Imperforate hymen presenting as chronic low back pain.
Erel Domany1, Oded Gilad, Michael Shwarz
1Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Pediatrics
|August 21, 2013
Summary
An imperforate hymen can cause chronic lower back pain in adolescents, not just abdominal issues. Surgical correction (hymenectomy) resolved the pain, suggesting a link between gynecological conditions and myofascial pain syndrome.
Area of Science:
- Gynecology
- Pain Medicine
- Adolescent Medicine
Background:
- Imperforate hymen typically presents with primary amenorrhea and cyclic abdominal pain.
- Chronic lower back pain is an unusual initial presentation for this condition.
Observation:
- A 13-year-old female presented solely with a 6-month history of chronic lower back pain.
- Physical examination revealed trigger points in the quadratus lumborum and gluteus medius muscles.
- Abdominal ultrasound identified hematometrocolpos, indicative of an imperforate hymen.
Findings:
- Surgical correction via hymenectomy led to complete resolution of the patient's back pain.
- This case suggests a potential viscerosomatic reflex pathway.
Implications:
- Considers imperforate hymen in the differential diagnosis for chronic lower back pain in adolescent females.
- Highlights the potential for gynecological conditions to manifest as musculoskeletal pain.
- Suggests myofascial pain syndrome as a possible consequence of conditions like hematometrocolpos.
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