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Hymenal atresia – a rare congenital anomaly with the risk of late diagnosis


Authors: Nikoleta Chubanovová 1 ;  Roman Chmel Jr. 1,2 ;  Kelčík R. 1;  Nováková J. 1;  Marta Nováčková 1
Authors‘ workplace: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha 1;  LF UK v Plzni 2
Published in: Ceska Gynekol 2022; 87(2): 118-123
Category: Review Article
doi: https://doi.org/10.48095/cccg2022118

Overview

Objective: Comprehensive analysis of causes, clinical signs, dia­gnostic process, differential dia­gnosis and therapy of hymenal atresia. Methods: Literature search using the Web of Science, Google Scholar and PubMed databases with keywords and analysis of articles published in high impact and reviewed journals. Results: Hymenal atresia is a congenital malformation of a woman‘s genitals, which is manifested by complete obstruction of the vaginal introitus by a closed hymen. It should be dia­gnosed in the neonatal period, but clinically it usually manifests itself only during puberty as a result of menstrual blood retention (cryptomenorrhea) with the cyclic abdominal pain at monthly intervals. The therapy is based on optimally timed surgical creation of communication in the hymen (hymenotomy, hymenectomy) enabling free evacuation of menstrual contents. The aim of this simple treatment method is immediate subjective relief from pain and a permanent solution to this congenital anomaly. Conclusion: Knowledge of all types of congenital malformations of the female genitalia is a basic condition for an early and effective dia­gnostic process in adolescent girls with abdominal pain. The girl who has not yet menstruated and has cyclic lower abdominal pain and a tumor behind the pubic symphysis should be examined by a specialist in pediatric and adolescent gynecology who will confirm hymenal atresia according to a bluish and closed hymen, and suggest prompt and effective therapy.

Keywords:

hymenal atresia – hematocolpos – hymen – hymenectomy – hymenotomy


Sources

1. Lardenoije C, Aardenburg R, Mertens H. Imperforate hymen: a cause of abdominal pain in female adolescents. BMJ Case Rep 2009; 2009: bcr08.2008.0722. doi: 10.1136/bcr.08.2008.0722.

2. Basaran M, Usal D, Aydemir C. Hymen sparing surgery for imperforate hymen: case reports and review of literature. J Pediatr Adolesc Gynecol 2009; 22 (4): e61–e64. doi: 10.1016/j.jpag.2008.03.009.

3. Veiga VF, Ribeiro B, Afonso H et al. Pelvic pain in young girls: not only dysmenorrhoea! BMJ Case Rep 2018; 2018: bcr2018226041. doi: 10.1136/bcr-2018-226041.

4. Ramareddy RS, Kumar A, Alladi A. Imperforate hymen: varied presentation, new associations, and management. J Indian Assoc Pediatr Surg 2017; 22 (4): 207–210. doi: 10.4103/0971-9261.214451.

5. Berenson AB, Chacko MR, Wiemann CM et al. Use of hymenal measurements in the dia­gnosis of previous penetration. Pediatrics 2002; 109 (2): 228–235. doi: 10.1542/peds.109.2.228.

6. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49 (6): 944–955. doi: 10.1016/s0015-0282 (16) 59942-7.

7. Shaw LM, Jones WA, Brereton RJ. Imperforate hymen and vaginal atresia and their associated anomalies. J R Soc Med 1983; 76 (7): 560–566.

8. Ruggeri G, Gargano T, Antonellini C et al. Va­ginal malformations: a proposed classification based on embryological, anatomical and clinical criteria and their surgical management (an ana­lysis of 167 cases). Pediatr Surg Int 2012; 28 (8): 797–803. doi: 10.1007/s00383-012-3121-7.

9. Bhargava P, Dighe M. Prenatal US dia­gnosis of congenital imperforate hymen. Pediatr Radiol 2009; 39 (9): 1014. doi: 10.1007/s00 247-009-1222-9.

10. Vitale V, Cigliano B, Vallone G. Imperforate hymen causing congenital hydrometrocolpos. J Ultrasound 2013; 16 (1): 37–39. doi: 10.1007/s40477-013-0009-x.

11. Shaked O, Tepper R, Klein Z et al. Hydrome­trocolpos – dia­gnostic and therapeutic dilemmas. J Pediatr Adolesc Gynecol 2008; 21 (6): 317–321. doi: 10.1016/j.jpag.2007.12.011.

12. Lee KH, Hong JS, Jung HJ et al. Imperforate hymen: a comprehensive systematic review. J Clin Med 2019; 8 (1): 56. doi: 10.3390/jcm 8010056.

13. Anselm OO, Ezegwui UH. Imperforate hymen presenting as acute urinary retention in a 14-year-old nigerian girl. J Surg Tech Case Rep 2010; 2 (2): 84–86. doi: 10.4103/2006-8808.73623.

14. Kurdoglu Z, Kurdoglu M, Kucukaydin Z. Spontaneous rupture of the imperforate hymen in an adolescent girl with hematocolpometra. ISRN Obstet Gynecol 2011; 2011: 520304. doi: 10.5402/2011/520304.

15. Strickland J. Pediatric and adolescent gynecology. In: Holcomb GW, Murphy JP (eds). Ashcraft’s pediatric surgery. 5th ed. Philadelphia: Saunders Elsevier 2010: 1019–1022.

