What Is Imperforate Hymen

Overview

Imperforate Hymen (IH), with an estimated incidence of 0.05-0.1%, is a rare congenital malformation of the female reproductive tract in which the hymen completely obstructs the vaginal opening causing amenorrhea and cyclic pelvic pain.¹ Despite being a rare condition, it is the most common type of vaginal blockage anomaly. A person Assigned Female at Birth (AFAB) is said to have IH when a membrane extends across the area of the hymen, blocking the vaginal opening totally or partially in the case of partial imperforation.²

Causes of imperforate hymen

Imperforate Hymen often occurs during fetal development. The hymen normally open during embryonic development.3 If the hymen fails to open during the baby’s growth in-utero, an Imperforate hymen is seen. The exact reason for this occurrence remains unascertained.⁴

Signs and symptoms of imperforate hymen

Most symptoms of IH are caused by the backing up of menstrual blood into the vagina, uterus, or fallopian tube. Many times, symptoms do not occur until a child AFABhas reached puberty, and these may include:

• Lack of menstruation (Amenorrhea)
• Abdominal or pelvic pain
• A feeling of bloating in the belly
• Constipation or painful bowel movements
• Back pain
• Painful urination³

Management and treatment for imperforate hymen

Hymenectomy is a procedure carried out to open the hymen. It is a minor surgery performed under general anaesthesia, which involves the use of scissors or a scalpel to cut an opening in the hymen and the subsequent drainage of the trapped blood. This procedure is often done when the child AFAB is older.³

Post-surgical pain is managed with nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics are given to prevent or reduce the risk of postoperative infection. There are usually little to no complications after surgery, and the patient can live a normal life with normal menstruation, sexual intercourse and pregnancy.

Diagnosis 

IHis simply diagnosed with a pelvic examination. The doctor may ask you to lie on your back with your knees bent and your feet up while they inspect your genitals for any abnormalities. Once an IH is suspected, the doctor may order a pelvic or vaginal ultrasound to help confirm the diagnosis.

FAQs

How can I prevent an imperforate hymen?

There is no way to prevent an imperforate hymen since it occurs during fetal development, and the cause is not exactly ascertained.³

How common is imperforate hymen

IHis estimated to occur in 1 out of every 1000 births of babies AFAB. It is an uncommon anomaly despite being the most common form of vaginal obstruction.⁵

Who is at risk of imperforate hymen?

Any child with AFAB could be at risk of IHand it is mostly diagnosed during adolescence.

What can I expect if I have an imperforate hymen?

Common symptoms to expect when you have an imperforate hymen include amenorrhea (absence of menstruation), pelvic pain, difficult or painful urination, and sometimes back pain. Further complications if not detected and managed early,¹ include vagianal infection, endometriosis, and kidney issues.² 

When should I see a doctor?

You should see a doctor if you experience any amenorrhea, pelvic pain, back pain, painful urination or any other symptoms of IH. Following a Hymenectomy, you should contact your health care provider when you have signs that your vagina is closing or signs of infection like fever, vaginal discharge or lower back pain.³

Summary

Imperforate hymen is a rare congenital condition in which the hymen obstructs the vaginal opening. It is treatable with a simple surgical procedure called hysterectomy, and you can have a normal menstrual and sexual life as well as a healthy pregnancy. If you have doubts about having IH, contact your General Practitioner (GP).