Primary amenorrhea with transverse vaginal septum and scant hematocolpos: A case report


Background: A genital outflow tract obstruction is an uncommon cause of primary amenorrhea. If ovulation occurs, menstrual bleeding is prevented. Patients typically present with abdominal/pelvic pain due to hematocolpos. Absence of significant hematocolpos could indicate a secondary source of primary amenorrhea and be challenging to the clinical diagnosis. Case: 17 year-old patient with primary amenorrhea, appropriate Tanner staging secondary sex characteristics, and transverse vaginal septum presents with virtual absence of hematocolpos. After vaginal septum resection, the patient began menstruating, although only evidenced by two cycles of vaginal spotting. Conclusion: Significant hematocolpos is an expected sequella of distal outlet obstruction when collated with secondary sexual characteristics. Absence of such along with suboptimal return of menstruation reflects pathophysiology which may be attributed to a coexistent disorder of the hypothalamus or higher central nervous system function.

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Homa, L. , Thomas, S. and Sanfilippo, J. (2012) Primary amenorrhea with transverse vaginal septum and scant hematocolpos: A case report. Open Journal of Pediatrics, 2, 87-91. doi: 10.4236/ojped.2012.21015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Herman-Giddens, M.E., Slora, E.J., Wasserman, R.C., Bourdony, C.J., Bhapkar, M.V., Koch, G.G., et al. (1997) Secondary sexual characteristics and menses in young girls seen in office practice: A study from the pediatric research in office settings network. Pediatrics, 99, 505-512. doi:10.1542/peds.99.4.505
[2] Practice Committee of the American Society for Reproductive Medicine (2008) Current evaluation of amenorrhea. Fertility and Sterility, 90, 219-225. doi:10.1016/j.fertnstert.2008.08.038
[3] Reindollar, R.H., Byrd, J.R. and McDonough, P.G. (1981) Delayed sexual development: A study of 252 patients. American Journal of Obstetrics & Gynecology, 140, 371.
[4] Deligeoroglou, E., Athanasopoulos, N., Tsimaris, P., Dimopoulos, K.D., Vrachnis, N. and Cretsas, G. (2010) Evaluation and management of adolescent amenorrhea. Annals of the New York Academy of Sciences, 1205, 23-32. doi:10.1111/j.1749-6632.2010.05669.x
[5] Stein, A.L., Levenick, M.N. and Kletzky, O.A. (1989) Computed tomography versus magnetic resonance imaging for the evaluation of suspected pituitary adenomas. Obstetrics & Gynecology, 73, 996-999. doi:10.1097/00006250-198906000-00018
[6] Rock, J.A., Zacur, H.A., Dlugi, A.M., et al. (1982) Pregnancy success rates following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstetrics & Gynecology, 59, 448-451.
[7] Golden, N.H. and Carlson, J.L. (2008) The pathophysiology of amenorrhea in the adolescent. Annals of the New York Academy of Sciences, 1135, 163-178. doi:10.1196/annals.1429.014
[8] Speroff, L. and Fritz, M. (2005) Clinical gynecology, endocrinology and infertility. 7th Edition, Williams and Wilkins, Lippincott, 438-439.
[9] Welt, C.K., Chan, J.L., Bullen, J., et al. (2004) Recombinant human leptin in women with hypothalamic amenorrhea. The New England Journal of Medicine, 351, 987- 997. doi:10.1056/NEJMoa040388
[10] Gordon, C. (2010) Functional hypothalamic amenorrhea. The New England Journal of Medicine, 363, 365-371. doi:10.1056/NEJMcp0912024
[11] Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J. and Warren, M.P. (2007) American college of sports medicine position stand: The female athlete triad. Medicine & Science in Sports & Exercise, 39, 1867-1882.
[12] Amortegui, A.J., Kanbour, A.I. and Silverstein, A. (1979) Diffuse vaginal adenosis associated with imperforate hymen. Obstetrics & Gynecology, 53, 760-762.
[13] Sailer, J.F. (1979) Hematometra and hematocolpos: Ultrasound findings. American Journal of Roentgenology, 132, 1010-1011.
