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New Treatments for Imperforate Hymen

The imperforate hymen is most readily evident in neonates, often bulging with a mucoid substance and a distended, bright red, hymeneal curtain and red to pink labia minora and majora. Later in the neonatal period, the findings of an imperforate hymen become bland and undetectable except by ultrasound. 

After menarche, imperforate hymen may become evident as an abdominal mass when accumulated menstrual blood forms a hematocolpos. In the evaluation of abdominal masses in girls who have not yet menstruated, preoperative confirmation of hymeneal patency is imperative to avoid unnecessary tests.

Imperforate hymen requires surgical intervention before the onset of menarche to avoid hematocolpos. Because the risks of general anesthesia are greatest in the first 6 months of life, surgical intervention should be delayed until the perimenarchal period  because the tissues are naturally re-estrogenized and thus heal more readily and because children can be cognizant and participatory of the imperforate himen .

At this age, although most patients prefer general anesthesia, some have the ability to cooperate with an office hymenotomy.

It is important to provide patients with a choice so that they can make their own decisions. This empowers them and encourages them to take an active part in their gynecologic health. The important subliminal message is that their reproductive functions are something they have control over.