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.
Pelvic ultrasound can reveal additional associated congenital malformations of the uterus or cervix.
Ultrasound also reveals hematocolpos or hematometra. MRI can delineate other associated abnormalities, such as those of the urinary tract. Although repair is facilitated when estrogen stimulation is present, repair of an imperforate hymen can be performed in infancy, childhood, or adolescence. A Bovie with three-fourths of its tip shielded can be used to excise the hymen close to the hymenal ring. After the fluid is drained, the hymenal area is further opened and the vaginal mucosa is sutured to the hymenal ring to prevent recurrence.