Clinical features, diagnostic approach, and outcome of imperforate hymen: A single institution case series

Imperforate hymen is uncommon but it is one of the most common obstructive lesions of the female genital tract. Hydro/hematometrocolpos, derived from retained uterine and vaginal secretions and menstrual blood, causes various nonspecific symptoms. This study aimed to examine the clinical features, diagnostic approach, and outcomes of imperforate hymen at a single institution in Japan.

We retrospectively reviewed all patients with imperforate hymen at Osaka Red Cross Hospital between January 2012 and November 2023.

Six patients were identified. Five patients were diagnosed at puberty (range: 10-13 years) and one was diagnosed in the neonatal period. A neonatal case was diagnosed incidentally during the follow-up of labial fusion. In the adolescent cases, various initial symptoms (e.g., lower abdominal pain, lower back pain, urinary retention, constipation, and abdominal distension) caused the first visit to various clinical departments, such as Internal Medicine, Emergency, Pediatrics, Obstetrics and Gynecology, Orthopedics, and Surgery. In all cases, a large cystic lesion in the lower abdomen, suggestive of hematometrocolpos, was easily detected by abdominal ultrasonography, which resulted in consultation with the appropriate clinical department or performance of additional imaging tests, such as magnetic resonance imaging, in some cases. All patients were treated with a hymenectomy or hymenotomy and circumferential suture at the vaginal introitus. Postoperative stenosis or reclosure during follow-up was not observed.

Physicians should consider imperforate hymen as a possible diagnosis when examining adolescent girls who have not yet had menarche and present with refractory lower abdomen-related symptoms, and abdominal ultrasonography should be performed.