eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Imperforate Hymen: Workup

Author: Judith A Lacy, MD, Clinical Educator, Department of Obstetrics and Gynecology, Division of Gynecologic Specialties, Pediatric and Adolescent Gynecology, Stanford University School of Medicine and Lucile Packard Children's Hospital
Coauthor(s): Paula J Adams Hillard, MD, Professor, Department of Obstetrics/Gynecology, Stanford University Medical Center
Contributor Information and Disclosures

Updated: Dec 12, 2007

Workup

Laboratory Studies

  • No laboratory studies are indicated for the diagnosis of imperforate hymen other than imaging studies or laboratory studies indicated as preoperative studies related to any underlying medical conditions.

Imaging Studies

  • Pelvic and abdominal ultrasonography
    • Pelvic ultrasonography is the essential initial diagnostic modality to confirm the diagnosis, and it may be performed via the transabdominal, transperineal, or transrectal route. A pelvic ultrasonogram most often demonstrates a hematocolpos, hematometra, and, possibly, hematosalpinges when the diagnosis is made after the onset of menarche.
    • A pelvic ultrasonogram may suggest that the diagnosis is not an imperforate hymen but is a more complicated müllerian abnormality of vertical or lateral fusion (eg, obstructing vaginal septa, müllerian agenesis). In this case, other imaging studies are indicated.
    • A pelvic examination under anesthesia also may be helpful in planning the repair of complex anomalies if the results from imaging studies are inconclusive.
    • Renal anomalies should be excluded when other müllerian defects of the uterus and vagina are suspected. An abdominal ultrasonogram may show duplication or absence of the collecting system.
  • Pelvic and abdominal MRI: If the diagnosis of imperforate hymen is not absolutely certain based on physical examination or pelvic ultrasonographic findings, an MRI should be obtained to clearly define the anatomy prior to any planned surgical procedure.

Other Tests

  • Pelvic examination under anesthesia
    • Prior to making a decision about appropriate surgical repair of an anomaly that may be more complex than a simple imperforate hymen, a pelvic examination under anesthesia may aid surgical planning.
    • Consultation with experienced gynecologists may be appropriate, as may be the involvement of an interdisciplinary team if the anomaly appears to be complex.

Diagnostic Procedures

  • No diagnostic procedures are indicated for a classic presentation and findings of imperforate hymen. If the diagnosis is in question (imperforate hymen vs transverse vaginal septum), additional imaging studies are indicated (see Imaging Studies). A clinician who is not experienced or absolutely confident of the diagnosis and is not experienced with the definitive surgical therapeutic procedure should refer the patient to a clinician with experience and expertise.
  • Pelvic examination under anesthesia (see Other Tests) may be helpful in clarifying complex anomalies.
  • Attempts at needle aspiration to reduce the size of or drain the obstructed fluid collection should absolutely be avoided to prevent introduction of bacteria into a previously sterile environment, which would place the individual at risk for infectious complications and its sequelae.

More on Imperforate Hymen

Overview: Imperforate Hymen
Workup: Imperforate Hymen
Treatment: Imperforate Hymen
Follow-up: Imperforate Hymen
Multimedia: Imperforate Hymen
References
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References

  1. Heger AH, Ticson L, Guerra L, et al. Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings. J Pediatr Adolesc Gynecol. Feb 2002;15(1):27-35. [Medline].

  2. Walsh B, Shih R. An unusual case of urinary retention in a competitive gymnast. J Emerg Med. Oct 2006;31(3):279-81. [Medline]. [Full Text].

  3. Dane C, Dane B, Erginbas M, Cetin A. Imperforate hymen-a rare cause of abdominal pain: two cases and review of the literature. J Pediatr Adolesc Gynecol. Aug 2007;20(4):245-7. [Medline]. [Full Text].

  4. Blask AR, Sanders RC, Rock JA. Obstructed uterovaginal anomalies: demonstration with sonography. Part II. Teenagers. Radiology. Apr 1991;179(1):84-8. [Medline].

  5. Botash AS, Jean-Louis F. Imperforate hymen: congenital or acquired from sexual abuse?. Pediatrics. 2001;108(3):E53. [Medline].

  6. Emans SJ, Laufer MR, Goldstein DP. Dysmenorrhea, pelvic pain, and the premenstrual syndrome. In: Emans SJ, Laufer MR, Goldstein DP, eds. Pediatric and Adolescent Gynecology. 5th ed. Philadelphia, Pa: Lippincott-Raven; 2004:376-84.

  7. Joki-Erkkilä MM, Heinonen PK. Presenting and long-term clinical implications and fecundity in females with obstructing vaginal malformations. J Pediatr Adolesc Gynecol. Oct 2003;16(5):307-12. [Medline].

  8. Lim YH, Ng SP, Jamil MA. Imperforate hymen: report of an unusual familial occurrence. J Obstet Gynaecol Res. 2003;19(6):399-401. [Medline].

  9. Olive DL, Henderson DY. Endometriosis and mullerian anomalies. Obstet Gynecol. Mar 1987;69(3 Pt 1):412-5. [Medline].

  10. Reinhold C, Hricak H, Forstner R, et al. Primary amenorrhea: evaluation with MR imaging. Radiology. 1997;203(2):383-390. [Medline].

  11. Rock JA, Zacur HA, Dlugi AM, et al. Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstet Gynecol. Apr 1982;59(4):448-51. [Medline].

  12. Shaw LM, Jones WA, Brereton RJ. Imperforate hymen and vaginal atresia and their associated anomalies. J R Soc Med. Jul 1983;76(7):560-6. [Medline].

  13. Stelling JR, Gray MR, Davis AJ, et al. Dominant transmission of imperforate hymen. Fertil Steril. Dec 2000;74(6):1241-4. [Medline].

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Further Reading

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Keywords

hymenal obstruction, variations in hymenal configuration, variations in hymenal anatomy, anomaly of the female reproductive tract, hematocolpos, hematometra, hematosalpinges, hymenotomy, müllerian defects

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Contributor Information and Disclosures

Author

Judith A Lacy, MD, Clinical Educator, Department of Obstetrics and Gynecology, Division of Gynecologic Specialties, Pediatric and Adolescent Gynecology, Stanford University School of Medicine and Lucile Packard Children's Hospital
Judith A Lacy, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Women's Association, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Coauthor(s)

Paula J Adams Hillard, MD, Professor, Department of Obstetrics/Gynecology, Stanford University Medical Center
Paula J Adams Hillard, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Medical Association, American Medical Women's Association, Association of Professors of Gynecology and Obstetrics, Association of Reproductive Health Professionals, North American Society for Pediatric and Adolescent Gynecology, Ohio State Medical Association, Phi Beta Kappa, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert K Zurawin, MD, Associate Professor, Director of Baylor College of Medicine Program for Minimally Invasive Gynecology, Director of Fellowship Program, Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine
Robert K Zurawin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Harris County Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Texas Medical Association
Disclosure: Johnson and Johnson Honoraria Speaking and teaching; Conceptus Honoraria Speaking and teaching; Biosphere Medical Honoraria Speaking and teaching; Eli Lilly Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

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