Imperforate Hymen Workup

Updated: Nov 15, 2021
  • Author: Paula J Adams Hillard, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
  • Print

Laboratory Studies

No laboratory studies are indicated for the diagnosis of imperforate hymen other than imaging studies required to clarify the diagnosis or laboratory studies indicated as preoperative studies related to any underlying medical conditions.


Imaging Studies

Pelvic and abdominal ultrasonography

Pelvic ultrasonography is the essential initial diagnostic modality to confirm the diagnosis, and it may be performed via the transabdominal, transperineal, or transrectal route. A pelvic sonogram most often demonstrates a hematocolpos, hematometra, and, possibly, hematosalpinges when the diagnosis is made after the onset of endometrial shedding.

A pelvic sonogram may suggest that the diagnosis is not an imperforate hymen but is a more complicated müllerian abnormality of vertical or lateral fusion (eg, obstructing vaginal septa, müllerian agenesis). In this case, further imaging studies are indicated, typically with MRI. [27]

A pelvic examination under anesthesia also may be necessary in planning the repair of complex anomalies if the results from imaging studies are inconclusive.

Renal anomalies should be excluded when other müllerian defects of the uterus and vagina are suspected. An abdominal ultrasonogram may show duplication or absence of the collecting system. [28]

Pelvic and abdominal MRI

If the diagnosis of imperforate hymen is not absolutely certain based on physical examination or pelvic ultrasonographic findings, an MRI should be obtained to clearly define the anatomy prior to any planned surgical procedure.


Other Tests

Pelvic examination under anesthesia

Prior to making a decision about appropriate surgical repair of an anomaly that may be more complex than a simple imperforate hymen, a pelvic examination under anesthesia may aid surgical planning.

Consultation with experienced gynecologists may be appropriate, as may be the involvement of an interdisciplinary team if the anomaly appears to be complex.


Diagnostic Procedures

No diagnostic procedures are indicated for a classic presentation and findings of imperforate hymen. If the diagnosis is in question (imperforate hymen vs transverse vaginal septum), additional imaging studies are indicated (see Imaging Studies). A clinician who is not experienced or absolutely confident of the diagnosis and is not experienced with the definitive surgical therapeutic procedure should refer the patient to a clinician with experience and expertise.

Pelvic examination under anesthesia (see Other Tests) may be helpful in clarifying complex anomalies.

Important: Attempts at needle aspiration to reduce the size of or drain the obstructed fluid collection should absolutely be avoided to prevent introduction of bacteria into a previously sterile environment, which would place the individual at risk for infectious complications and its sequelae.