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What Is an Imperforate Hymen?

Medically Reviewed by Poonam Sachdev on November 11, 2021

An imperforate hymen is a condition where the vagina lacks a regular opening. It affects 1% to 2% of girls.

The vagina has a thin membrane surrounding its opening, called the hymen. A healthy hymen has a small, circular opening in the center. The term "imperforate" describes the absence of a normal opening. 

The hymen can be partially or completely imperforate. In cases of partial imperforation, the vagina still has a small opening — but this opening is blocked with extra tissue. 

When the hymen has no opening, it blocks the vaginal canal. The condition usually gets diagnosed when the girl becomes a teenager or has her first period. 

Some girls may experience painful symptoms, while others may not observe any change in their bodies. An imperforate hymen is not a serious health issue and can easily be treated with minor surgery.

What Is the Cause of Imperforate Hymen?

The hymen fails to perforate (open) during fetal development, resulting in an imperforate hymen.

What Are the Symptoms of an Imperforate Hymen?

The symptoms of an imperforate hymen can vary in different stages of a girl's life. Newborns may experience certain symptoms, while an older child may see other signs. 

The most common imperforate hymen symptom in newborns is the presence of a bulge in the hymenal membrane.

Imperforate hymen symptoms in young girls include:

  • Amenorrhea, or restriction of menstrual flow
  • Missing the first menstrual cycle
  • Severe abdominal pain
  • Bloating or fullness in the lower abdomen
  • Problems during urination, mainly at the time of the first period
  • Difficulties with bowel movements
  • Back pain

If your child has a partially imperforate hymen, she won't experience problems in her menstruation cycle. She will most likely complain about severe pain in her abdomen. She may also have trouble putting in tampons.

How Is an Imperforate Hymen Diagnosed?

An imperforate hymen can be diagnosed in childhood, infancy, or puberty. Sometimes doctors can't differentiate between a healthy hymen and an imperforate one. The problem is most easily diagnosed when the girl begins her period.

If your teenager complains about severe abdominal pain, you should take her to a gynecologist. The doctor will review her medical history and perform a physical exam. During the exam, the doctor will look at the external vulva and hymenal membrane. 

There is no specific test to determine this condition. It is often not distinguished from a septum in the vagina.

Pelvic magnetic resonance imaging (MRI) can help to diagnose imperforate hymen. This can help the doctor decide on the surgery. This diagnosis exam is not painful.

What Is the Treatment for an Imperforate Hymen?

After the diagnosis, the doctor may recommend a minor surgical procedure to remove the extra hymen tissue. The surgery can be done in infancy or later in life.

The procedure starts with the removal of excess tissue from the hymen. Then, sutures or dissolvable stitches are placed in the area to prevent the scarring and re-blockage of the opening.

Infants who don't show any symptoms don't need any surgery. The doctor only suggests surgery for newborns if the mucus collection in their vagina causes pain. 

Most doctors prefer to do surgery when the girl reaches puberty. This is because they get a greater surface area to operate on. Another reason is the help of the hormone estrogen in post-surgery repair and healing. Estrogen helps the tissues relax and heal easily without any scarring.

Once the surgery is done, your child will have a perforated hymen. She will not face any health issues in the long run. Her vagina will work normally, and she won't have any problems in her menstrual cycle. 

The surgery won't affect the ability to bear children in the future, nor will it affect sexual activity.

Show Sources

SOURCES:
Abdelrahman, H., Felony, M. StatPearls, "Imperforate Hymen," StatPearls Publishing, 2021.
Boston Children's Hospital: "Imperforate Hymen."
Children's Hospital Colorado: "What is an imperforate hymen?"
Journal of Clinical Medicine: "Imperforate Hymen: A Comprehensive Systematic Review."
Medscape: "Imperforate Hymen."

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