Diagnosis and Management of Hymenal Variants: ACOG Committee Opinion, Number 780.

At puberty, a patient with an imperforate hymen typically presents with a vaginal bulge of thin hymenal tissue with a dark or bluish hue caused by the hematocolpos behind it. Other findings that may be present include an abdominal mass, urinary retention, dysuria, constipation, and dyschezia. On evaluation, the goal is to differentiate an imperforate hymen from other obstructing anatomic etiologies, such as labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Surgical intervention is necessary only in symptomatic prepubertal patients. After confirmation of the diagnosis, surgical intervention usually is deferred until pubertal estrogenization has occurred because the imperforate hymen may open spontaneously at puberty. It is important to complete an abdominal and a perineal examination. If the physical examination reveals a bulging hymen and ultrasonography reveals hematocolpos, further imaging is not required. However, if the diagnosis is not certain or there is a concern for a distal vaginal atresia, cervical atresia, an obstructed uterine horn, or transverse or longitudinal vaginal septum, magnetic resonance imaging is recommended. The ideal time for surgical intervention on hymenal tissue is before the onset of pain and after onset of pubertal development, when the vaginal tissue is estrogenized. Surgical management of clinically significant hymenal variations involves excision of the hymenal tissue and rarely is associated with long-term sequelae. If there is concern that the patient has a distal vaginal atresia or a transverse vaginal septum, the patient should be referred to a center with expertise in the management of these conditions.

Imperforate Hymen Causing Hematocolpos and Urinary Retention.

BACKGROUND: Acute urinary retention is rare in the pediatric population and is typically caused by an obstructing entity. It may result from hematocolpos caused by imperforate hymen. Imperforate hymen is rare, with an associated incidence of 1 in 2000 people. Nonetheless, in a pediatric age female who presents with urinary retention and who has a history of primary amenorrhea or a history of cyclical pelvic pain an examination of the external genitalia should be performed to rule out this condition. CASE REPORT: A 12-year-old girl presented to the emergency department with urinary retention and was discharged with a diagnosis of urinary tract infection. She returned the following day to the emergency department with worsening abdominal pain. A computed tomography scan revealed a fluid-filled vagina measuring 12.5 cm. Her bladder measured 15.4 cm. The patient was taken to the operating room for further evaluation by the consulting gynecologist. At the time of surgery, 1000 mL of urine were evacuated after catheterization. Three hundred milliliters of chocolate-colored fluid, consistent with menstrual blood, were evacuated at time of hymenotomy. Hymenotomy was performed with a cruciate incision. No complications were encountered. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To date, there have been >40 reported cases of imperforate hymen causing hematocolpos and subsequent urinary retention. However, given the rarity of imperforate hymen, hematocolpos leading to acute urinary retention can still be missed. Untreated urinary retention can lead to a compromise in bladder function and subsequent kidney damage.

Hematocolpos por himen imperforado en una adolescente / Hematocolpus due to non-perforated hymen in an adolescent

Se describe el caso clínico de una adolescente de 12 años de edad, quien había estado ingresada 5 años atrás en el Servicio de Terapia Intensiva del Hospital Pediátrico Docente Sur Antonio María Béguez César de Santiago de Cuba por presentar enfermedad estafilocócica y amenorrea primaria. Esta vez acudió a consulta con dolor abdominal recurrente desde hacía 3 meses, localizado en hipogastrio, acompañado de náuseas y vómitos, que se aliviaba con los analgésicos habituales. Se le realizó la prueba de embarazo cuyo resultado fue negativo y las imágenes ecográficas sugirieron la presencia de hematocolpos. Se le realizó himenotomía y egresó de la institución 48 horas después con evolución favorable.

The case report of a 12 years-old adolescent is described who had been admitted 5 years ago in the Intensive Therapy Service of Antonio María Béguez Caesar Southern Teaching Pediatric Hospital in Santiago de Cuba staphylococcal disease and primary amenorrhoea. This time she attended the service with recurrent abdominal pain for 3 months, located in hypogastrium, accompanied by nauseas and vomits that were alleviated with the habitual analgesic ones. The pregnancy test was carried out with negative result and the echographic images suggested hematocolpus. The himenotomy was practiced and was discharged from the institution 48 hours later with favorable clinical course.

Case of early postoperative adhesion in a patient with molimina due to transverse vaginal septum concomitant with imperforate hymen.

Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation.

[Vaginismus and our experience in treating this sexual problem].

According to various statistics from 4.2 to 42% of women in reproductive age, complained of a mild or severe problems in sexual function. The study presents own data on treatment of vaginismus in 14 girls and young women aged 16 to 36 years who have turned from 2007 to 2012 to the Cabinet Children and adolescent gynaecology at the University Hospital "Maychin dom". A primary examination established a high and tenacious hymen in 7 (50%) patients. The patients demonstrated fear, but still allowed careful examination. At 3 girls (21.43%) a combined cause of complaints was found. They demonstrated fear of pain during coitus and reported bad memory of the first sexual attempts; they had high and tenacious hymen and were able to tolerate touching the vulva after much persusions. In 3 (21.43%) patients consequences of puritan education were registered. They did not allowed to touch the vulva despite the declaration that would allow such. In one patients (7.14%) a unstretchable vagina was found. She demonstrated dyspareunia (avoiding intercourse and having one failed marriage) but she tolerated penetration of her vagina of one phalanx. In all cases of vaginismus we performed educational lectures and artefitial defloration.