16. Dia­gnosis and management of hymenal variants: ACOG committee opinion, Number 780. Obstet Gynecol 2019; 133 (6): e372–e376. doi: 10.1097/AOG.0000000000003283.

17. Dietrich JE, Millar DM, Quint EH. Obstructive reproductive tract anomalies. J Pediatr Adolesc Gynecol 2014; 27 (6): 396–402. doi: 10.1016/j.jpag.2014.09.001.

18. Bekaert T, Ramboer K. Hematometrocolpos due to an imperforate hymen. J Belg Soc Radiol 2018; 102 (1): 2. doi: 10.5334/jbr-btr.1413.

19. Management of acute obstructive utero­vaginal anomalies: ACOG committee opinion, Number 779. Obstet Gynecol 2019; 133 (6): e363–e371. doi: 10.1097/AOG.0000000000003 281.

20. Gágyor D, Pilka R, Ondrová D et al. Distální vaginální ageneze. Ceska Gynekol 2019; 84 (4): 283–288.

21. Hořejší J. Congenital developmental defects of derivates of müllerian ducts. Endocr Dev 2012; 22: 251–270. doi: 10.1159/000331689.

22. Rahman H, Trehan N, Singh S et al. Transverse vaginal septum with secondary inferti­lity: a rare case. J Minim Invasive Gynecol 2016; 23 (5): 673–674. doi: 10.1016/j.jmig.2016.02.011.

23. Pan HX, Luo GN, Qin CL. Laparoscopic utero­vaginal anastomosis in patients with conge­nital cervicovaginal atresia: an institutional experience with 23 patients. Eur J Obstet Gynecol Reprod Biol 2021; 260: 218–224. doi: 10.1016/ j.ejogrb.2021.03.034.

24. Zurawin RK, Dietrich JE, Heard MJ et al. Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the li­terature. J Pediatr Adolesc Gynecol 2004; 17 (2): 137–141. doi: 10.1016/j.jpag.2004.01.016.

25. Chmel R Jr, Pastor Z, Mužík M et al. Syndrom Mayer-Rokitansky-Küster-Hauser – age­neze dělohy a pochvy: aktuální znalosti a terapeutické možnosti. Ceska Gynekol 2019; 84 (5): 386–392.

26. Chmel R, Cekal M, Pastor Z et al. Assisted reproductive techniques and pregnancy results in women with Mayer-Rokitansky-Küster- -Hauser syndrome undergoing uterus transplantation: the Czech experience. J Pediatr Adolesc Gynecol 2020; 33 (4): 410–414. doi: 10.1016/j.jpag.2020.03.006.

27. Miller RJ, Breech LL. Surgical correction of va­ginal anomalies. Clin Obstet Gynecol 2008; 51 (2): 223–236. doi: 10.1097/GRF.0b013e31816d2181.

28. Joki-Erkkilä MM, Heinonen PK. Presenting and long-term clinical implications and fecundity in females with obstructing vaginal malformations. J Pediatr Adolesc Gynecol 2003; 16 (5): 307–312. doi: 10.1016/s1083-3188 (03) 00 157-8.

29. Acar A, Balci O, Karatayli R et al. The treatment of 65 women with imperforate hymen by a central incision and application of Foley catheter. BJOG 2007; 114 (11): 1376–1379. doi: 10.1111/j.1471-0528.2007.01446.x.

30. Ossman AM, El-Masry YI, El-Namoury MM et al. Spontaneous reformation of imperforate hymen after repeated hymenectomy. J Pediatr Adolesc Gynecol 2016; 29 (5): e63–e65. doi: 10.1016/j.jpag.2016.02.001.

31. Rai O, Lama S, Wazir Pandita S. The importace of a thorough clinical examination in adolescent girl presenting with acute urinary retention. BMJ Case Rep 2021; 14 (2): e240378. doi: 10.1136/bcr-2020-240378.

32. Russell VR, Ibrahim M, Phillips G et al. Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation. BMJ Case Rep 2021; 14 (3): e238547. doi: 10.1136/bcr-2020-238547.

33. Watrowski R, Jäger C, Gerber M et al. Hymenal anomalies in twins – review of the literature and case report. Eur J Pediatr 2014; 173 (11): 1407–1412. doi: 10.1007/s00431-013-2123-3.

34. Peleg D, Shinwell ES. Newborn imperforate hymen resulting in hydronephrosis. J Pediatr 2019; 207: 258. doi: 10.1016/j.jpeds.2018.12. 051.

35. Zhang M, Luo Y, Wang S et al. A case report of hydronephrosis caused by imperforate hymen in an infant. Medicine (Baltimore) 2020; 99 (45): e23072. doi: 10.1097/MD.0000000000023072.

36. Grimstad F, Strickland J, Dowlut-McElroy T. Management and prevention of postoperative complications in a neonate with a symptomatic imperforate hymen. J Pediatr Adolesc Gynecol 2019; 32 (4): 429–431. doi: 10.1016/j.jpag.2019.04.003.

37. Wong JW, Siarezi S. The dangers of hymeno­tomy for imperforate hymen: a case of iatrogenic pelvic inflammatory disease with pyosalpinx. J Pediatr Adolesc Gynecol 2019; 32 (4): 432–435. doi: 10.1016/j.jpag.2019.04. 002.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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Czech Gynaecology

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2022 Issue 2

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