Genital examination can reveal hydrometrocolpos, or a bulging, bluish vaginal mass that is caused by vaginal secretions and menstrual blood accumulating behind the imperforate hymen. Clinical symptoms in adolescents include primary amenorrhea and abdominal pain, which can accompany a midline lower abdominal mass on examination. 38, 39 Imperforate hymens are generally diagnosed as incidental findings in young females or later in adolescence when a girl remains amenorrheic despite age-appropriate breast and pubic hair development. Most commonly this is an isolated finding with an incidence that ranges from 0.014% to 0.1% in term births. Imperforate hymen ( Figure 10-7) is a congenital anomaly in which the hymenal membrane has no functional opening and occludes the entrance to the vagina.
Wallace MD, Michelle Amaya MD, MPH, in Child Abuse and Neglect, 2011 Imperforate Hymen Proper examination under anesthesia and forensic swabbing of affected areas should be undertaken with the use of a standardized protocol. The associated finding of a hematoma, abrasion, or laceration in combination with hymenal transection should raise the possibility of this diagnosis. 47.14).Īcquired abnormalities of the hymenal ring usually result from sexual abuse. In pubertal girls, general anesthesia with excision of excess hymenal tissue may be indicated ( Fig. Simple aspiration of the vagina without a definite drainage procedure should be discouraged because incompletely evacuated material may be prone to ascending bacterial growth. In newborns, repair by incision of the hymenal tissue at the bedside is performed in the transverse direction to avoid inadvertent extension of the incision anteriorly or posteriorly (which may injure the urethra or rectal structures). In these circumstances, a bluish bulging hymen may be observed on genital inspection and a mass will be appreciated on rectoabdominal palpation. On occasion, the diagnosis is not made until the adolescent period, when the patient experiences amenorrhea and possibly cyclic abdominal pain. If the diagnosis is made after the neonatal period, the mucus often will have been reabsorbed, and a bulge in the hymenal membrane may no longer be evident. The buildup of retained vaginal secretions in the neonatal period, which imparts a whitish appearance to the bulging hymenal membrane, is caused by maternal estradiol stimulation. The diagnosis is most frequently made at birth by noting the presence of a bulge along the posterior aspect of the introitus, which represents retained fluid within the vagina, or by palpation of a suprapubic mass from a distended vagina ( Fig. Imperforate hymen is probably the most common congenital obstructive anomaly of the female reproductive tract. Congenital abnormalities of the hymen are not uncommon and range from an imperforate hymen to one with numerous small microperforations. When symptomatic (i.e., bleeding), they should be excised to ensure that they do not represent a malignancy and to provide symptomatic relief.
HYMENAL TAGS SKIN
Hymenal skin tags are almost a normal finding and are rarely symptomatic ( Fig. Partin MD, PhD, in Campbell-Walsh-Wein Urology, 2021 Imperforate Hymen and Hymenal Skin Tags Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings. A longitudinal study of hymenal development from 3 to 9 years of age. Dr Kao is clinical assistant professor of pediatrics at the University of Calgary and pediatric consultant at the Alberta Children’s Hospital.
The parents were reassured of the benign nature of the lesion and that it will resolve with time.ĭr Leung is clinical professor of pediatrics at the University of Calgary and pediatric consultant at the Alberta Children’s Hospital in Calgary, Alberta. New hymenal tags may appear postnatally as a result of extension of an intravaginal or external hymenal ridge. The tags are commonly located in the superior and inferior positions and tend to resolve spontaneously. Hymenal tags are present in 3% to 13% of normal female newborns. The rest of the examination findings were unremarkable. The flesh-colored smooth-surfaced lesion protruding from the vagina was characteristic of a hymenal tag. The mother was not taking any medications during the pregnancy. She was born to a 26-year-old primigravida at term after an uncomplicated pregnancy and normal spontaneous delivery.
The mass protruding from the introitus of this 1-month-old girl was first noted at birth. Leung AKC, Kao CP. A collage of genital lesions in children, part 6. Pion Kao, MDĪlberta Children’s Hospital and University of Calgary
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