HYMEN IMPERFORATE PDF

Box , Seoul , Korea; ca. 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.

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Box , Seoul , Korea; ca. 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.

The literature review identified citations and articles case reports, 12 case series containing patients who were finally included two papers were not written in English.

Among postnatal patients, the mean age of the patients was Abdominal pain Most patients diagnosed with the condition underwent surgical treatment There were no differences in outcomes between two surgical methods. In addition, 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. Imperforate hymen IH is an uncommon congenital anomaly of the female genital tract, in which the hymen completely obstructs the vaginal opening, with an approximate incidence of 0. IH obstructs uterine and vaginal secretions also called hematocolpos , causing amenorrhea and cyclic pelvic pain [ 2 ].

There have been rare cases of familial IH occurrence; most cases are thought to occur sporadically and no genetic mutations have been identified [ 5 ]. IH is often diagnosed in adolescent girls after menarche, mainly presenting with amenorrhea and lower abdominal pain or urinary retention [ 6 ]. Most young girls with IH are asymptomatic and diagnosed incidentally until menarche.

IH can be diagnosed by inspecting the external genitalia, which presents a bulging, bluish hymenal membrane [ 1 ], but an abdominal ultrasound may accurately show a pelvic cystic mass [ 1 ]. Although IH is a benign congenital disorder, late detection and diagnosis may result in severe morbidity and requirement of additional interventions [ 2 ].

Without proper management, IH can cause infections, subfertility, endometriosis, or hydronephrosis and renal failure in rare cases [ 8 ]. The treatment of choice is based on cruciate incision or excision of the hymen [ 1 ].

In contrast to hymenectomy with X, T, cross, or crucial incision, and resection of excess tissues, hymen-preserving surgeries, such as a simple vertical incision and annular hymenotomy, can be an option for patients desiring virginity [ 9 , 10 ]. Alternative treatments include a carbon dioxide laser or insertion of a Foley catheter [ 11 , 12 ].

Therefore, when adolescent girls present with abdominal pain or acute urinary retention, clinicians must suspect IH and conduct thorough abdominal and gynecological examinations.

Although there have been many case reviews and reports, no systematic review on IH has been reported. Therefore, we searched cases of IH and reviewed the epidemiology, symptoms, treatment options, and clinical outcomes. We also aimed to raise awareness among clinicians by discussing several cases of IH with severe complications. We included studies if they met the following criteria: I published in a peer-reviewed journal with accessible full-length content in English, II included patients with IH, III presented symptoms or imaging findings, IV evaluated treatment, and V reported on relevant outcomes.

Finally, eligible articles case reports, 12 case series were identified for the systematic review of IH. We reorganized the eligible articles into two groups: 1 articles with postnatal patients articles, cases, Supplementary Table S2 ; and 2 articles with prenatal diagnosis 17 articles, 17 cases, Supplementary Table S3.

Two case series are not belonged to either postnatal or prenatal groups, not containing detailed patient information Supplementary Table S4. Articles in each group were reviewed and analyzed entirely. Details of the selection process are presented in Figure 1. We have presented the data extracted from each case report or case series in Supplementary Tables S2 and S3. Discrepancies were resolved through a discussion. A total of patients classified according to various variables have been listed in Table 1.

Variables such as age, sex, regional distribution, perinatal diagnosis, the number of doctors for diagnosis, gynecological history, and combined abnormality were studied. The mean age of the patients was Only 11 patients 4.

Only 26 patients Further, 22 patients 9. We found that five patients came to the hospital because of child abuse and they were first diagnosed during the physical examination process. One of them was sexually abused but her hymen was intact in keeping with the imperforation status.

More information about the patients is presented in Table 1. Clinical presentation of the patients with IH is shown in Table 2. In some cases, patients presented symptoms that could not easily be associated with IH, e. In some cases, patients also needed to receive additional surgeries such as vaginal septum repair, vaginoplasty, or closure of fistula. Nine patients received medical therapies. Eight of them were administered prophylactic antibiotics or treated via irrigation of the vaginal cavity with an antibiotic solution in combination with surgical therapies.

A GnRH agonist was used as a mono-therapeutic agent in an month-old Asian patient who had a history of central precocious puberty combined with vaginal atresia. Two patients were found to have observational follow-ups without interventions. Three patients received no treatment at all, and were spontaneously cured.

