What Is an Imperforated Hymen?
When the vagina does not have a regular opening, it is referred to as an imperforate hymen. An imperforate hymen is not a severe health problem, and this condition can be easily treated with minor surgery. The hymen is a very thin membrane surrounding the vaginal opening. A normal hymen has a tiny, circular opening in the center. In cases of the absence of a normal opening, it is referred to as the imperforated hymen. Imperforate hymens can affect around 1 in 1,000 and 1 in 10,000 girls. It can mostly be detected when doctors examine newborn babies. If it is undetected, it can cause uncomfortable symptoms as the girl grows or near puberty.
Imperforated hymen can be of two types, completely or partially imperforated.
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In partial imperforation cases, the vagina will have a small opening, but some excess tissues will obstruct the opening of the vagina.
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In complete imperforation cases, the hymen has no opening, so the vaginal canal will be completely blocked. This condition normally gets noticed when the girl does not get her first period during her teenage.
What Is the Cause of Imperforated Hymen?
An imperforate hymen may happen when the hymenal membrane does not form properly during embryological development. Without removing the imperforated hymen, the menstrual blood may not flow, as it stays as an obstruction to the flow. Even sexual intercourse is not possible.
What Are the Symptoms of Imperforate Hymen?
An imperforate hymen is usually present from birth. However, most girls will not be aware of having the condition until puberty. The symptoms also vary in different stages of life. The most common symptom of the imperforate hymen in newborn babies is the presence of a bulge or lump in the hymenal membrane.
The other symptoms usually occur when a girl reaches puberty. Symptoms may include abdominal pain and swelling that normally last for several days. These symptoms occur due to the buildup of menstrual blood caught inside the vagina. This blood build-up can also spread into the uterus and fallopian tubes. Other symptoms related to an imperforate hymen include:
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Menstruation does not occur despite having other sexual maturity signs, such as the development of the breasts and pubic hair.
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Pelvic or abdominal pain often comes and goes each month.
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Fullness or bloating in the lower abdomen.
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Lower back pain.
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Pain during urination or absence of urination can occur in some cases when the collected blood compresses against the urethra. The urine is carried from the bladder to the outside of the body through the urethra tube.
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Constipation.
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Some women may experience a painful abdominal mass.
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Penetrative sex is not possible due to the blocked hymen.
If a child has a partially imperforate hymen, they will not experience any problems during the menstruation cycle. But they may most likely complain about severe abdominal pain as well as trouble inserting tampons.
How Is Imperforate Hymen Diagnosed?
In babies, the imperforate hymen can sometimes cause the hymen to bulge due to the buildup of milky mucus that is produced by the mother’s hormones, which cannot drain into the vagina. Surgery is recommended to make an opening in the hymen, but some parents prefer waiting until their daughters are older.
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Medical History: During teenage, if any symptoms of imperforate hymen occur, then the first thing that should be done is to make an appointment with a doctor, who will examine the patient and confirm the diagnosis. During the appointment with the doctor, they will ask questions regarding the medical history and the changes experienced during puberty.
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Symptoms: The doctor will ask about the history of the period. People with imperforate hymen may have gotten their period, but they might not have seen any menstrual blood flow. While in other hymen anomalies such as a micro perforate (a hymen that surrounds the vagina fully but only one small hole will be present in it) or a cribriform hymen (a hymen that surrounds the vagina but it has small holes present on it), there will be very little blood passing through the vagina during the period.
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Physical Examination: A physical examination is done by the doctor. They will also look at the vagina and check for an imperforate hymen. In most cases, the doctor will be able to check whether the hymen is covering the vagina or not.
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Magnetic Resonance Imaging and Pelvic Ultrasound: If the doctor is unsure or suspects a partially blocked hymen like microperforated, septated, or cribriform, they may suggest some tests like an MRI (magnetic resonance imaging) or pelvic ultrasound for confirmation.
What Is the Treatment for Imperforated Hymen?
After a diagnosis of an imperforate hymen, the doctors will recommend surgery to correct it. This surgery can also happen at the doctor’s office; general anesthesia is not required. The doctor will apply a localized anesthetic to numb the area.
A surgery called a hymenectomy or hymenotomy is done to create an opening in the hymen. It is performed when the hymen is abnormally thick or otherwise obstructing the menstrual blood flow. This procedure will only take one or two hours. During this procedure, the doctor will cut open the hymen, and any excess tissue is removed. After completing this step, the doctors will close up the wound using dissolvable stitches that will dissolve as the wound heals. After the surgery, the doctor will give instructions about keeping the wound clean, preventing infections, and promoting healing.
Few instructions are recommended after surgery, such as:
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Not to lift heavy objects.
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To do warm sitz baths (to emerge the genital area in a special tub containing warm water).
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Take pain medication to reduce pain, swelling, or inflammation.
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Apply ointment or cream to the wound to promote healing.
Recovering back to a normal lifestyle is possible within a few days. A follow-up appointment will be scheduled a few weeks after the surgery to check that everything has healed properly. After hymenectomy, it is possible to have a normal period, have sexual intercourse, and use tampons.
What Are the Complications of Imperforated Hymen?
If the imperforated hymen is not detected early and treated, it can lead to several complications.
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Vaginal infection.
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Fertility-reducing endometritis.
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Kidney issues.
Conclusion:
An imperforate hymen is one of the common woman’s genital tract malformations. It can be caused due to improper embryo development. Abdominal pain and absence of periods are the main symptoms. It can be relieved by creating a small opening in the hymen; generally, full relief of symptoms occurs without any complications. After the surgery, women can have normal menstruation and sex life.
