Hymen

  • Mohamed A. Baky Fahmy
Chapter

Abstract

The hymen is named after the God of marriage “Hymenaios” in classical Greek mythology; the word “hymen” is usually synonymous with virgin membrane. Human female is the only primate member to possess a hymen. Variants in hymenal configuration are often seen varying from hymen semilunaris, anularis, cribriformis, septus, fimbriatus, navicularis. Estrogen withdrawal at an older age may convert some of the annular types into this crescentric-shaped configuration.

Hymen imperforatus is an external congenital genital anomaly when a nonperforated membrane of the hymenal tissue covers the entrance into the vagina, the membrane composed of vaginal epithelium and epithelium of the urogenital sinus interposed by mesoderm. Imperforation of hymenal tissue may also be present in variations as microperforate, septate, stenotic, or cribriform hymen. In hydrocolpos, the newborn may present with a whitish bulging mass filling the introitus (hydrocolpos or mucocolpos); rarely, the vaginal content may be infected, and the neonate may present with a distended vagina and uterus with pure pus; especially if a fistula with the urogenital sinus is present, this is called pyocolpos; neonatal hydrometrocolpos is a hydrocolpos with extensive retained fluid resulting in gross distension of the uterus and vagina with fluid due to congenital vaginal outflow obstruction. Hematocolpos is defined as an accumulation of menstrual blood above an imperforate hymen leading subsequently to the distention of the vagina to a variable degree; usually, it is presented after the age of menarche when the young girl presents with cyclic abdominal pain.

Transverse vaginal septa (TVS) may occur at any level above the hymen. It results from incomplete fusion between the vaginal components of the Mullerian ducts and the urogenital sinus.

Hymenal tag is a normal redundant hymenal tissue protruding from the floor of the vagina during the first weeks after birth. It eventually disappears without treatment, but hymenal polyps are an elongated projection of hymenal tissue protruding beyond the hymenal rim or extending from the rim itself.

Keywords

Estrogen Lidocaine Peritonitis Endometriosis Lymphedema 

References

Embryological Background

  1. 1.
    Balke JM, Boever WJ, Ellersieck MR, Seal US, Smith DA. Anatomy of the reproductive tract of the female African elephant (Loxodonta africana) with reference to development of techniques for artificial breeding. J Reprod Fertil. 1988;84:485–92.PubMedCrossRefGoogle Scholar
  2. 2.
    Frazer JE. Manual of embryology. London: Bailliere, Tindall and Cox; 1931, Fig. 266, p. 438.Google Scholar
  3. 3.
    Burel A, Mouchel T, Odent S, Tiker F, Knebelmann B, et al. Role of HOXA7 to HOXA13 and PBX1 genes in various forms of MRKH syndrome (congenital absence of uterus and vagina). J Negat Results Biomed. 2006;5:4–12.PubMedCentralPubMedCrossRefGoogle Scholar

Variation in Hymenal Development

  1. 4.
    Moore KL, Persaud TVN. Before we are born. Essentials of embryology and birth defects. 5th ed. Philadelphia: WB Saunders; 1998.Google Scholar
  2. 5.
    Mor N, Merlob P, Reisner SH. Types of hymen in the newborn infant. Eur J Obstet Gynecol Reprod Biol. 1986;22(4):225–8.PubMedCrossRefGoogle Scholar
  3. 6.
    Berenson AB, Heger AH, Hayes JM, Bailey RK, Emans SJ. Appearance of the hymen in prepubertal girls. Am Acad Pediatr. 1992;89(3):387–94.Google Scholar

Imperforate Hymen (IH)

  1. 7.
    Godefroy M. Imperforation de la membrane hymen. Lancette Fr Gaz Hop. 1856;29:567.Google Scholar
  2. 8.
    Estel C, Baum M, Tausch S. Diagnosis and therapy of imperforate hymen. Zentralbl Gynakol. 1995;117:108–10.PubMedGoogle Scholar
  3. 9.
    Mahoney PJ, Chamberlain JW. Hydrometrocolpos in infancy – congenital atresia of the vagina with abnormally abundant cervical secretions. J Pediatr. 1940;17:772–80.CrossRefGoogle Scholar
  4. 10.
    Laufer MR, Goldstein DP, Hendren WH. Structural anomalies of the female reproductive tract. In: Emans SJH, Laufer MR, Goldstein DP, editors. Pediatric and adolescent gynecology. Philadelphia: Lippincott; 2005. p. 334–416.Google Scholar
  5. 11.
    Davis ME, Pearl SA. Biology of the human vagina in pregnancy. Am J Obstet Gynecol. 1938;35:77.Google Scholar
  6. 12.
    Goodman FR, Bacchelli C, Brady AF, Brueton LA, Fryns JP, et al. Novel HOXA13 mutations and the phenotypic spectrum of hand-foot-genital syndrome. Am J Hum Genet. 2000;67:197–202.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 13.
    McKusick VA, Weilbaecher GR, Gragg GW. Recessive inheritance of a congenital malformation syndrome. JAMA. 1968;204:113–8.PubMedCrossRefGoogle Scholar
  8. 14.
    Botash AS, Jean-Louis F. Imperforate hymen: congenital or acquired from sexual abuse? Pediatrics. 2001;108(3):53–7.CrossRefGoogle Scholar
  9. 15.
    Bakos O, Berglund L. Imperforate hymen and ruptured hematosalpinx: a case report with a review of the literature. J Adolesc Health. 1999;24:226–8.PubMedCrossRefGoogle Scholar
  10. 16.
    Spencer R, Levy DM. Hydrometrocolpos. Ann Surg. 1962;155:558–71.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 17.
    Liang CC, Chang SD, Soong YK. Long-term follow-up of women who underwent surgical correction for imperforate hymen. Arch Gynecol Obstet. 2003;269:5–8.PubMedCrossRefGoogle Scholar

Vaginal Septa

  1. 18.
    Celayir AC, Kurt G, Sahin C, Cici I. Spectrum of etiologies causing hydrometrocolpos. J Neonatal Surg. 2013;2(1):5.Google Scholar
  2. 19.
    Burgis J. Obstructive Müllerian anomalies: case report, diagnosis, and management. Am J Obstet Gynecol. 2001;185(2):338–44.PubMedCrossRefGoogle Scholar
  3. 20.
    Heinonen PK. Complete septate uterus with longitudinal vaginal septum. Fertil Steril. 2006;85(3):700–5.PubMedCrossRefGoogle Scholar

Hymenal Polyp and Tags

  1. 21.
    Borglinn E, Selander P. Hymenal polyps in newborn infants. Acta Paediatr. 1962;51(S135):28–31.CrossRefGoogle Scholar
  2. 22.
    Nucci MR, Young RH, Fletcher CDM. Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an under recognized lesion often misdiagnosed as sarcoma. Am J Surg Pathol. 2000;24:231–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Mohamed A. Baky Fahmy
    • 1
  1. 1.CairoEgypt

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