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

imperforate hymen
Illustration of an imperforate hymen

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.

References

1.
Brown M. Emergency! Macmillan; 1997.
2.
J. Adams Hillard P, Hillard P Adams. The 5-Minute Obstetrics and Gynecology Consult. Lippincott Williams & Wilkins; 2008.
3.
Joshi A, Tanwar H, Wagaskar V, Kaje Y, Satalkar MR. Imperforate Hymen with Acute Urinary Retention. JCR. September 2015:382-386. doi: 10.17659/01.2015.0098
4.
Kaiser G L. Symptoms and Signs in Pediatric Surgery. Springer Science & Business Media; 2012.
5.
Lardenoije C, Aardenburg R, Mertens H. Imperforate hymen: a cause of abdominal pain in female adolescents. BMJ Case Rep. 2009;2009. [PubMed]
6.
Sharma. Concise Textbook Of Forensic Medicine & Toxicology. Elsevier India; 2007.
7.
Wilkinson. Wilkinson and Stone Atlas of Vulvar Disease. Lippincott Williams & Wilkins; 2012.
2 Comments
  1. […] is a condition in which blood is collected and retained in the uterus, commonly the result of an imperforate hymen or transverse vaginal […]

  2. […] is a gynaecological condition in which the vagina fills with menstrual blood, often secondary to an imperforate hymen1. It is often seen in patients who also suffer from Robinow syndrome, double uterus and other […]

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