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Am Fam Physician. 2005;72(10):2093-2098

Imperforate hymen is a rare disorder that can manifest clinically as abdominal pain, back pain, constipation, urinary symptoms, primary amenorrhea, and peritonitis. Some-times it is acquired secondary to sexual abuse. It is easily diagnosed; however, late diagnosis may be associated with greater morbidity and more testing than earlier diagnosis. Posner and Spandorfer performed a retrospective medical record review to determine whether there was a difference in symptoms and medical evaluation in patients diagnosed with imperforate hymen before eight years of age compared with patients diagnosed at eight years or older.

In a computerized search of medical records spanning 13 years from a large tertiary care center, researchers found 23 patients with imperforate hymen. Of these, 10 (43 percent) were diagnosed before four years of age, and the remaining 13 were 10 years or older at diagnosis. One girl in the younger group was symptomatic at the time of diagnosis, compared with all of the girls in the latter group. In this older group, almost one half were given preliminary diagnoses other than imperforate hymen, with 11 (85 percent) undergoing ancillary diagnostic testing. In the younger group, only one child underwent testing before diagnosis. Three children in the younger group had ultrasound examinations to confirm the physical examination findings, whereas eight of the 12 ultrasound examinations performed in the older group were part of the diagnostic work-up of symptoms.

The authors conclude that protracted symptoms relating to imperforate hymen might be avoided with early diagnosis. Imperforate hymen readily can be detected by a physical examination of the hymenal area while the child lies in frog-leg or knee-chest position. In older patients, imperforate hymen presents as a bulging mass at the vaginal introitus. The authors suggest that an external genitalia examination included in routine newborn and infant evaluations could prevent morbidity in later years. Treatment is with surgical hymenectomy, but the optimal timing of this is unclear.

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