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Mohammed TN, Elgadi A, Nuri GME. A rare cause of amenorrhea: Hematocolpos in a post-cystocele repair patient. Clin Case Rep 2024; 12:e8766. [PMID: 38595964 PMCID: PMC11002097 DOI: 10.1002/ccr3.8766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Key Clinical Message Secondary hematocolpos is a rare but serious complication after cystocele repair. This warrants multidisciplinary management (gynecology and urology) to optimize outcomes & minimize iatrogenic risks. Abstract Hematocolpos is the term used for the accumulation of menstrual blood in the vagina. It is most commonly seen in adolescent girls but can also occur in elderly women as a result of gynecological conditions. We present the case of a 48-year-old female who presented with amenorrhea and abdominal pain following surgical repair of a cystocele. Investigation revealed secondary hematocolpos due to surgical trauma. Surgical drainage and correction of the uterus were performed, resulting in immediate pain relief. This case underscores the importance of considering hematocolpos in patients with post-surgical amenorrhea, and further research is needed to better understand its causes, risk factors, and optimal management strategies.
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Affiliation(s)
| | - Ammar Elgadi
- Faculty of MedicineUniversity of KhartoumKhartoumSudan
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2
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Zade RD, Choudhary A, Inamdar SA, Bankar NJ, Junghari M. Imperforate Hymen: A Report of a Case With Classical Signs. Cureus 2024; 16:e56014. [PMID: 38606216 PMCID: PMC11008086 DOI: 10.7759/cureus.56014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
An imperforate hymen (IH) is a condition where the hymen, which is a thin membrane that partially covers the vaginal opening, completely obstructs the vaginal canal. This condition is associated with problems such as pelvic mass, cyclical abdominal discomfort, and difficulty in urination. The occurrence of IH is quite rare, with an incidence of only one in 1000-10,000 women worldwide. We discuss a classical case of primary amenorrhoea with associated complaints of urinary retention and its management by hymenotomy (cruciate incision). We also considered the risk of hymen re-closure due to the lack of estrogenization of genital tissue and offered the patient the option of vaginal molding.
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Affiliation(s)
- Rasika D Zade
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amruta Choudhary
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Nagpur, IND
| | - Saunitra A Inamdar
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawarhal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mugdha Junghari
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Walser SA, Costigan H, Stuckey HL, Berg A, Stephens MB. The Opaque Language of Sexuality: Medical Students' and Providers' Beliefs About Virginity. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2619-2638. [PMID: 37039944 DOI: 10.1007/s10508-023-02578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Although virginity is not a medical term and is instead socially constructed, it remains unknown what medical providers believe about the biological basis of virginity. This study explored providers' and medical students' beliefs about virginity and the potential impact of such beliefs on healthcare. This was a concurrent mixed-method survey study of 124 medical students and 216 healthcare providers (Registered Nurse, Physician Assistant, Nurse Practitioner, and Doctor of Medicine) at Penn State Health and The Pennsylvania State University College of Medicine. Participants rated their level of agreement with common misconceptions about virginity on a six-point Likert scale. Open-ended questions gave respondents the opportunity to define virginity and to describe terms like virgin and virginal in the context of sexual experience and the medical lexicon. We identified common themes in the qualitative data using thematic analysis. Frequencies of misconceptions and statistically significant demographic associations were identified in the quantitative data. Definitions of virginity were varied and vague, most with negative connotations. A majority of respondents said that virginity has no biological basis. Many participants identified downsides to use of terms like virgin, virginity, and virginal in medicine. The most prevalent misconceptions about virginity were related to the hymen. Seventeen percent of students and 26% of providers at least somewhat agreed that it was possible to determine whether a person has engaged in vaginal intercourse through a gynecological exam. Misconceptions about virginity persist in medicine and bias, even if unintended, may impact the quality-of-care people with vaginas receive. Language around sexual health should be specific, inclusive, clinically relevant, and free from judgment. Medical education must continue to work to eliminate the concept of a biological basis to virginity.
