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Outflow Obstructions Clinical Presentation

  • Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD  more...
Updated: Aug 20, 2015


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.[4]  Severe long-standing obstruction may cause urinary retention, constipation, and hydronephrosis.[5]


Physical Examination

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.[6]

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:

  • Hematocolpos
  • Hematometra
  • Pyohematocolpos
  • Pyohematometra
  • Urinary retention, hydronephrosis (rare)
  • Postoperative recurrence of obstruction
  • Constipation
  • Abdominal mass
Contributor Information and Disclosures

Latha Chandran, MBBS, MD, MPH Professor of Pediatrics, Vice Dean for Undergraduate Medical Education, Stony Brook University School of Medicine, New York

Latha Chandran, MBBS, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.


Joseph A Puccio, MD, FAAP Director, Division of Adolescent Medicine, Stony Brook University Hospital; Assistant Professor, Department of Pediatrics, Stony Brook University School of Medicine

Joseph A Puccio, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

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