Microperforated hymen: a case of delayed diagnosis

  • Olívia Maria Ferraz Ferrarini Medical School – Universidade de São Paulo, São Paulo/SP
  • Lívia Oliveira Munhoz Department of Gynecology – Hospital das Clínicas – Faculdade de Medicina – Universidade de São Paulo, São Paulo/SP
  • Ricardo Santos Simões Department of Obstetrics – Hospital Universitário – Universidade de São Paulo, São Paulo/SP
  • Pérsio Yvon Adri Cezarino Department of Obstetrics – Hospital Universitário – Universidade de São Paulo, São Paulo/SP
  • Mauricio Paulo Ângelo Mieli Department of Obstetrics – Hospital Universitário – Universidade de São Paulo, São Paulo/SP
  • Paulo Francisco Ramos Margarido Department of Obstetrics – Hospital Universitário – Universidade de São Paulo, São Paulo/SP
  • Fábio José Guida Diagnostic Imaging Service – Hospital Universitário – Universidade de São Paulo, São Paulo/SP
  • Edmund Chada Baracat Clinical Division of Gynaecological – Faculdade de Medicina – Universidade de São Paulo, São Paulo/SP
Keywords: Hymen, Dysmenorrhea, Dyspareunia, Surgical Procedures, Operative

Abstract

Although the incidence of microperforated hymen (MH) is unclear, this hymenal subocclusive anomaly is considered a rare entity. Differently from imperforated hymen, MH may be asymptomatic until puberty when the women’s quality of life is jeopardized. Depending on the size of the microperforation, MH’s clinical features me be very similar to those found in imperforated hymen cases. However, MH may present infectious complications since the accumulated secretion retained in the vaginal canal has contact with the external environment and therefore represents a source of entry for infectious agents. The authors report a case of a 28-year-old woman who sought the gynecologist complaining of inability to have vaginal intercourse. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. Physical examination and imaging disclosed a microperforation of the hymenal membrane at 10 o’clock position. Hymenotomy under general anesthesia was undertaken. Outcome was favorable and the patient could thenceforth have a normal life. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The delayed onset of symptoms and psychological embarrassing aspects, which postpone gynecological consultation, may contribute for misdiagnoses. We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable.

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Published
2014-09-30
How to Cite
Ferrarini, O., Munhoz, L., Simões, R., Cezarino, P., Mieli, M., Margarido, P., Guida, F., & Baracat, E. (2014). Microperforated hymen: a case of delayed diagnosis. Autopsy and Case Reports, 4(3), 59-63. Retrieved from http://www.revistas.usp.br/autopsy/article/view/98479
Section
Article / Clinical Case Report