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Imperforate Hymen: A Comprehensive Systematic Review

Authors
 Keum Hwa Lee  ;  Ji Sun Hong  ;  Hyuk Jun Jung  ;  Hyun Ki Jeong  ;  Seo Jin Moon  ;  Woo Hyun Park  ;  Yoon Mi Jeong  ;  Seung Won Song  ;  Yongjune Suk  ;  Min Ji Son  ;  Jae Jung Lim  ;  Jae Il Shin 
Citation
 Journal of Clinical Medicine, Vol.8(1) : 56, 2019 
Journal Title
 Journal of Clinical Medicine 
Issue Date
2019
Keywords
abdominal pain ; genitourinary symptoms ; hymenectomy ; hymenotomy ; imperforate hymen ; improvement ; systematic review
Abstract
Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed, Scopus and Medline databases was performed for sources published up to 3 July 2018 for English-language studies with the term "imperforate hymen". The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.
Files in This Item:
T201900337.pdf Download
DOI
10.3390/jcm8010056
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
신재일(Shin, Jae Il) ORCID logo https://orcid.org/0000-0003-2326-1820
이금화(Lee, Keum Hwa) ORCID logo https://orcid.org/0000-0002-1511-9587
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167602
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