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J. Clin. Med. 2019, 8(1), 56; https://doi.org/10.3390/jcm8010056

Imperforate Hymen: A Comprehensive Systematic Review

1
Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 120-752, Korea
2
Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
3
Yonsei University Wonju College of Medicine, Wonju 26426, Korea
4
Yonsei University College of Medicine, Seoul 120-752, Korea
5
Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 19 November 2018 / Revised: 29 December 2018 / Accepted: 3 January 2019 / Published: 7 January 2019
(This article belongs to the Section Obstetrics & Gynecology)
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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 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. View Full-Text
Keywords: imperforate hymen; abdominal pain; genitourinary symptoms; hymenectomy; hymenotomy; improvement; systematic review imperforate hymen; abdominal pain; genitourinary symptoms; hymenectomy; hymenotomy; improvement; systematic review
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MDPI and ACS Style

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.; Lim, J.J.; Shin, J.I. Imperforate Hymen: A Comprehensive Systematic Review. J. Clin. Med. 2019, 8, 56.

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