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Imperforate Hymen (Treatment)
eMedicine Pediatrics, 2014Treatment Medical Therapy Medical therapy has no role in the management of imperforate hymen because the retained secretions are typically sterile.
Surgical Therapy Surgical intervention for imperforate hymen should require only 1 definitive procedure to evacuate the retained secretions and to ensure the maintenance of patency.
Simple drainage of the material confined beyond the hymen is contraindicated because it does not allow for adequate drainage of the thick fluid, it is not definitive, and it increases the risk of infection (pyometras).
Simple incision of the hymen may be associated with postoperative stenosis with strictures, and it is not the method generally preferred at many centers.
An elliptical excision of the membrane is performed close to the hymenal ring, followed by evacuation of the obstructed material.
Avoid compressing the uterus and fallopian tubes to speed evacuation of the trapped contents after the hymen is incised.
Preoperative Details After the appropriate diagnostic studies are performed, an outpatient procedure to be done under general anesthesia is scheduled.
Distinguishing an imperforate hymen from a transverse vaginal septum is important because the latter requires a relatively extensive procedure to reconstruct a functional vaginal tract and because it has implications in terms of reduced fertility.
The clinical and radiologic distinction between the conditions is based on the presence of a thin distal membrane in an imperforate hymen versus a thick, proximal septum in a transverse vaginal septum.
Transverse vaginal septum cannot be treated with a cruciate incision, and imperforate hymen does not require a procedure more extensive than hymenotomy.
In contrast to imperforate hymen, transverse vaginal septum poses some concern about future pregnancy outcomes.