Microperforate Hymen Research Articles

Microperforate Hymen Presenting as Vaginismus: Management and Literature Review

Microperforate hymen is a rare anomaly which affects the quality of life and sexual activity of young women. We present a surgical technique for the treatment of microperforate hymen. We report a 30-year-old nulliparous lady who presented with vaginismus, intermenstrual bleeding and menorrhagia. Physical examination revealed a pinpoint hymenal membrane opening at 12 o’clock position. The patient underwent hymenectomy and hysteroscopy with dilatation and curettage. Two Foley catheters were used: one was inserted into the urethra, the other into the vagina via the hymenal opening. Bulb of the vaginal catheter was inflated to demarcate hymenal membrane from urethra to prevent urethra injury during the hymenectomy. A cruciate incision was made over hymen membrane. Recovery was unremarkable, and patient was able to have sexual intercourse. This case highlights the importance of performing a thorough genital examination to identify anomalies. Early surgical intervention prevents complications and improve affected women’s quality of life.

Persistent microperforate hymen as a rare maternal cause of dystocia in a ewe

AbstractSuccessful management of obstetrical emergency, such as dystocia, is essential to prevent huge economic loss to sheep farming. Dystocia can lead to mortality of both the dam and the fetus, if timely correct diagnosis and feasible intervention are delayed. The present case describes an uncommon obstetrical emergency, that is, dystocia due to a rare condition of persistent microperforate hymen as a maternal factor for dystocia. A primiparous, crossbred ewe (aged 1.5 years) was presented at our clinic as an obstetrical emergency at full term. After a complete history was taken, a physical (including per vaginum) examination was performed. This allowed a diagnosis of a persistent microperforate hymen. Management included excision of the transverse band followed by assisted delivery. The ewe recovered successfully, and survived along with its lamb, at least until the post‐operative check at 3 weeks.

2. Repair of a Microperforate Hymen

2. Repair of a Microperforate Hymen

Successful Reproductive Outcome Following Challenging Surgical Management of Mullerian Anomalies

Background: Mullerian duct anomalies consist of a set of structural malforma-tions of reproductive organ resulting from abnormal development of the paramesonephric or Müllerian ducts. The prevalence of these anomalies ranges from 0.001 to 10% in the general population and from 8-10% in women with an adverse reproductive history. The aim of this study was to diagnose different type of mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of surgical management of malformation of genital tract. Methods: A prospective observational study of mullarian anomalies and its diagnosis & reproductive outcome was observed by using data from women with congenital anomalies attended in OPD either with complains or incidental diagnosis with HSG,during laparoscopy at tertiary care center. Total 100 women with different types of mullarian anomalies were included in study. Results: Most common utero-vaginal anomaly seen in present study was septate uterus with on basis of clinical examination. Out of 100 patient (35)35% were diagnosed mullerian agenesis. Cervico vaginal agenesis (15)15%, Septate uterus 28(28%), Bicornaute uterus 7(7%), Transverse vaginal septum 5 % ,unicornuate 5%, Didelphi’s with longitudinal vaginal septum 2%, Microperforate Hymen 3(3%). Among all patients 26 patients were pregnant. Among primary amenorrhea 35 patient of mullarian agenesis after progressive non-surgical vaginal dilatation 22 patient had no coital difficulty. 5 patients were need vaginoplasty. Among 15 patients of cervicovaginal agenesis 6 become menstruating, 2 were pregnant, 6 patient failed anastomosis, needed total abdominal hysterectomy 3 patients on oral pill. Among 5 transverse vaginal septum, 5 having regular menestration among 2 become pregnant. Among other mullarian anamolies after challenging surgical management 22 patient become pregnant. Conclusion: Present study shows prevalence of congenital malformation of female reproductive tract is 0.83% at our .....

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

A Case Report of Microperforate hymen presented with primary infertility

Micro perforate hymen is an uncommon congenital defect in which the hymen has a microscopic pinpoint aperture. It is a different entity from imperforate hymen, but it might present with more or less similar complaints. Here we are discussing about a unique case of pinpoint hymenal opening or microperforate hymen where the patient presented to us with primary infertility. Most cases of micro perforate hymen present in the paediatric age group with recurrent urinary tract infections and recurrent vulvovaginitis. Rare cases in a review of literature noted that a patient was seen to present with urethral dilatation during coital activity. In this case report, we present a patient who came with primary infertility who has never been examined in the past. She had regular menstrual cycles but scanty flow with the main complaint of dyspareunia. After examination, she was found to have microperforate hymen and suspected transverse vaginal septum defect. Hence, routine investigations were done, and we proceeded with hymenectomy. This example demonstrates the importance of a thorough genital examination and the inclusion of hymenal abnormalities in the differential diagnosis of women with recurrent dysuria, vaginitis, primary infertility, and oligomenorrhoea, so that early intervention can be done to improve the woman's quality of life and reduce pregnancy difficulties.

