The hymen is a thin membrane. It most often covers part of the opening of the vagina. Imperforate hymen is when the hymen covers the whole opening of the vagina.
Imperforate hymen is the most common type of blockage of the vagina.
Imperforate hymen is something a girl is born with. No one knows why this happens. There is nothing that the mother did to cause it.
Girls can be diagnosed with imperforate hymen at any age. It is most often diagnosed at birth or later at puberty.
At birth or early childhood, the health care provider may see that there is no opening in the hymen during a physical exam.
At puberty, girls usually do not have any problems from an imperforate hymen until they start their period. The imperforate hymen blocks the blood from flowing out. As the blood backs up the vagina, it causes:
- Mass or fullness in the lower part of the belly (from the build up of blood that can't come out)
- Stomach pain
- Back pain
- Problems with urinating and bowel movements
The provider will do a pelvic exam. They may also do some tests like a pelvic ultrasound. They have to be sure that the problem is imperforate hymen and not another problem. The provider may recommend that the girl see a specialist to make sure that the diagnosis is imperforate hymen.
A minor surgery can fix an imperforate hymen. The surgeon makes a small cut or incision and removes the extra hymen membrane.
- Girls who are diagnosed with imperforate hymen as babies most often have surgery when they are older and have just started puberty. Their breasts are starting to grow and they have a little bit of pubic hair. But they do not have their period yet.
- Girls who are diagnosed when they are older have the same surgery. The surgeon also makes sure that the old menstrual blood comes out.
Girls recover from this surgery in a few days.
After surgery, the girl may have to insert dilators into the vagina for 15 minutes each day. A dilator looks like a tampon. This keeps the incision from closing on itself and keeps the vagina open.
After girls recover from the surgery, they will have normal periods. They can use tampons, have normal sexual intercourse, and have children.
When to Call the Doctor
Call the health care provider if:
- There are signs of infection after surgery, such as pain, pus, or fever.
- The hole in the vagina seems to be closing. The dilator will not go in or there is a lot of pain when it is inserted.
Kaefer M. Management of abnormalities of the genitalia in girls. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 149.
Sucato GS, Murray PJ. Pediatric and adolescent gynecology. In: Zitelli, BJ, McIntire SC, Norwalk AJ, eds. Atlas of Pediatric Diagnosis. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 18.
Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.