Anomalies of the hymen are congenital defects of the hymen, which are associated with its underdevelopment or a change in structure. They may not have symptoms. Sometimes a sign of an anomaly is the absence of menstrual bleeding in a teenager, hematocolpos, a violation of sexual function. Pathology is diagnosed during a gynecological examination, pelvic ultrasound is used to exclude a combined defect. Treatment is performed surgically: the hymen is dissected to ensure the outflow of menstrual blood and the possibility of sexual contact.
ICD 10
Q52.3 Hymen completely covering the entrance to the vagina
General information
Anomalies of the hymen are rare. Malformations of the genital organs are diagnosed in 4% of cases of all congenital pathologies, how often violations of the structure of the hymen are detected among them is not known for sure, its aplasia accounts for 0.03%. Anomalies of the hymen are often combined with atresia and doubling of the vagina, exstrophy of the bladder. The association of the frequency of urogenital defects in the fetus with low socio-economic status, unfavorable living conditions of the pregnant woman has been established. In recent years, there has been a 10-fold increase in the number of congenital malformations of reproductive organs.
Causes
In most cases, it is impossible to establish the exact causes of abnormalities of the reproductive organs. Bad habits and unbalanced nutrition of the expectant mother, unavailability of medical care, pregnancy up to 20 years contribute to an increase in the risk of congenital abnormalities. The immediate producing causes are divided into several groups:
- Genetic. The risk of giving birth to girls with hymen abnormalities and other urogenital defects increases in ethnic groups where closely related marriages are performed.
- Infectious factors. Among pregnant women with low social status, sexual infections (syphilis), viral diseases (measles, etc.) are more common. Untimely access to a doctor leads to late diagnosis of diseases and the risk of fetal damage.
- Environmental factors. This is the totality of all external negative influences experienced by a pregnant woman. These include toxic emissions from industrial enterprises, inhalation of gasoline vapor, paintwork, the effect of pesticides, medicines, tobacco and alcohol, which increase the frequency of fetal defects.
Pathogenesis
The formation of external reproductive organs occurs from the tissues surrounding the cloaca of the embryo, therefore, malformations are the result of negative effects in the early stages of pregnancy. At 5-7 weeks, the anterior edge of the cloaca forms the genitourinary sinus. This is the future germ of the bladder and external genitalia. The development of this part of the reproductive system occurs before the formation of gonads, therefore it is not hormone dependent.
Gradually, a genitourinary tubercle is formed in front of the ventral part of the cloaca, which turns into a clitoris, from the lateral genital folds in the future, the labia minora are formed, which limit the genitourinary cleft. A depression appears in it, on which a paramesonephric tubercle is noticeable. In the future, it transforms into the vestibule of the vagina and the hymen, which is clearly visible by 24-25 weeks of gestation.
If a pregnant woman is negatively affected at 5-7 weeks of gestation, developmental abnormalities affect all external reproductive organs. If the sewerage of the paramesonephric tubercle does not begin within 10-12 weeks, anomalies are observed only in the hymen, because other genitals have already been formed by this time. In some cases, due to the resorption of the folds of the future hymen, for unknown reasons, the hymen may not form at all.
Classification
No special classification of hymen anomalies has been developed in clinical gynecology. In ICD 10, they are included in the group assigned the code Q 52.3 – the hymen that covers the entrance to the vagina. In practice, the following types of defects are distinguished:
- Aplasia. Complete absence of the hymen.
- Atresia. Secondary overgrowth of the hymen, occurs in the 2nd trimester.
- Nonperforated hymen. During embryogenesis, through holes are not formed in the hymen.
- High semilunar hymen. The upper edge, which limits the entrance to the vagina, reaches the outer opening of the urethra. Often the anomaly is confused with atresia.
- Hymen with micro-holes. Several small holes are found in the hymen, which can disrupt the outflow of blood during menstruation.