[14] Wenof, M., Reyniak, J.V., Novendstern, J. and Castadot, M.J. (1979) Transverse vaginal septum. Obstetrics & Gynecology, 54, 60-64. doi:10.1097/00006250-197907000-00015
[15] Rock, J.A., Zacur, H.A., Dlugi, A.M., Jones, H.W. Jr. and TeLinde, R.W. (1982) Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstetrics & Gynecology, 59, 448-451.
[16] Shaw, L.M., Jones, W.A. and Brereton, R.J. (1983) Imperforate hymen and vaginal atresia and their associated anomalies. Journal of the Royal Society of Medicine, 76, 560-566.
[17] Letts, M. and Haasbeek, J. (1990) Hematocolpos as a cause of back pain in premenarchal adolescents. Journal of Pediatric Orthopaedics, 10, 731-732. doi:10.1097/01241398-199011000-00005
[18] McIvor, R.A. (1990) Haematocolpos once-in-a-lifetime cause of recurrent abdominal pain. Archives of Emergency Medicine, 7, 51-52.
[19] Catapano, M., Loscalzo, J. and Sama, A. (1995) Imperforate hymen with bilateral hydronephrosis: An unusual emergency department diagnosis. Journal of Emergency Medicine, 13, 337-339. doi:10.1016/0736-4679(95)00008-X
[20] Polasek, P.M., Erickson, L.D. and Stanhope, C.R. (1995) Transverse vaginal septum associated with tubal atresia. Mayo Clinic Proceedings, 70, 965-968. doi:10.4065/70.10.965
[21] Peterson-Sweeney, K.L. and Stevens, J. (1996) 13-year- old female with imperforate hymen. Nurse Practitioner, 21, 90-94. doi:10.1097/00006205-199608000-00008
[22] Kushnir, O., Garde, K. and Blankstein, J. (1997) Rectal sonography for diagnosing hematocolpometra. A case report. Journal of Reproductive Medicine, 42, 519-520.
[23] Ahmed, S., Morris, L.L. and Atkinson, E. (1999) Distal mucocolpos and proximal hematocolpos secondary to concurrent imperforate hymen and transverse vaginal septum. Journal of Pediatric Surgery, 34, 1555-1556. doi:10.1016/S0022-3468(99)90129-X
[24] Bakos, O. and Berglund, L. (1999) Imperforate hymen and ruptured hematosalpinx: A case report with a review of the literature. Journal of Adolescent Health, 24, 226-228. doi:10.1016/S1054-139X(98)00077-9
[25] Buick, R.G. and Chowdhary, S.K. (1999) Backache: A rare diagnosis and unusual complication. Pediatric Surgery International, 15, 586-587. doi:10.1007/s003830050680
[26] Hall, D.J. (1999) An unusual case of urinary retention due to imperforate hymen. Journal of Accident & Emergency Medicine, 16, 232-233. doi:10.1136/emj.16.3.232
[27] Rana, A., Manandhar, B., Amatya, A., Baral, J., Gurung, G., Giri, A. and Giri, K. (2002) Mucocolpos due to complete transverse septum in middle third of vagina in a 17-year-old girl. Journal of Obstetrics and Gynaecology Research, 28, 86-88. doi:10.1046/j.1341-8076.2002.00021.x
[28] Ali, A., Cetin, C., Nedim, C., Kazim, G. and Cemalettin, A. (2003) Treatment of imperforate hymen by application of Foley catheter. European Journal of Obstetrics & Gynecology and Reproductive Biology, 106, 72-75. doi:10.1016/S0301-2115(02)00214-2
[29] Chircop, R. (2003) A case of retention of urine and haematocolpometra. European Journal of Emergency Medicine, 10, 244-245. doi:10.1097/00063110-200309000-00019
[30] Liang, C.C., Chang, S.D. and Soong, Y.K. (2003) Long-term follow-up of women who underwent surgical correction for imperforate hymen. Archives of Gynecology and Obstetrics, 269, 5-8. doi:10.1007/s00404-002-0423-3
[31] Joki-Erkkil?, M.M. and Heinonen, P.K. (2003) Presenting and long-term clinical implications and fecundity in females with obstructing vaginal malformations. Journal of Pediatric and Adolescent Gynecology, 16, 307-312. doi:10.1016/S1083-3188(03)00157-8
[32] Stone, S.M. and Alexander, J.L. (2004) Images in clinical medicine. Imperforate hymen with hematocolpometra. The New England Journal of Medicine, 12, e6.
