Hymenal anomalies in twins--review of the literature and case report

Evaluation of a microperforate hymen leading to the incidental diagnosis of a borderline ovarian tumour

Microperforate hymens are rare anatomical variants with an unknown incidence and very few reported cases. Borderline ovarian tumours are similarly uncommon, with an incidence of approximately 0.002%-0.006%. The concurrent presence of a microperforate hymen and a borderline ovarian tumour is therefore exceedingly unique with no documented cases to date. In this report, we review the case of a nulliparous woman in her late 20s who initially presented with an inability to have penetrative intercourse. A subocclusive hymenal variant was noted on examination and further imaging work-up resulted in the incidental discovery of a large ovarian mass subsequently noted to be a borderline ovarian tumour. Herein, we review contemporary approaches to the diagnosis and management of both hymenal variants and borderline ovarian tumours, and discuss fertility-sparing strategies for young women diagnosed with ovarian neoplasms.

Unusual presentation of a septate hymen leading to a retained vaginal tampon in the urinary bladder

There is a wide range of hymenal variants which exist and usually become apparent to women during puberty. Our case describes a 16-year-old woman with a previously undiagnosed hymenal septum who presented with a retained tampon within the urinary bladder. This case report discusses a rare presentation of a hymenal variant and highlights the importance of understanding the difference in pelvic examinations in children and adolescents when compared with adults and awareness of the different hymenal variants.

Microperforate Hymen and Pyocolpos: A Case Report and Review of the Literature

BACKGROUND

Microperforate hymen is a rare congenital anomaly characterized by a small pinpoint opening in the hymen; girls with this anomaly are prone to develop ascending pelvic infections and recurrent urinary tract infections.

CASE

We report the case of a 3-year-old girl who presented with fevers, abdominal pain, recurrent vaginitis, and dysuria. She was found to have a microperforate hymen and pyocolpos. She was treated with intravenous antibiotics and underwent hymenotomy and drainage of 150 cc of purulent fluid.

SUMMARY AND CONCLUSION

This case highlights the need to perform thorough genital inspection and to consider hymenal anomalies in the differential diagnosis of girls who present with recurrent dysuria, vaginitis, fevers, and abdominal pain. Early intervention might prevent the development of pyocolpos and other sequelae associated with this anomaly.

Microperforate hymen presenting with incomplete abortion: A case report

A 20-year-old patient with 3 months of amenorrhea presented in the labor room with bleeding per vaginum and having experienced lower abdominal pain for 2 h. She had a history of difficult intercourse and prolonged menstrual flow. Inspection revealed a bleeding point over an obstructing membrane at the level of the vaginal introitus. Subsequent vaginal examination confirmed the diagnosis of microperforate hymen. Her urine pregnancy test was positive and an ultrasound examination revealed the presence of retained products of conception in the endometrial cavity. Hymenectomy was carried out to evacuate the retained products of conception and the margins of the hymen were sutured to prevent restenosis. The outcome was uneventful. This case study suggests that even though subocclusive hymenal anomalies, such as microperforate hymen, can interfere with normal vaginal intercourse, it does not lead to infertility and can permit pregnancy. Hence, awareness about this rare entity may lead to early detection and improvement in the patient's quality of life.

Microperforated hymen: a case of delayed diagnosis

Although the incidence of microperforated hymen (MH) is unclear, this hymenal subocclusive anomaly is considered a rare entity. Differently from imperforated hymen, MH may be asymptomatic until puberty when the women’s quality of life is jeopardized. Depending on the size of the microperforation, MH’s clinical features me be very similar to those found in imperforated hymen cases. However, MH may present infectious complications since the accumulated secretion retained in the vaginal canal has contact with the external environment and therefore represents a source of entry for infectious agents. The authors report a case of a 28-year-old woman who sought the gynecologist complaining of inability to have vaginal intercourse. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. Physical examination and imaging disclosed a microperforation of the hymenal membrane at 10 o’clock position. Hymenotomy under general anesthesia was undertaken. Outcome was favorable and the patient could thenceforth have a normal life. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The delayed onset of symptoms and psychological embarrassing aspects, which postpone gynecological consultation, may contribute for misdiagnoses. We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable.