Imperforate Hymen

Aka: Imperforate Hymen

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II. Epidemiology

  1. Incidence: 1 in 2000 female patients
  2. Presents in teenage girls at Menarche

III. Pathophysiology

  1. Congenital Abnormality
    1. Hymen does not canalize during Embryonic development
  2. An Imperforate Hymen traps menstrual blood
    1. Vagina and Uterus distend with menstrual fluid (hematometrocolpos)
    2. Pain results from blood collection or retrograde menstrual flow into the Pelvis

IV. Symptoms

  1. No Menses
  2. Vague Abdominal Pain
    1. May be chronic or recurrent
  3. Associated symptoms
    1. Constipation
    2. Urinary symptoms

V. Signs

  1. Hematocolpos
    1. Introitus with blue, bulging membrane
    2. Represents blood trapped behind Imperforate Hymen

VI. Differential Diagnosis

  1. See Pediatric Abdominal Pain Causes
  2. See Differential Diagnosis of Acute Pelvic Pain
  3. Transverse vaginal septum

VII. Management

  1. Operating room hymenectomy
    1. Performed by gynecology or pediatric surgery
    2. Avoid incising Hematocolpos in the emergency department

VIII. Prognosis

  1. Not typically associated with longterm complications (e.g. Infertility) once treated

IX. References

  1. Claudius and Willner in Herbert (2019) EM:Rap 19(1): 2-4
  2. Humphrey (2025) Am Fam Physician 112(2): 203-4 [PubMed]

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