Imperforate Hymen: A Comprehensive Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Search Strategy
2.2. Extraction of Data
3. Results
3.1. Characteristics of Patients
3.2. Clinical Presentation
3.3. Treatment
3.4. Outcomes and Characteristics
3.5. Imperforate Hymen before Birth
4. Discussion
Supplementary Materials
Author Contributions
Acknowledgments
Conflicts of Interest
References
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Variables | Total Number of Patients (n = 236) |
---|---|
Number of Patients (%) | |
Age | |
Neonate (<1 month) | 26 (11.0%) |
Infant (1 month–2 years) | 13 (5.5%) |
Child (2 years–12 years) | 33 (14.0%) |
Adolescent (12 years–18 years) | 153 (64.8%) |
Adult (>18 years) | 11 (4.7%) |
Sex | |
Female | 236 (100%) |
Male | 0 (0.0%) |
Patient’s country | |
Asia | 37 (15.7%) |
Europe | 52 (22.0%) |
Africa | 13 (5.5%) |
America | 105 (44.5%) |
Middle east | 29 (12.3%) |
The number of doctors for diagnosis | |
One | 94 (40.0%) |
More than one * | 45 (19.1%) |
Gynecological history | |
Familial history of imperforate hymen | 22 (9.3%) |
Menstruation | 8 (3.4%) |
Hymenotomy or hymenectomy | 6 (2.5%) |
Abuse | 5 (2.1%) |
Central precocious puberty | 2 (0.8%) |
Previously hymen opened | 1 (0.4%) |
Labial adhesion | 1 (0.4%) |
Misdiagnosed as Müllerian agenesis treated with vaginal dilator | 1 (0.4%) |
Multiple abnormality † | |
Yes | 48 (20.3%) |
No | 188 (79.7%) |
Clinical Presentation | Total Number of Patients (n = 236) |
---|---|
Number of Patients (%) | |
General condition | |
Fever | 5 (2.1%) |
Hot flushes | 2 (0.8%) |
Lethargy | 3 (1.3%) |
Loss of appetite | 2 (0.8%) |
General discomfort | 2 (0.8%) |
Weight gain | 1 (0.4%) |
Poor feeding | 1 (0.4%) |
Cardiovascular | |
Sudden chest pain with swelling of the upper torso | 1 (0.4%) |
Tachypnea | 1 (0.4%) |
Palpable mass | 23 (9.7%) |
Respiratory | |
Respiratory distress | 2 (0.8%) |
Rapid breathing | 1 (0.4%) |
Thoracoabdominal respiration | 1 (0.4%) |
Gastrointestinal | |
Abdominal pain | 128 (54.2%) |
Abdominal discomfort | 10 (4.2%) |
Abdominal distension | 18 (7.6%) |
Constipation | 13 (5.5%) |
Diarrhea | 3 (1.3%) |
Vomiting | 5 (2.1%) |
Nausea | 5 (2.1%) |
Tenesmus | 2 (0.8%) |
Fecal frequency and urgency | 1 (0.4%) |
Inability to pass meconium | 1 (0.4%) |
Peritoneal sign | 1 (0.4%) |
Genitourinary | |
Urinary retention | 48 (20.3%) |
Urinary frequency | 12 (5.1%) |
Urinary incontinence | 4 (1.7%) |
Urinary urgency | 2 (0.8%) |
Urinary hesitancy | 1 (0.4%) |
Nocturia | 2 (0.8%) |
Renal failure | 5 (2.1%) |
Urinary tract infection | 1 (0.4%) |
Bladder distension | 1 (0.4%) |
Straining during urination | 1 (0.4%) |
Polyuria | 1 (0.4%) |
Oliguria | 1 (0.4%) |
Dysuria | 23 (9.7%) |
Abnormal menstruation * | 33 (14.0%) |
Heavy vaginal bleeding | 1 (0.4%) |
Others | 10 (4.2%) |
Perineal pain and pruritus | 1 (0.4%) |
Perineal bulge | 7 (3.0%) |
Large interlabial swelling | 1 (0.4%) |
Vaginal irritation/tenderness/fullness/swelling | 4 (1.6%) |
Problems in sexual intercourse | 1 (0.4%) |
Musculoskeletal | |
Back pain | 21 (8.9%) |
Leg pain | 2 (0.8%) |
Lower limb swelling | 2 (0.8%) |
Neurologic | |
Headache | 3 (1.2%) |
Epileptic attacks | 1 (0.4%) |
Syncope | 1 (0.4%) |
