Gross hymenal abnormality of significance is imperforate hymen. It is due to failure of disintegration of the central cells of the Mullerian eminence that projects into the urogenital sinus. The existence is almost always unnoticed until the girl attains the age of 14–16 years. As the uterus is functioning normally, the menstrual blood is pent up inside the vagina behind the hymen (cryptomenorrhea. Depending upon the amount of blood so accumulated, it first distends the vagina (hematocolpos). The uterus is next involved and the cavity is dilated (hematometra). In the late and neglected cases, the tubes may also be distended after the fimbrial ends are closed by adhesions (Hematosalpinx).
Clinical features: The girl is aged about 14–16 years. The chief complaints are periodic lower abdominal pain, which may be continuous, primary amenorrhea and urinary symptoms, such as frequency, dysuria or even retention of urine. In fact, in significant cases the presenting feature may be the retention of urine. The cause of retention is due to elongation of the urethra.
Abdominal examination reveals a suprapubic swelling, which may be uterine or full bladder. Prior catheterization reveals the true state.
Vulval inspection reveals a tense bulging membrane of bluish coloration. In majority, however, it is not the true hymen but the obstructing membrane is a transverse vaginal septum close to the inner aspect of the hymen. Rectal examination reveals the bulged vagina. Ultrasonography can make the diagnosis of hematometra and hematocolpos.
In newborn (usually within one week of birth), accumulated mucus behind the imperforate membrane gives the clinical entity of mucocolpos. The secretion is either from the desquamated vaginal epithelial cells or from the cervical glands.
ROLE OF HOMOEOPATHIC MEDICINES IN MANAGING HYMEN ABNORMALITIES: -
Homoeopathic medicines are highly effective to manage complaints related to hymen abnormalities. The medicines that can be thought of are: -
- Natrum Mur
- Argentum nit