Although visualization of an imperforate hymen can occur on genital inspection with labial separation, the majority of patients present with history of amenorrhea, recurrent lower abdominal cyclical pain, or lower abdominal midline mass. Severe, long-standing obstruction may cause urinary retention, constipation, and hydronephrosis. If menstruation occurs and hematocolpos develops, the hymen may bulge and exhibit a bluish discoloration. If low, a knee-chest examination may reveal the presence of the bulging septum. The vagina is seen as a blind pouch.
Digital examination reveals the septum in the vagina.
The most common location is the upper third of the vagina. Septa usually have microperforations, but these are uaually insufficient in preventing hematocolpos. History and physical examination usually establish the diagnosis. In rare cases of transverse vaginal septum with microperforation, ascending infection may lead to pyohematometra. Fluid culture is helpful in determining appropriate antibiotic therapy.