‘ The most frequent type of blockage of the vagina’

Imperforate Hymen

Imperforate hymen is the most frequent type of blockage of the vagina. Imperforate hymen may be due to a congenital error or lack of central degeneration during development or a result of inflammatory occlusion after perforation. It is a congenital anomaly of the external genitalia which prevents menstrual loss from escaping through the introitus. Imperforate hymen may present at two ages of development.

It may present in early childhood when the infant present with bulging hymen behind which is a mucocele. It may also present in later life.

The usual presentation at puberty is intermittent abdominal pain which is usually cyclical. The pain is due to dysmenorrhea associated with the accumulation of menstrual blood within the vagina, a condition known as haematocolpos. The uterus been muscular organ does not usually get involved but when it does, it is known as haematometra. As the mass enlarges, there may be associated difficulty with micturition and defecation. Typical examination findings are that of a lower abdominal swelling, imperforate hymen on vaginal examination and a large bulging mass into the vagina is felt on rectal examination.

Hymenal abnormalities typically are isolated occurrences without other associated reproductive tract or urinary tract abnormalities. The differential diagnosis of haematocolpos include transverse vaginal septum and vaginal atresia. Correct diagnosis of this condition is based on a good history and physical examination and may be confirmed by ultrasonography.

Treatment is by cruciate incision to release the build-up menstrum and thereby establishing patency of the outflow tract. This is performed with care to prevent injury to the urinary tract and rectum. Broad spectrum antibiotic is administered to prevent infection. With successful treatment of the haematocolpos and patent genital tract, patients with imperforate hymen can look forward to a normal sexual and reproductive life.