29. Resealing of a Spontaneously Draining Imperforate Hymen

<h3>Background</h3> Microperforate and imperforate hymen are ostensibly separate diagnoses on a spectrum of hymenal anomalies. The incidence of imperforate hymen is 1 in 1000 births, while the rate for microperforate hymen is unknown, with few case reports (1). A patient with an imperforate hymen is often symptomatic with obstructive features of the genitourinary tract, whereas a patient with a microperforate hymen may be asymptomatic, have recurrent infections, or report obstructive symptoms (1, 2, 3). We present a unique case of an imperforate hymen with spontaneous rupture, that resealed and then ruptured spontaneously again. <h3>Case</h3> A 12-year-old premenarchal female, with a history of imperforate hymen, diagnosed on specialist exam at age 3, presented to the emergency department (ED) with back pain and urinary retention. Following an abdominal exam, she passed many clots vaginally, saturating adult-sized diapers. She was diagnosed with menarche and discharged. She was referred to a pediatric gynecologist for follow-up. Following her ED visit she had continued bleeding with malodorous discharge, and stated she had been using tampons. An exam limited by patient tolerance was remarkable for no patent hymenal opening, no vaginal bleeding or discharge. She did not tolerate a q-tip test. A pelvic ultrasound was ordered for her puzzling presentation and uncertain anatomy and revealed a normal uterus, bilateral ovaries, and no evidence of hematocolpos. An exam under anesthesia (EUA) and vaginoscopy was planned. She subsequently reported a second presentation to an outside ED. She again reported back pain, constipation and inability to void. Similar to her first presentation, her symptoms were relieved by an episode of profuse vaginal bleeding with strong foul odor that resolved after a few days. EUA findings included normal clitoris with smegma, normal labia majora and minora, urethra, and no obvious hymenal patency with labial traction. With a recto-abdominal exam, a microperforation was identified. Bloody discharge was expressed, and a hysteroscope was gently passed. Vaginoscopy confirmed a normal vaginal canal and cervix. An uncomplicated hymenectomy was performed. At her postoperative visit, she had no complaints. Her exam was unremarkable and the tissue was healing normally; no follow-up was indicated. <h3>Comments</h3> This case sheds light on an atypical case where the lines between a microperforate hymen and an imperforate hymen were blurred. There are few case reports in the literature of resealing of the hymen after hymenectomy, but no other cases reporting resealing after spontaneous perforation (4, 5).

Spontaneous Pregnancy in Postoperative Microperforated Hymen: A Case Report

Abstract: Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords:Abstract: Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords: hymen, microperforate, infertility, spontaneous pregnancy

Concurrent Microperforate Hymen and Transverse Vaginal Septum - Case Report and Review of Literature

Imperforate hymen and transverse vaginal septum are categorized under obstructive genital tract anomalies. The occurrence of both anomalies is a single patient is extremely rare and the sub-occlusive variant of these anomalies occurring together has never been reported before. A 29 year old nullipara who was previously healthy and menstruating regularly presented with a sudden onset of acute urinary retention. After clinical examination and imaging study, diagnosis of obstructed microperforate hymen and transverse vaginal septum was made. The anomalies had caused pyocolpos which had spontaneously drained out before surgery. During surgery, there was no obvious hymenal perforation and there was a pin-point opening of the transverse vaginal septum. The anomalies were surgically corrected by hymenectomy and septoplasty. This is the first case report in the literature describing the concurrent sub-occlusive variant of hymen and transverse vaginal septum in the form of microperforate hymen and transverse vaginal septum.

Microperforate Hymen Presenting as Tubo-Ovarian Abscess in Adulthood

Microperforate hymen is a rare vaginal anomaly that is usually reported in childhood due to recurrent urogenital infections. Unlike imperforate hymen where the presenting complaints are classical due to complete vaginal obstruction, the less profound and varied presentation of microperforate hymen may go unnoticed. We report a case of a 39-year-old, with a background history of amenorrhea, who presented with acute abdomen suggestive of tubo-ovarian abscess, and was finally diagnosed to have microperforate hymen. She underwent hymenectomy to correct the anomaly. To our knowledge, this is the oldest age of presentation of a congenital form of microperforate hymen. A high index of suspicion and early detection of microperforate hymen and properly timed intervention is essential to prevent acute symptoms and long term detrimental sequalae to women’s reproductive and psychosexual health.