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Affiliation(s)
- Sarah A Walser
- The Pennsylvania State University College of Medicine, University Park Regional Campus, 1850 East Park Ave., State College, PA, 16801, USA.
| | - Heather Costigan
- Department of Humanities and Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Heather L Stuckey
- Department of Humanities and Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Arthur Berg
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Mark B Stephens
- Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, University Park Regional Campus, State College, PA, USA
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Marino G, Alfieri N, Tessitore IV, Barba M, Manodoro S, Frigerio M. Hematocolpos due to imperforate hymen: a case report and literature systematic review. Int Urogynecol J 2023; 34:357-369. [PMID: 35713674 DOI: 10.1007/s00192-022-05270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Hematocolpos is a rare condition, where menstrual blood fills the vagina, instead of being expelled, due to a series of uterovaginal pathologies, the most frequent of which is the imperforate hymen. To date, few cases of hematocolpos have been reported in the literature. METHODS We report a case of hematometrocolpos due to imperforate hymen initially misdiagnosed as constipation and subsequently as ovarian mass; moreover, the present study undertakes a systematic review of studies on hematometrocolpos due to imperforate hymen to synthesize available knowledge on epidemiology, diagnosis, and management about this rare condition. RESULTS A total of 35 studies, describing 61 patients, were identified. The presence of hematocolpos should be suspected in premenarchal patients complaining of low abdominal pain, abdominal swelling, and urinary retention. Genital examination disclosing a tender, pale hymen and ultrasound represent a useful tool for diagnosis. The goal of the management is to timely perform hymenotomy to drain the hematocolpos, followed by hymenectomy to prevent recurrence. Follow-up is needed to diagnose possible recurrences. CONCLUSIONS In the case of an adolescent girl complaining of genital pain associated with primary amenorrhea, hematocolpos due to imperforate hymen should be suspected.
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Affiliation(s)
- G Marino
- University of Milano-Bicocca, Monza, Italy
| | | | | | - M Barba
- University of Milano-Bicocca, Monza, Italy
| | - S Manodoro
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milano, Italy
| | - Matteo Frigerio
- ASST Monza, San Gerardo University Hospital, via G.B. Pergolesi, 33, Monza, IT, Italy.
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Aljahdali EA, Kurdi MO. Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Imperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year’s period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition.
Methods
Twenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed.
Results
Saudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa.
Conclusion
Early diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families.
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Aboueddahab Z, Guelzim K, Kouach J. Familial occurrence of concomitant imperforate hymen and transverse vaginal septum: a case report. Pan Afr Med J 2022; 42:207. [PMID: 36284573 PMCID: PMC9547026 DOI: 10.11604/pamj.2022.42.207.33418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
The imperforate hymen and transverse vaginal septum are female reproductive tract abnormalities. Their concurrent occurrence is rare. So far, no manifestation of both anomalies within the same family has been reported in the literature. We report the first familial case of two sisters having both mentioned abnormalities. Our patient was the youngest sister of a 14-year-old, who presented with cyclic lower abdominal pain. Clinical and imaging examinations showed an imperforate hymen with hematometrocolpos. In addition, the surgery confirmed a low transverse vaginal septum, which was resected using a virginity-preserving procedure. In conclusion, the presence of both mentioned abnormalities between siblings reflects a potential genetic etiology, also in order to avoid late diagnostics of such anomalies, the imperforate hymen must be screened in the birth room.
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Affiliation(s)
- Zineb Aboueddahab
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Khalid Guelzim
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V university, Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V university, Rabat, Morocco
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Acar A, Ercan F, Balci O, Elçi Atılgan A, Alan C, Niftiyev K. Long-Term Results of an Imperforate Hymen Procedure that Leaves the Hymen Intact. J Obstet Gynaecol India 2021; 71:168-172. [PMID: 34149219 DOI: 10.1007/s13224-020-01407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022] Open
Abstract
Purpose of the Study The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period. Methods A Foley's catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley's catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days. Results The mean age of the patients at the time of this study was 28.3 ± 2.6 years, and the mean age at diagnosis was 13.2 ± 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus. Conclusion A circular incision with insertion of Foley's catheter prevents many social problems by preserving the hymen's architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.
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Affiliation(s)
- Ali Acar
- Department of Gynecology and Obstetrics, Meram School of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Fedi Ercan
- Division of Perinatology, Department of Obstetrics and Gynecology, Sanliurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Osman Balci
- Department of Gynecology and Obstetrics, Meram School of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Adeviye Elçi Atılgan
- Department of Gynecology and Obstetrics, Meram School of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Cemre Alan
- Department of Gynecology and Obstetrics, Meram School of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Kemal Niftiyev
- Department of Gynecology and Obstetrics, Meram School of Medicine, University of Necmettin Erbakan, Konya, Turkey
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