What is an imperforated hymen?

I recently took my three-year-old daughter for a check-up. The doctor said she has an imperforated hymen. What is this and is it a severe and urgent problem?

Imperforate hymen is a congenital anomaly of the lower part of the female genital tract, at the level of the vagina. The normal hymen is a ring of tissue that allows excretions to pass through its opening – in the case of the newborn girl, because the newborn is exposed to mother’s hormones while in the womb, and, later on, menstrual blood. The diagnosis is often made in the newborn period when the pediatrician sees a bulge (the obstructed lower part of the genital tract) in the vagina, or at adolescence when a girl fails to have menstrual periods and, again, a bulge (this time filled with menstrual blood that can’t escape) is visible. Imperforate hymen is treated with surgery to open up the blockage.

Imperforate hymen should not be confused with the far more common labial adhesions, in which the labia (the small lips of skin that surround the entrance to the vagina) appear partially or completely blocked by a shiny membrane. The labia in little girls are relatively sticky because they don’t yet have estrogen, which at puberty helps to keep them apart. For labial adhesions, your pediatrician may be able to gently spread the labia apart or suggest a short course of estrogen cream. No operation is necessary. Should there be any question about the diagnosis, seek a second opinion from an experienced pediatrician, a pediatric gynecologist or a pediatric surgeon.

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