Imperforate Hymen

An imperforate hymen is a congenital disorder I which the hymen completely occludes the vaginal opening. It is one of the most common female genital tract malformations, occurring in approximately 1 in 2000 girls³. The condition arises due to a failure of the hymen to perforate during fetal development.

The condition commonly goes unnoticed until adolescence when the girl passes the age of menarche⁵ and has not had a period (amenorrhea). Menstrual blood cannot flow freely from the vagina and backs up in the vagina (Hematocolpos) or the uterus (Hematometra).

While an imperforate hymen is not a particularly detrimental condition until secondary conditions develop, it can no less lead to emotional and mental issues for young girls. Feelings of abnormality and isolation are not uncommon in young girls as they may be embarrassed by the condition, believing they are different and “weird.”

Additionally, cases of sexual dysfunction have been reported in some women. Sexually active young girls may have difficulty achieving penetration and may present with excessive bleeding if secondary hematocolpos is present and penetration is achieved. Other cases have seen women achieve sexual penetration of the urethra, believing it to be the vagina as it was the only opening¹.

Clinical presentation

Children rarely present with an imperforate hymen as symptoms will present with the onset of puberty. The condition most commonly presents in adolescent females.

Symptoms of an imperforate hymen include amenorrhea and cyclic pelvic pain. Other symptoms may present secondary to hematocolpos and hematometra, including urinary retention, urinary frequency, constipation, back pain, nausea, and diarrhea².

Infants may present with acute urinary retention in some cases⁴.

Nursing Considerations

Nurses should be mindful of the condition whenever inserting a catheter into any female child or adolescent. As an imperforate hymen occludes the vaginal opening, it can make it difficult for the nurse to identify landmarks, particularly locating the vagina in young girls.

Externally, an imperforate hymen can be identified by a solid, pinkish-whitish bulge over the vagina.

Adolescent patients may be highly embarrassed by the condition and may feel violated by medical professionals constantly examining and discussing their genitals. For this reason, the nurse should be vigilant in supporting the patient’s emotional needs and reinforce that they are in a supportive environment.

Medical management

An imperforate hymen requires surgical intervention to perforate the hymen (hymenotomy) and draining the vaginal canal and uterus of any menstrual blood⁷.

As the condition is physical in nature, medical interventions are restricted to pain management and comfort of the patient. In some cases, the oral contraceptive pill may be used to suppress the menstrual cycle and prevent excessive menstrual blood congestion.

Pathophysiology

An imperforate hymen occurs during fetal development. It is believed to be due to the sinovaginal bulbs failing to canalise with the rest of the vagina⁵. In some cases, a Cribriform hymen may occur, which is a similar condition however the hymen contains many minute openings⁶.