When an introitus cannot be visualized, evaluation for an imperforate hymen
or agenesis of the lower vagina is necessary (Figure 1b and 1c).
Management of imperforate hymen
with the carbon dioxide laser.
An imperforate hymen
results from failure of the caudal paramesonephric ducts to fuse with the urogenital sinus, leading to an obstruction located between the vagina and the vestibule, just cranial to the opening of the urethra [1, 2].
Of the 3 adolescent girls with primary amenorrhoea, 2 girls (66.66%) had vaginal atresia and 1 girl (33.33%) had imperforate hymen
8 adolescent girls presented with secondary amenorrhoea; 6 out of 8 girls i.e.
"Pelvic mass'' is often the working diagnosis in cases of imperforate hymen
, vaginal atresia, cervical agenesis, and uterine didelphys with obstructed hemivagina.
), generalised bleeding disorder, or if the girl is pre-puberty.
The differential diagnosis for primary amenorrhea with a present uterus includes an imperforate hymen
, which can also cause hematocolpos.
However, measures to rule out anatomical problems, such as imperforate hymen
, are important.
-- Some cases of apparent imperforate hymen
are actually mullerian agenesis, and that possibility should be in the differential diagnosis, David M.
"With the obstructions, for example, they may just think it is an imperforate hymen
and are not even aware that there is even an entity called obstructed hemivagina."
Delayed menarche may be caused by chronic illness; cryptomenorrhea (symptoms of menorrhea occur without any external bleeding, as in cases of imperforate hymen
); and polycystic ovary syndrome, among other endocrine problems.
Congenital causes of hematometra formation are imperforate hymen
and transverse vaginal septum.