In those undergoing surgery, this was the only mode of treatment for In all, 8. In three patients, three kinds of therapies were used in combination 1.

Detailed information is shown in Supplementary Table S5. A GnRH agonist was used as a mono-therapeutic agent in an month-old Asian patient [ 14 ]. The patient had a history of central precocious puberty and a combined abnormality of vaginal atresia.

We could not obtain information about outcomes in Of the remaining, improvement was seen in patients Outcomes of patients have been described in Table 5. There were 15 patients with complications including vaginal adhesion. These patients had characteristics similar to those of patients with improvement.

Hymenectomy, however, showed more frequent complications than hymenotomy. They were all diagnosed at their perinatal stage and combined abnormalities were observed. We included 17 cases of newborns with a diagnosis of IH before birth Table 6. Abnormalities were diagnosed before delivery in 16 newborns. The hymen is the junction of the urogenital sinus and the sinovaginal bulbs. In embryonic stages, the hymen is perforated to make a connection between the vestibule and the vaginal canal.

If this stage fails, individuals are born with IH [ 15 , 16 ]. IH is a rare disease, with an estimated incidence rate of 0. Generally, this rare congenital anomaly is diagnosed during adolescence after menarche, presenting with abdominal pain and amenorrhea.

IH does not present itself as an abdominal mass during the perinatal period [ 15 ], and most patients with IH are asymptomatic and not diagnosed until menarche. Our study also showed that among patients included in the reviewed articles, patients were diagnosed after birth and only 17 6. Early diagnosis was missed in the remaining patients. Most patients presented with abdominal pain Delayed diagnosis is mainly associated with the asymptomatic period for a long time as it is painless during the accumulation of menstrual blood.

IH is a rare disease that may not be detected until the onset of menses, when the accumulation of menstrual blood in the uterus and vagina called hematocolpos develops symptoms resulting from its mechanical effect on the bladder and urethra [ 18 , 19 , 20 ]. If left untreated, this condition can also cause obstructive urinary symptoms, constipation, or dysuria [ 9 ].

However, IH can be detected for diagnosis in adolescent girls with abdominal pain, even before menarche. In our study, 26 This indicates that IH can be readily diagnosed by inspecting the external genitalia. If uncertainties remain, ultrasonography or magnetic resonance imaging can help ease the diagnosis [ 1 ]. However, clinicians rarely conduct appropriate physical examinations and take a detailed gynecological history because of the low incidence and nonspecific symptoms of IH.

Therefore, diagnosis of IH is missed or delayed in most cases [ 6 ]. Choice of treatment is based on hymenectomy cruciate incision or excision of hymen [ 8 ]. Hymen-preserving surgeries, such as simple vertical incision and annular hymenotomy, can be an option for patients desiring virginity [ 9 , 10 ].

Alternative treatments include carbon dioxide laser or insertion of a Foley catheter [ 10 , 12 ]. In our study, most patients received surgical therapy Surgery was the main single treatment option Three patients received three kinds of therapies 1. In cases with a conservative approach, no improvement was observed.

There was no difference of improved outcome between hymenotomy and hymenectomy, and use of prophylactic antibiotics were only identified in six patients. Besides, complications such as reclosure, vaginal adenosis, or vaginal adhesion were only noted in 6. According to our data Table 5 and previous several papers, hymenotomy can be enough for reducing these complications [ 9 , 18 , 21 ]. Thus, we propose that early diagnosis, detection of IH, and minimal preserving hymen surgery are of importance.

Although IH is a benign congenital disorder, it can cause endometriosis, subfertility, infection, or hydronephrosis and renal failure without proper management. Among patients described in case reports, there were five patients with transverse vaginal septum combined with imperforate hymen [ 22 , 23 , 24 , 25 , 26 ] and one patient with uterocervicovaginal septum [ 27 ].

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What Is an Imperforate Hymen?

An imperforate hymen is a condition in which the hymen covers the entire opening of the vagina , sealing it shut. The condition is a congenital disorder, meaning that it's something a girl is born with. No one knows why it happens. The hymen is a thin membrane that usually covers part of the opening of the vagina.

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Imperforate Hymen | Symptoms & Causes

An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when menstrual blood accumulates in the vagina and sometimes also in the uterus. It is treated by surgical incision of the hymen. Affected newborns may present with acute urinary retention. Vaginal atresia and a transverse vaginal septum require differentiation.

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