- Septate hymen. It is not an anomaly of development, because it does not delay menstrual blood. But it can become an obstacle to the beginning of sexual life, because the partition goes in a vertical direction and prevents the introduction of the penis.
There are other variants of the structure of the hymen that do not relate to anomalies. In girls, there is a ring-shaped, semilunar form of the hymen, fringed, perforated in several places or dense (rigid) hymen. Less often, lip-shaped, tongue-shaped, dicotyledonous and tubular hymenal are detected.
Symptoms
Clinical signs of pathology depend on the type of anomaly. Girls with hymen aplasia do not have menstrual blood outflow disorders, so the defect is detected accidentally during a routine examination. During the first sexual contact, there are no painful sensations and blood discharge. Sometimes there is also an increased elasticity and extensibility of the hymen, which does not belong to anomalies.
With an unperforated hymen, there is no outflow of menstrual blood, the girl does not begin menstruation, but cyclical abdominal pain appears. They intensify on the days when menstruation should begin, and persist for 7-10 days. They may be accompanied by other signs of premenstrual syndrome – headaches, irritability, breast swelling. Gradually, the feeling of bursting in the perineum increases. Similar symptoms are observed with hymen atresia.
Complications
Aplasia of the hymen rarely leads to complications, but increases the risk of genitourinary infections in childhood. High semilunar hymen does not delay menstrual bleeding, but often prevents normal urination. When urine is thrown into the vagina, chronic colpitis develops, which is difficult to treat.
With an unperforated hymen, prolonged accumulation of blood leads to the formation of hematocolpos and hematometers. In the absence of timely treatment, there is a risk of infection, the development of endometritis and subsequent infertility. Retrograde blood flow through the fallopian tubes into the abdominal cavity can lead to peritonitis.
Diagnostics
An examination of a girl with suspected hymen abnormalities is carried out by an obstetrician-gynecologist. In case of pain in the lower abdomen, a surgeon’s consultation is prescribed to exclude a profile pathology. To confirm the diagnosis, as well as to diagnose combined malformations, the following research methods are prescribed:
- Gynecological examination. In the area of the entrance to the vagina, an elastic layer of red-blue tissue is determined due to the accumulation of blood, bulging outwards. With aplasia, the entrance to the genital tract is free, there are no remnants of the hymen at the edges.
- Ultrasound of the pelvic organs. It shows the accumulation of blood in the vagina, uterus, and an increase in its volume. Additionally, the ovaries are examined, the blood flow in the pelvis is evaluated.
- MRI of the pelvis. It is prescribed for suspected abnormalities of the development of internal genitalia. With the help of tomography, you can determine the structure and position of the uterus, ovaries.
Treatment
With hymenal aplasia, special treatment is not required. Drug therapy is necessary in the case of colpitis, cervicitis, endometritis, which develop due to ascending infection. Locally or systematically, girls are prescribed antibacterial drugs, which I select for the type of pathogen. In case of chronic infection, anti-relapse therapy is carried out.
With atresia, dense, high semilunar or non-perforated hymen, surgical treatment is necessary. In the case of a rigid hymen, surgical defloration is performed as planned. When forming a hematometer or hematocolpos, emergency surgical treatment is indicated. Under anesthesia, the hymen is dissected, blood clots are removed, the vagina and uterine cavity are sanitized. At the final stage, hymenoplasty is performed.
Prognosis and prevention
With an isolated anomaly of the hymen, which is not combined with additional defects of the genitals, the prognosis is satisfactory. After treatment, a short recovery period is required, the menstrual cycle is normalized, there are no obstacles to sexual activity and reproductive function disorders. If there are other congenital anomalies, the prognosis depends on the severity and the possibility of their elimination.
Prevention of genital anomalies in girls is carried out by non-specific methods. Women planning pregnancy need to eat properly and in a balanced way, eliminate the influence of toxic substances, and reduce stress levels. To reduce the risk of any abnormalities, closely related marriages and pregnancy at a young age are avoided.