Psychiatric | |
Irritability | 1 (0.4%) |
Others † | 15 (6.4%) |
Treatment | Total Number of Patients (n = 236) |
---|---|
Number of Patients (%) | |
Surgical therapy | 197 (83.5%) |
Hymenotomy | 83 (35.2%) |
Hymenectomy | 86 (36.4%) |
Laparotomy | 5 (2.1%) |
Vaginal septum repair | 4 (1.7%) |
Vaginoplasty | 1 (0.4%) |
Vaginal canal extraction | 1 (0.4%) |
Vaginal septoplasty | 1 (0.4%) |
Vaginal orifice dilatation | 3 (1.3%) |
Perforation and dilatation of hymen | 1 (0.4%) |
Puncture of hymen | 1 (0.4%) |
Unknown surgical correction | 1 (0.4%) |
Surgical incision of the imperforate hymen | 1 (0.4%) |
Excision of fistula | 1 (0.4%) |
Simple closure of fistula | 1 (0.4%) |
Repairing urethrovaginal fistula | 1 (0.4%) |
Removal of calculi in pelvis | 1 (0.4%) |
Laparoscopic adhesiolysis | 2 (0.8%) |
Bladder suturing | 1 (0.4%) |
Anal cut back operation | 1 (0.4%) |
Abdominoperineal pull-through | 1 (0.4%) |
Medical therapy * | 9 (3.8%) |
Prophylactic antibiotics | 7 (3.0%) |
Irrigation of vaginal cavity with antibiotic solution | 1 (0.4%) |
GnRH agonist | 1 (0.4%) |
Observation | 2 (0.8%) |
None (self-limited) | 3 (1.2%) |
Unknown | 1 (0.4%) |
Outcome | Total Number of Patients (n = 236) |
---|---|
Number of Patients (%) | |
Improved | 141 (59.7%) |
Complicated * | 15 (6.6%) |
Died † | 5 (2.1%) |
Unknown | 75 (31.8%) |
Variables | Total Number of Improved Patients (n = 141) | Total Number of Complicated * Patients (n = 15) | Total Number of Deceased † Patients (n = 5) |
---|---|---|---|
Number of Patients (%) | Number of Patients (%) | Number of Patients (%) | |
Age | |||
Neonate, prenatal (<1 month) | 13 (9.2%) | 1 (6.7%) | 5 (100.0%) |
Infant (1 month–2 years) | 5 (3.5%) | 1 (6.7%) | 0 (0.0%) |
Child (2 years–12 years) | 13 (9.2%) | 2 (13.3%) | 0 (0.0%) |
Adolescent (12 years–18 years) | 101 (71.6%) | 9 (60.0%) | 0 (0.0%) |
Adult (>18 years) | 9 (6.4%) | 2 (13.3%) | 0 (0.0%) |
Patient’s country | |||
Asia | 27 (19.1%) | 3 (20.0%) | 1 (20.0%) |
Europe | 28 (19.9%) | 4 (26.7%) | 3 (60.0%) |
Africa | 8 (5.7%) | 1 (6.7%) | 1 (20.0%) |
America | 54 (38.3%) | 7 (46.7%) | 0 (0.0%) |
Middle east | 24 (17.0%) | 0 (0.0%) | 0 (0.0%) |
The number of doctors for diagnosis ‡ | |||
One | 67 (47.5%) | 9 (60.0%) | -(-%) |
More than one | 37 (26.2%) | 3 (20.0%) | -(-%) |
Gynecological history | |||
Familial history of imperforate hymen | 14 (9.9%) | 0 (0.0%) | 0 (0.0%) |
Menstruation | 5 (3.5%) | 1 (6.7%) | 0 (0.0%) |
Hymenotomy or hymenectomy | 5 (3.5%) | 0 (0.0%) | 0 (0.0%) |
Abuse | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Central precocious puberty | 2 (1.4%) | 0 (0.0%) | 0 (0.0%) |
Labial adhesion | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) |
Combined abnormality ** | |||
Yes | 26 (18.4%) | 3 (20.0%) | 5 (100.0%) |
Transverse vaginal septum | 4 (2.8%) | 1 (6.7%) | 0 (0.0%) |
No | 116 (82.3%) | 12 (80.0%) | 0 (0.0%) |
Clinical presentations | |||
Amenorrhea | 21 (14.9%) | 4 (26.7%) | 0 (0.0%) |
Abdominal pain | 86 (61.0%) | 11 (73.3%) | 0 (0.0%) |
Abdominal discomfort | 5 (3.5%) | 1 (6.7%) | 0 (0.0%) |
Back pain | 13 (9.2%) | 1 (6.7%) | 0 (0.0%) |
Abdominal distension | 13 (9.2%) | 1 (6.7%) | 1 (20.0%) |
Bladder distension | 3 (2.1%) | 0 (0.0%) | 0 (0.0%) |
