Hymen atresia is complete overgrowth, obstruction of the hymenal septum, which prevents the vaginal and menstrual secretions from coming out. It is more often manifested during puberty; it is characterized by false amenorrhea, pain, hematocolposom, sometimes – hematometer and hematosalpinx, inability to have sexual intercourse. Disease can be complicated by pyohematometry and pyohematosalpinx. Treatment consists in a cruciform dissection of the hymen.
With atresia of the hymen, there is completely no lumen or natural opening connecting the internal and external parts of the genitals. The hymen with atresia is dense and completely blocks the entrance to the vagina. According to etiological factors, gynecology distinguishes between congenital atresia (nonperforated hymen) and secondary overgrowth of the hymen caused by cicatricial or adhesive processes.
Primary (congenital) hymen atresia is a malformation of intrauterine development. The formation of the hymen occurs at the 19th week of intrauterine development from the distal sections of the paramesonephral canal, followed by the formation of holes in the hymenal septum. In violation of these processes, atresia of the hymen develops.
Secondary atresia of a normally formed hymen may be associated with the consequences of childhood infections (measles, scarlet fever, diphtheria, etc.), specific and nonspecific vulvovaginitis, scarring or adhesions.
In premenarchal girls, disease usually does not manifest clinically. In rare cases, the accumulation of secretions in the vagina (hydrocolpos, mucocolpos) causes pressure on neighboring organs, causing a clinic of urination disorders. Symptoms usually coincide with the onset of menstruation. In the absence of menstrual discharge, girls have cyclically recurring spastic pain in the lower back and lower abdomen. Due to the lack of the possibility of getting out, menstrual blood accumulates in the vagina limited by the hymen, stretching its walls – a hematocolpos is formed. In the future, with atresia of the hymen, there may be an accumulation of blood in the cavity and tubes of the uterus (hematometer and hematosalpinx).
With the development of mucocolpos in girls, an examination of the external genitals reveals a swelling of the hymen between the labia in the form of a tumor-like formation of a yellowish-grayish hue the size of a cherry or pigeon egg. With hymen atresia, puberty patients complain of regular, monthly pains of a bursting cramping nature, in the lower abdomen, the absence of menstrual bleeding.
When examined on the chair, the normal structure and development of the external genitalia and the absence of an entrance to the vagina are found. Hematocolpos looks like a tumor-like, bluish-colored protrusion of the hymen from the genital slit. With atresia of the hymen through the rectum, a stretched vagina of a tight elastic consistency with an uneven surface is determined. During recto-abdominal examination, the uterus is palpated above the womb in the form of a painful elastic tumor.
With hymen atresia, the fibrotic hymen is dissected (hymenotomy, surgical defloration). After preparing the perineum and the surgical field, the hymen is infiltrated with 0.5% novocaine solution. Having separated the labia, the hymen in the place of protrusion is longitudinally dissected between the clamps. Blood clots and liquid blood are evacuated through the surgical incision. The longitudinal incision is extended down and up to the base, complementing it with a cross-shaped transverse dissection of the hymen. The vagina is completely freed from bloody masses. To prevent repeated atresia of the hymen, the edges of the incision are wrapped with separate catgut sutures.
If disease is accompanied by hematosalpinx, the first stage of the operation is laparotomy, and then hymenotomy. To exclude an ascending infection, it is not recommended to douche and tampon the vagina.
Complications and prevention
The development of hematosalpinx is fraught with the addition of infection and the development of pyohematosalpinx. The key to the prevention of primary hymen atresia is to ensure the conditions of normal embryogenesis and fetal development, pregnancy management in specialized obstetric and gynecological institutions. To prevent secondary overgrowth of the hymen, it is necessary to monitor girls after infections, prevent vulvovaginitis. Proper hymenotomy usually excludes the development of repeated hymen atresia.