Imperforate Hymen Workup

  • Author: Paula J Adams Hillard, MD; Chief Editor: Richard Scott Lucidi, MD   more...
 
Updated: Sep 19, 2011
 

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.

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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 sonogram most often demonstrates a hematocolpos, hematometra, and, possibly, hematosalpinges when the diagnosis is made after the onset of endometrial shedding.
    • A pelvic sonogram 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, further imaging studies are indicated, typically with MRI.[18]
    • 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.[19]
  • 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.
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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.
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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.
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Contributor Information and Disclosures
Author

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, Association of Professors of Gynecology and Obstetrics, Association of Reproductive Health Professionals, North American Society for Pediatric and Adolescent Gynecology, Phi Beta Kappa, and Society for Adolescent Medicine

Disclosure: Bayer-Schering Consulting fee Consulting; Ortho Pharmaceutical Consulting fee Consulting; Teva Pharmaceuticals Grant/research funds Other

Specialty Editor Board

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; ConMed Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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

Richard Scott Lucidi, MD  Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Judith A Lacy, MD to the development and writing of this article.

References

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  10. Yildirim G, Gungorduk K, Aslan H, Sudolmus S, Ark C, Saygin S. Prenatal diagnosis of imperforate hymen with hydrometrocolpos. Arch Gynecol Obstet. Nov 2008;278(5):483-5. [Medline].

  11. Bhargava P, Dighe M. Prenatal US diagnosis of congenital imperforate hymen. Pediatr Radiol. Sep 2009;39(9):1014. [Medline].

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

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Abdominal mass with imperforate hymen.
Imperforate hymen, classic appearance of bulging, blue-domed, translucent membrane.
Extensive labial adhesion. Not to be confused with imperforate hymen.
Vaginal agenesis. Not to be confused with imperforate hymen.
Diagram of hematometra and hematocolpos with imperforate distal transverse vaginal septum.
 
 
 
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