IMPERFORATE HYMEN IN AN ADOLESCENT – LATE DIAGNOSIS OF A COMMON CONGENITAL MALFORMATION

Abstract

Imperforate hymen is the most common congenital malformation of the female genital tract, with an estimated prevalence of 0.05% to 0.1%. It is a membranous obstruction resulting from failed canalization of the urogenital sinus during embryonic development. It often remains asymptomatic until menarche, when the accumulation of menstrual blood leads to hematocolpos and hematometra, presenting with progressive pelvic pain, abdominal mass, and urinary compression symptoms. Although the diagnosis is primarily clinical, delays are common and may result in complications such as hydronephrosis, infection, and chronic pelvic pain. We report the case of a 13-year-old adolescent with lower abdominal pain for two months, occasional urinary retention, and primary amenorrhea. Physical examination revealed a painful hypogastric mass and a tense, bluish hymenal membrane without a central opening. Laboratory tests were normal, while transabdominal ultrasonography showed hematocolpos and hematometra, as well as bladder compression. Once the diagnosis of imperforate hymen was confirmed, the patient underwent a cruciate hymenectomy under general anesthesia, with drainage of approximately 250 mL of retained blood. The postoperative course was satisfactory, with complete symptom resolution and appropriate counseling on menstrual health and fertility. Three months after the procedure, the patient presented spontaneous and regular menstruation, with no recurrence. This case reinforces the importance of clinical suspicion of obstructive genital tract malformations in adolescents presenting with primary amenorrhea and pelvic pain. Careful inspection of the external genitalia is essential for early diagnosis, preventing urinary and gynecological complications. Simple and timely surgical treatment ensures an excellent reproductive prognosis and significant improvement in quality of life.