Urinary frequency | 10 (7.1%) | 0 (0.0%) | 0 (0.0%) |
Urinary retention | 39 (27.7%) | 1 (6.7%) | 1 (20.0%) |
Constipation | 4 (2.8%) | 1 (6.7%) | 0 (0.0%) |
Headache | 2 (1.4%) | 1 (6.7%) | 0 (0.0%) |
Dysuria | 11 (7.8%) | 3 (20.0%) | 0 (0.0%) |
Renal failure | 5 (3.5%) | 0 (0.0%) | 0 (0.0%) |
Urinary tract infection (UTI) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Palpable mass | 12 (8.5%) | 2 (13.3%) | 0 (0.0%) |
Treatments | |||
Hymenectomy | 66 (46.8%) | 9 (60.0%) | 1 (20.0%) |
Hymenotomy | 66 (46.8%) | 3 (20.0%) | 0 (0.0%) |
Vaginoplasty | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) |
Vaginal septum repair | 4 (2.8%) | 2 (13.3%) | 0 (0.0%) |
Vaginal orifice dilatation | 2 (1.4%) | 1 (6.7%) | 0 (0.0%) |
Observation | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Prophylactic antibiotics | 5 (3.5%) | 1 (6.7%) | 0 (0.0%) |
Laparotomy | 4 (2.8%) | 0 (0.0%) | 0 (0.0%) |
Variables | Total Number of Patients (n = 17) |
---|---|
Number of Patients (%) | |
Maternal age (years) | |
<20 | 1 (5.9%) |
20–24 | 0 (0.0%) |
25–29 | 5 (29.4%) |
30–35 | 3 (17.6%) |
>35 | 6 (35.3%) |
Unknown | 2 (11.8%) |
Gravidity | |
Primipara | 7 (41.2%) |
Multipara | 7 (41.2%) |
Unknown | 3 (17.6%) |
Gestational age (wks) | |
Preterm (<38) | 13 (76.5%) |
Normal (38–42) | 3 (17.6%) |
Post-term (>42) | 0 (0.0%) |
Unknown | 1 (5.9%) |
Diagnosed abnormality * before born | |
Nothing diagnosed † | 1 (5.9%) |
Single kinds of abnormalities | 9 (52.9%) |
Hydrocolpos | 1 (5.9%) |
Hydrometrocolpos | 5 (29.4%) |
Fetal pelvic cyst/mass | 2 (11.8%) |
Hydronephrosis | 1 (5.9%) |
Two kinds of abnormalities | 5 (29.4%) |
Hydrocolpos + Fetal pelvic cyst/mass | 1 (5.9%) |
Hydrometrocolpos + Fetal pelvic cyst/mass | 1 (5.9%) |
Fetal pelvic cyst/mass + Hydronephrosis | 2 (11.8%) |
Fetal pelvic cyst/mass + Kidney pelvic dilatation | 1 (5.9%) |
Three kinds of abnormalities | 2 (11.8%) |
Hydrocolpos + Fetal pelvic cyst/mass + Hydronephrosis | 2 (11.8%) |
Treatment | |
Hymenectomy | 5 (29.4%) |
Hymenotomy | 9 (52.9%) |
Others ‡ | 3 (17.6%) |
Outcome | |
Improved | 9 (52.9%) |
Complicated | 1 (5.9%) |
Died | 1 (5.9%) |
Unknown | 6 (35.3%) |
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Lee, K.H.; Hong, J.S.; Jung, H.J.; Jeong, H.K.; Moon, S.J.; Park, W.H.; Jeong, Y.M.; Song, S.W.; Suk, Y.; Son, M.J.; et al. Imperforate Hymen: A Comprehensive Systematic Review. J. Clin. Med. 2019, 8, 56. https://doi.org/10.3390/jcm8010056
Lee KH, Hong JS, Jung HJ, Jeong HK, Moon SJ, Park WH, Jeong YM, Song SW, Suk Y, Son MJ, et al. Imperforate Hymen: A Comprehensive Systematic Review. Journal of Clinical Medicine. 2019; 8(1):56. https://doi.org/10.3390/jcm8010056
Chicago/Turabian StyleLee, Keum Hwa, 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, and et al. 2019. "Imperforate Hymen: A Comprehensive Systematic Review" Journal of Clinical Medicine 8, no. 1: 56. https://doi.org/10.3390/jcm8010056
APA StyleLee, K. H., Hong, J. S., Jung, H. J., Jeong, H. K., Moon, S. J., Park, W. H., Jeong, Y. M., Song, S. W., Suk, Y., Son, M. J., Lim, J. J., & Shin, J. I. (2019). Imperforate Hymen: A Comprehensive Systematic Review. Journal of Clinical Medicine, 8(1), 56. https://doi.org/10.3390/jcm8010056