Himen imperforado / Imperforate hymen

El himen imperforado es una anomalía obstructiva del tracto genital inferior femenino que se da en menos del 0,1% de los recién nacidos. El hecho de no realizar una exploración ginecológica a adolescentes sintomáticas por pudor conlleva frecuentemente al retraso diagnóstico. Presentamos a una paciente adolescente sin menarquia remitida a urgencias para estudio de dolor abdominal cíclico asociado a una masa abdominal con retención de orina y estreñimiento. La simple inspección de los genitales externos nos permitió realizar el diagnóstico después de 2 años de sintomatología(AU)

Imperforate hymen is an obstructive anomaly of the female reproductive tract which occurs in less than 0.1% of newborns. Not performing an adequate gynecologic physical examination in symptomatic adolescent girls due to embarrassment can often delay its diagnosis. We present the case of an adolescent girl without menarche who was referred to our hospital for cyclic abdominal pain associated with an abdominal mass accompanied by urinary retention and constipation. Examination of her external genitalia allowed rapid diagnosis after a 2-year history of these symptoms(AU)

An evolutionary interpretation of the significance of physical pain experienced by human females: defloration and childbirth pains.

The phenomena surrounding the pains commonly related to both first coitus and delivery have been addressed rather poorly in previous work, as regards their evolutionary aspects, during the investigation of human sexuality and reproductive behavior. In particular, the function of the hymen and the significance of defloration are largely misunderstood. The present paper aims to analyse the meaning of these two female physical pains in an evolutionary context. Accordingly, childbirth and defloration pains are hypothesized to manifest an adaptation designed to increase inclusive fitness in human evolutionary history. Clearly, the significance of pain as a message is essentially emotional. Indeed, the intense sexual emotions that may precede and/or follow the pain, the breaking and bleeding of the hymen during the first complete sexual act may generate distinctive strong feelings on/from each side of the newly formed couple. As to labor pain, both the shared intimacy with the mother and the emotional background during confinement may create mutual solicitude among the protagonists (i.e. midwifes, father, mother). Such feelings or attitudes may subsequently turn out to be beneficial to all of them, and more particularly to the newborn. As a general consequence, it appears that the two physical pains under consideration may have behavioral implications, in the sense that they contribute to increasing the stability of the connection between partners and thus, indirectly, to the welfare or even the survival (especially in former times) of the newborn child.

Patología ginecológica de la recién nacida en cirugía pediátrica / Newborn gynaecology pathology in paediatric surgery

La Cirugía Pediátrica actúa en la actualidad desde la edad fetal hasta la edad de los 16 años. Abarca pues la patología ginecológica desde la etapa de recién nacida hasta la edad de la adolescencia, si bien existe una falta de especialización en la etapa de la adolescencia que se escapa a nuestra especialidad y es tratada por la especialidad de ginecología, en donde existen subespecialistas en la edad pediátrica del adolescente integrada de forma mixta en Unidades de Adolescencia y Ginecología. En este artículo nos vamos a referir a aquellas patologías en las que la experiencia en la especialidad de Cirugía Pediátrica se encuentra constatada por su ejercicio de forma continuada y rutinaria en la etapa de recién nacida

Paediatric Surgery treat children from born to sixteen years old, and because of it specialization less in adolescence, it is treat by gynaecology. This article aim is the study of surgery pathologies of newborns

The adolescent hymen.

The genital examination is not a routine part of health maintenance assessment in prepubertal and pubertal girls. However, evaluation of minors for suspected sexual abuse has been addressed extensively in the last two decades. In spite of this, normal anatomic variations and developmental changes are not fully investigated. This paper reviews current knowledge about the hymen, with a focus on puberty and adolescence. More is known about the external genitals of prepubertal children than of adolescent girls. No longitudinal studies have been performed among girls older than age 3. Tanner staging does not include detailed genital development. A variety of terms have been used to describe the configuration and/or distortion of the hymen: attenuation, clefts, tears and transections, bumps and notches. No studies have been published on the normal variations of the width of the hymenal rim, although an attenuated and/or narrow rim is categorized as consistent with penetrative sexual abuse according to an international consensus statement. Critiques of the literature on the hymen have been published by experts on forensic medicine, emphasizing the fact that the normal hymenal appearance in adolescents still is not well documented. Few studies on hymenal configuration in nonabused adolescent girls have been performed, including girls with and without experience of consensual vaginal intercourse and use of tampons. Longitudinal investigations are required for a better knowledge of female genital development during puberty, with a special focus on vulvar and hymenal anatomy.

Himen imperforado como causa de hematometrocolpos e hidronefrosis / Imperforate Hymen causing hematocolpometra and hydronephrosis

El himen imperforado es una malformación congénita poco frecuente, que generalmente se descubre al iniciarse la menarca, las menstruaciones sucesivas ocasionan hematometrocolpos, dando diversas manifestaciones clínicas. Informamos el caso clínico de una adolescente que presentó himen imperforado con salpingohematometrocolpos manifestándose con dolor abdominal crónico, estreñimiento, vómito, disuria, tenesmo vesical, retención aguda de orina, hidronefrosis y tumor pélvico-abdominal. Un diagnóstico temprano con evacuación de la sangre acumulada evitará la hematometra y el hematosalpinx reduciéndose el riesgo de endometriosis pélvica y el futuro de la fertilidad