Pyocolpos and Dysuria as Presenting Symptoms of Microperforate Hymen

Pyocolpos and Dysuria as Presenting Symptoms of Microperforate Hymen

Case Report: Pelvic Actinomyces in an Adolescent with Microperforate Hymen

Case Report: Pelvic Actinomyces in an Adolescent with Microperforate Hymen

A Rare Case Report of Microperforate Hymen with Difficulty in Penetration

ABSTRACT A rare case of 26-year-old women with microperforate hymen reported a difficulty in intercourse. Hymenectomy is the surgical treatment for imperforate hymen and microperforate hymen. A knife or electrocautery can be used to excise hymenal tissue. How to cite this article Kumar V, Kumar KV, Krishnamurthy KH, Kumar R. A Rare Case Report of Microperforate Hymen with Difficulty in Penetration. J South Asian Feder Menopause Soc 2014;2(2):97-98.

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

Subocclusive hymenal variants, such as microperforate or septate hymen, impair somatic functions (e.g., vaginal intercourse or menstrual hygiene) and can negatively impact the quality of life of young women. We know little about the prevalence and inheritance of subocclusive hymenal variants. So far, eight cases of familial occurrence of occlusive hymenal anomalies (imperforate hymen) have been reported. In one of these cases, monozygotic twins were affected. We are reporting the first case of subocclusive hymenal variants (microperforate hymen and septate hymen) in 16-year-old white dizygotic twins. In addition, we review and discuss the current evidence. The mode of inheritance of hymenal variants has not been determined so far. Because surgical corrections of hymenal variants should be carried out in asymptomatic patients (before menarche), gynecologists and pediatricians should keep in mind that familial occurrences may occur.

Microperforate Hymen in a Full Term Primigravida in Active Labour

Remote rural area with limited medical facilities had to under emergency lower caesarean section for acute labour as no vaginal opening was noticed. Patient was referred to tertiary centre for further management. JMS 2012;15(2):184-85

Microperforate (Pinhole) hymen and infertility; a rare case report

Inroduction Female genital tract anomalies may have a devastating impact on the potential for sexual activity and fertility. Microperforate (pinhole) hymen is one of them. Microperforate hymen can lead to infertility, primary amenorrhea, acute or chronic pelvic pain, abnormal vaginal bleeding, dysuria, pollakiuria or a foul-smelling vaginal discharge. Aim We aim to report a patient who had intercourse problems and infertility complaints later found to have a microper-forate hymen. Discussion Pinhole opening of hymen may permit passage of fluids. Consequently spontaneous pregnancy can occur rarely. A few reports showed pregnancies with intact hymen without penetration of penis. But in general patients have fertility problems. Conclusion The results of the surgery are similar in all techniques and the particular surgical centre will have its own preference of which technique it prefers since after diagnosis definitive treatment is surgical and effective. Failure to manage these patients correctly may have long-term sequelae for their psychological, sexual and reproductive health.

Urethral Coitus in a Patient with a Microperforate Hymen

Microperforate hymen is a rare condition consisting of a tiny hymeneal orifice with normal female genitals. A woman had microperforate hymen in which diagnosis and treatment was performed after decades of urethral coitus.

Pregnancy with a microperforated hymen

In fetal life the hymen separates the evaginated caudal end of the fused fetal paramesonephric ducts from the evaginated urogenital sinus. It may persist as a result of infection during intrauterine life; or if the epithelial cells in its center do not degenerate to produce the membrane; or if, because of excessive cell proliferation and coalescence, the area behind it does not regress. Discussions of hymenal anomalies tend to emphasize the diagnosis and treatment of imperforation in infertility cases w1,2x. We describe the case of a 21year-old woman who was incidentally found to have a microperforate hymen in the 27th gestational week of her first pregnancy. The presenting complaint was abdominal pain. The clinician sensed the presence of a membrane on bimanual pelvic examination. Careful inspection revealed an intact, microperforate hymen that was easily stretched by the examiner’s fingers and then reverted to its original configuration. The woman reported normal, regular periods of 4 days’ duration every 30 days since the age of 14 years, and exclusive use of pads (not tampons). She had coitus for the first time on her wedding night,

Vaginal stones with a pinpoint hymenal opening

Primary vaginal stones are a rarely reported complication of a congenital vaginal septum, an imperforated hymen, vaginal scarring or female circumcision. We report a woman who had vaginal stones with a microperforate hymen.