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BMJ Case Reports 2009; doi:10.1136/bcr.08.2008.0722
  • Reminder of important clinical lesson

Imperforate hymen: a cause of abdominal pain in female adolescents

  1. Céline Lardenoije,
  2. Robert Aardenburg,
  3. Helen Mertens
  1. Orbis Medical Centre, Obstetrics and Gynaecology, PO Box 5500, Sittard, 6130 MB, The Netherlands
  1. Céline Lardenoije, c.lardenoije{at}orbisconcern.nl
  • Published 26 May 2009

Summary

A 16-year-old girl presented with primary amenorrhea and had had cyclical abdominal pain for almost a year. At examination we observed a painful mass in the lower abdomen and normal secondary sex characteristics. Perineal examination showed a bluish bulging hymen. Transabdominal ultrasonography revealed a dense mass in the pelvis measuring about 12×11 cm. We diagnosed an imperforate hymen with haematocolpos and haematometra. The hymen was opened surgically and a large quantity of menstrual blood was drained from the vagina and uterus. Postoperative recovery was normal without any pain. The patient now menstruates regularly. An imperforate hymen occurs in 0.05% of women. It is important to be aware of this while examining a female adolescent presenting with cyclical abdominal pain and primary amenorrhea. Late discovery of an imperforate hymen may lead to pain, infections, hydronephrosis and endometriosis with subfertility as a possible consequence.

Footnotes

  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

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