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A thin membrane, called the hymen, normally surrounds the opening of the vagina, with a small, circular opening in the center. In the case of a completely imperforate hymen, this membrane does not have an opening, so it blocks the vaginal canal. "Imperforate" means lacking the normal opening.
If the hymen is only partially imperforate, there is a small opening to the vagina, but extra tissue prevents the vagina from being completely open. Imperforate hymens can vary in the amount of obstruction.
An imperforate hymen is caused by failure of the hymen to perforate (open) during a baby’s growth and development inside her mother’s uterus.
An imperforate hymen is a condition that girls are born with. It generally affects 1 to 2% of all girls. Nobody knows why it occurs.
Signs in a newborn:
A complete imperforate hymen may be detected in a newborn. There may be a bulge in the hymeneal membrane that is caused by a buildup of normal mucus in the vagina that cannot drain.
Symptoms in an older girl:
In an older girl, a complete imperforation completely blocks menstrual flow, which causes abdominal pain. It may also cause other signs and symptoms such as:
A partially imperforate hymen does not block menstrual flow. Your daughter may complain of pain or trouble inserting and removing tampons. This symptom is usually not associated with other abnormalities of the vagina, uterus and ovaries.
Some cases of an imperforate hymen are found early in newborns who have a bulge in the hymeneal membrane. However, most complete imperforate hymens and nearly all partially imperforate hymens are diagnosed when a girl gets her period.
A doctor at Children’s Hospital Colorado will talk to you and your daughter about her health history and symptoms. After carefully reviewing the history and symptoms, the doctor will perform a gentle and careful physical exam.
There is no specific test that is done to evaluate this condition. It is diagnosed based on the history and exam findings alone. However, there are times when an imperforate hymen cannot be distinguished from a septum in the vagina.
Pelvic imaging, using a magnetic resonance imaging (MRI) test, can help doctors decide on the correct surgical approach.
During a physical exam, the doctor will look at the external vulva and hymeneal opening. This exam is not painful and does not include an internal pelvic exam.
An imperforate hymen is treated with surgery to remove the excess hymeneal tissue. It is normally a "day surgery," which means your daughter will probably not need to stay in the hospital overnight.
The doctor will remove excess hymeneal tissue and place dissolvable stitches to avoid the formation of scar tissue and re-blockage of the hymeneal opening.
The timing of surgery is based on symptoms. Most newborns do not have any symptoms, so they do not require treatment. The doctor will only recommend surgery for a newborn if the fluid collection is causing pain or infection.
Generally, the doctor will not perform surgery until after puberty has started. This allows a greater surface area on which to operate. It also allows the presence of estrogen, which helps to facilitate surgical repair and healing. Estrogen makes the tissue pliable and relaxed, which helps it heal easily without scar tissue or closure in the vaginal opening.
Once the imperforate hymen has been surgically corrected, there should be no long-term issues. The vagina will function normally and your teenager will be able to comfortably have periods and use tampons if desired. Surgery does not interfere with the ability to have children in the future.
At Children’s Colorado, we provide expert care for the diagnosis, treatment and management of health issues of the female reproductive organs in children and teens.
Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns of girls of all ages. As this condition is treated with a minor outpatient procedure, we provide both outpatient and inpatient surgical services. We also have board-certified pediatric anesthesiologists to assist us during the procedure.
Doctors at Children’s Colorado understand that topics involving female reproductive organs can be stressful to address, which is why we’re extra sensitive to the mental and emotional needs of our patients and their families. We create a friendly environment for dialogue and encourage our patients to ask questions and talk openly with their care team.