When menstrual blood is unable to flow out due to an obstruction in the tract- Ascryptomenorrhea

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The retention of menstruation occurs when a woman has normal periods but the menstrual blood is unable to flow out due to an obstruction in the tract. This condition in medical parlance is known as ascryptomenorrhea. The woman will experience monthly period pain but no flow of blood (amenorrhea). In most cases, the condition may be corrected by surgery.

Understanding Genital Tract Outflow Obstruction

The lower two thirds of the vagina develop from the urogenital sinus, while the upper vagina, cervix, uterus, fallopian tubes, and ovaries develop from the Mullerian duct system. During development of the embryo, if there is failure of the two systems to fuse vertically, it results in cervical stenosis or atresia, vaginal atresia, transverse vaginal septum, and imperforate hymen. These malformations are rare and are usually accompanied by other abnormalities, especially related to the kidneys, urinary tract, and bones.

Causes

Imperforate hymen: the hymen is a membrane situated at the entrance to the vagina, which partially occludes the vaginal opening. In some cases, the hymen completely occludes the vagina, leading to retention of menstrual blood within the vagina. This congenital abnormality may be detected in a newborn baby but is more frequently detected soon after menarche. Signs of puberty such as breast development will be present but the girl will present with a history of primary amenorrhea. There may be cyclic menstrual pain each month but no menstrual flow. A painless mass may be felt at the lower abdomen, and urinary problems such as dysuria.
Transverse vaginal septum: it is a congenital condition which may lead to retained menses.
Severe labial adhesions: usually form due to vaginal inflammation, local irritation, trauma, or childhood sexual abuse.
Vaginal atresia and agenesis: are congenital defects of the female reproductive system where the vagina partially or completely fails to form.
Proximal transverse vaginal septum: it is a congenital defect due to an embryological abnormality meaning that it arises during during fetal development.
Cervical stenosis or atresia: the narrowing of the endocervical canal due to trauma, recurrent vaginal infections (vaginitis), cervical cancer, menopause or exposure to radiation. It can also be congenital. Atresia is the absence of cervical canal.

Complications associated with Menstrual Retention

Hematocolpos – blood retained in the vagina.
Hematometra – blood retained in the uterus.
Hematosalpinx – blood retained in the fallopian tubes.
Retrograde menstruation or back flow of menstrual blood.
Endometriosis
Peritonitis
Urinary retention

Treatment

The treatment options are mostly surgical:
Stab incision in the center of the imperforate hymen to drain all the fluid
Excision of vaginal septum
Vaginal reconstruction



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