The hymen is a membrane partially covering the external vaginal opening. Its elasticity and condition can vary depending on factors like sexual intercourse, disease, injury, or exercise. An imperforate hymen is a congenital condition where the hymen completely obstructs the vagina without an opening. It occurs in around 1 in 1000 births and is usually diagnosed when menstrual blood accumulates in adolescent girls. Surgical incision of the hymen is required to treat an imperforate hymen and relieve symptoms like pelvic pain and menstrual retention. Complications can include infections if not treated.

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 Hymen
Definition
The hymen is a membrane that surrounds or partially covers the
external vaginal opening.
The effects of sexual intercourse on the hymen are variable:
- If the hymen is sufficiently elastic, it may return to nearly its original
condition.
- In other cases, there may be remnants, or it may appear completely absent
after repeated penetration.
- Additionally, the hymen may be lacerated by disease, injury,
medical examination, masturbation or physical exercise.
For these reasons, the state of the hymen is not a conclusive indicator
of virginity.
Types Of hymen
1. Normal hymen: This is the most common hymen type among women,
in which it takes the shape of a half moon covering the vagina partially.
2. Microperforate hymen: That's when the hymen covers the whole vagina
with only a small opening.
3. Septate hymen: The type of hymen where the membrane has two
openings instead of one.
4. Cribriform Hymen: Characterized by small holes that allow menstrual
fluid to flow out of vagina.
5. Imperforate hymen: This is when the hymen covers the entire vaginal
area with no openings at all. This type is usually detected at an early age,
as it causes a constant abdominal pain, and it usually requires a surgical
treatment. Due to its nature, menstrual blood can’t flow out which causes
that pain, and that's why that case needs a medical examination.

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imperforate hymen
- is a congenital disorder where a hymen without an opening completely
obstructs the vagina.
- It is caused by a failure of the hymen to perforate during fetal
development.
- It is the most common obstructive anomaly of the female
reproductive tract.
- occurs in approximately 1/1000 newborn girls.

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- It is most often diagnosed in adolescent girls when menstrual blood
accumulates in the vagina and sometimes also in the uterus.
- It is treated by surgical incision of the hymen.
Signs And Symptoms
- In newborns may present with acute urinary retention.
- In adolescent, the most common symptoms are cyclic pelvic pain and
amenorrhea;
other symptoms associated with - hematocolpos (a medical condition in
which the vagina fills with menstrual blood) include urinary retention,
constipation, back pain, nausea, and diarrhea.

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Complications
1. peritonitis (inflammation of the peritoneum)
2. mucometrocolpos (dilatation of the vaginal canal and uterus due to
mucus accumulation)
3. hematometrocolpos (dilatation due to accumulation of menstrual
fluid)
4. UTI
5. urinary retention, constipation
Management
Before surgical intervention in adolescents, symptoms can be relieved by
the combined oral contraceptive pill taken continuously to suppress the
menstrual cycle or NSAIDs to relieve pain.
Surgical treatment of the imperforate hymen by hymenotomy (removal or
opening of the hymen)
Hymenotomy surgery:
---- Video. "Imperforate hymen with late repair" Youtube