): 1-14.