Imperforate hymen
Updates to Article Attributes
Imperforate hymen is a congenital condition in which the hymen lacks a normal opening.
Epidemiology
It happens in 0.1% of the female population, usually an isolated finding.
Clinical presentation
Primary amenorrheaamenorrhoea with cyclic lower abdominal pain during menarche age. An imperforate hymen can be diagnosed at physical examination upon identification of a bulging, bluish membrane that allows positive transillumination at the introitus; consequently, imaging is rarely indicated.
Pathology
Failure of the recanalisation process of the distal end of the vagina. The hymen indicates the junction between the urogenital sinus and sinovaginal bulb. Imperforate hymen occurs due to a failure of recanalisation of this membranous vestige.
Radiographic features
Ultrasound
The usual initial imaging modality of diagnosis, it shows a distended fluid-filled vagina (haematocolpos) and uterus (haematometra) with internal echoes representing haemorrhage of various ages.
MRI
Signal changes follow subacute bleeding episodes and the blood products in haematometrocolpos:
- T1: hyperintense endometrial fluid extending down to the level of the hymen
- T2: hypointense endometrial fluid extending down to the level of the hymen
Treatment and prognosis
The standard treatment is surgical. Simple incision should be avoided due to increased risk of ascending infection and sepsis 3.
-<p><strong>Imperforate hymen</strong> is a congenital condition in which the <a href="/articles/hymen">hymen</a> lacks a normal opening.</p><h4>Epidemiology</h4><p>It happens in 0.1% of the female population, usually an isolated finding. </p><h4>Clinical presentation</h4><p><a href="/articles/primary-amenorrhea">Primary amenorrhea</a> with cyclic lower abdominal pain during menarche age. An imperforate hymen can be diagnosed at physical examination upon identification of a bulging, bluish membrane that allows positive transillumination at the introitus; consequently, imaging is rarely indicated. </p><h4>Pathology</h4><p>Failure of the recanalisation process of the distal end of the vagina. The hymen indicates the junction between the urogenital sinus and sinovaginal bulb. Imperforate hymen occurs due to a failure of recanalisation of this membranous vestige.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The usual initial imaging modality of diagnosis, it shows a distended fluid-filled vagina (<a href="/articles/haematocolpos">haematocolpos</a>) and uterus (<a href="/articles/haematometrium">haematometra</a>) with internal echoes representing haemorrhage of various ages.</p><h5>MRI</h5><p>Signal changes follow subacute bleeding episodes and the blood products in <a href="/articles/haematometrocolpos">haematometrocolpos</a>:</p><ul>-<li>-<strong>T1</strong>: hyperintense endometrial fluid extending down to the level of the hymen</li>-<li>-<strong>T2</strong>: hypointense endometrial fluid extending down to the level of the hymen</li>- +<p><strong>Imperforate hymen</strong> is a congenital condition in which the <a href="/articles/hymen">hymen</a> lacks a normal opening.</p><h4>Epidemiology</h4><p>It happens in 0.1% of the female population, usually an isolated finding. </p><h4>Clinical presentation</h4><p><a href="/articles/primary-amenorrhea">Primary amenorrhoea</a> with cyclic lower abdominal pain during menarche age. An imperforate hymen can be diagnosed at physical examination upon identification of a bulging, bluish membrane that allows positive transillumination at the introitus; consequently, imaging is rarely indicated. </p><h4>Pathology</h4><p>Failure of the recanalisation process of the distal end of the vagina. The hymen indicates the junction between the urogenital sinus and sinovaginal bulb. Imperforate hymen occurs due to a failure of recanalisation of this membranous vestige.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The usual initial imaging modality of diagnosis, it shows a distended fluid-filled vagina (<a href="/articles/haematocolpos">haematocolpos</a>) and uterus (<a href="/articles/haematometrium">haematometra</a>) with internal echoes representing haemorrhage of various ages.</p><h5>MRI</h5><p>Signal changes follow subacute bleeding episodes and the blood products in <a href="/articles/haematometrocolpos">haematometrocolpos</a>:</p><ul>
- +<li>
- +<strong>T1</strong>: hyperintense endometrial fluid extending down to the level of the hymen</li>
- +<li>
- +<strong>T2</strong>: hypointense endometrial fluid extending down to the level of the hymen</li>
Image 4 MRI (T2) ( create )
Image 4 Ultrasound ( destroy )
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