Outflow Obstructions Clinical Presentation
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
Although observation of an imperforate hymen can occur upon genital inspection with labial separation, most patients present with a history of amenorrhea, recurrent lower abdominal cyclical pain, or lower abdominal midline mass. Severe long-standing obstruction may cause urinary retention, constipation, and hydronephrosis.
Physical examination reveals imperforation of hymenal tissue. Variations of an imperforate hymen include microperforate, septate, stenotic, and cribriform hymen. If menstruation occurs and hematocolpos develops, the hymen may bulge and exhibit a bluish discoloration.
In cases of transverse vaginal septum, physical findings depend on the site of the septum (ie, low, mid, or high). If the site is low, a knee-chest examination may reveal the presence of the bulging septum. The vagina is observed as a blind pouch. Digital examination reveals the septum in the vagina. The most common location is the upper third of the vagina. Septa usually have microperforations; however, these are usually insufficient in preventing hematocolpos.
Potential complications include the following:
- Urinary retention, hydronephrosis (rare)
- Postoperative recurrence of obstruction
- Abdominal mass
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