[33] Sakalkale, R. and Samarakkody, U. (2005) Familial occurrence of imperforate hymen. Journal of Pediatric and Adolescent Gynecology 18, 427-429. doi:10.1016/j.jpag.2005.06.008
[34] Nazir, Z., Rizvi, R.M., Qureshi, R.N., Khan, Z.S. and Khan, Z. (2006) Congenital vaginal obstructions: Varied presentation and outcome. Pediatric Surgery International, 22, 749-753. doi:10.1007/s00383-006-1730-8
[35] Walsh, B. and Shih, R. (2006) An unusual case of urinary retention in a competitive gymnast. Journal of Emergency Medicine, 31, 279-281. doi:10.1016/j.jemermed.2006.06.001
[36] Ambegaonkar, G. and Mulik, R. (2007) To pee or not to pee. Archives of Disease in Childhood, 92, 865. doi:10.1136/adc.2007.125203
[37] Acar, A., Balci, O., Karatayli, R., Capar, M. and Colakoglu, M.C. (2007) The treatment of 65 women with imperforate hymen by a central incision and application of Foley catheter. BJOG, 114, 1376-1379. doi:10.1111/j.1471-0528.2007.01446.x
[38] Dane, C., Dane, B., Erginbas, M. and Cetin, A. (2007) Imperforate hymen—A rare cause of abdominal pain: Two cases and review of the literature. Journal of Pediatric and Adolescent Gynecology, 20, 245-247. doi:10.1016/j.jpag.2006.12.003
[39] Mattern, M. and Staab, E. (2007) I-131 localization in hematocolpos: A differential diagnosis consideration for pelvic I-131 uptake. Clinical Nuclear Medicine, 32, 659-660. doi:10.1097/RLU.0b013e3180a1ad35
[40] Buyukbayrak, E.E., Ozyapi, A.G., et al. (2007) Imperforate hymen: A new benign reason for highly elevated serum CA 19.9 and CA 125 levels. Archives of Gynecology and Obstetrics, 277, 475-477. doi:10.1007/s00404-007-0493-3
[41] Kumar, K. and Waseem, M. (2008) An uncommon cause of abdominal pain in an adolescent. Southern Medical Journal, 101, 1065-1066. doi:10.1097/SMJ.0b013e31817fe318
[42] Adali, E., Kurdoglu, M., Yildizhan, R. and Kolusari, A. (2009) An overlooked cause of acute urinary retention in an adolescent girl: A case report. Archives of Gynecology and Obstetrics, 279, 701-703. doi:10.1007/s00404-008-0778-1
[43] Basaran, M., Usal, D. and Aydemir, C. (2009) Hymen sparing surgery for imperforate hymen: Case reports and review of literature. Journal of Pediatric and Adolescent Gynecology, 22, e61-e64. doi:10.1016/j.jpag.2008.03.009
[44] Gyimadu, A., Sayal, B., Guven, S. and Gunalp, G.S. (2009) Hematocolpos causing severe urinary retention in an adolescent girl with imperforate hymen: An uncommon presentation. Archives of Gynecology and Obstetrics, 280, 461-463. doi:10.1007/s00404-009-0931-5
[45] Tang, P.M., Chan, K.W., et al. (2009) Imperforate hymen: Cause of lower abdominal pain in teenage girls. Singapore Medical Journal, 50, e378-e379.
[46] Saks, E.K., Vakili, B. and Steinberg, A.C. (2009) Primary amenorrhea with an abdominal mass at the umbilicus. Journal of Pediatric and Adolescent Gynecology, 22, e1- e3. doi:10.1016/j.jpag.2008.07.016
[47] Dennie, J., Pillay, S., Watson, D. and Grover, S. (2010) Laparoscopic drainage of hematocolpos: A new treatment option for the acute management of a transverse vaginal septum. Fertility and Sterility, 94, 1853-1857. doi:10.1016/j.fertnstert.2009.09.041

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