It has been suggested that the anomaly has a genetic basis and indeed there is typically a strong family history for imperforate hymen. The classic clinical presentation is that of an adolescent female not with a gynecologic complaint such as amenorrhea, but rather with a history of periodic and poorly localized lower abdominal pain of long duration. Other complaints include constipation and neurologic disturbances particularly syncope. A history of lower abdominal pain and fullness or obscure urinary complaints in a woman 12 to 20 years of age should lead one to consider imperforate hymen with hematocolpos. Physical examination is typically unremarkable with the exception of an abdominal mass which may be present and typical pelvic findings consisting of an imperforate hymen which is bulging tense and has bluish discoloration.
Laboratory studies are usually unremarkable.
It is important to document a negative pregnancy test. Treatment consists of partial hymenectomy with drainage of the occluded blood and fluid. Typically there are no long- term sequellae. Annals of Emerg.