European Journal of Pediatrics

, Volume 173, Issue 11, pp 1407–1412 | Cite as

Hymenal anomalies in twins—review of the literature and case report

  • Rafal Watrowski
  • Christoph Jäger
  • Monika Gerber
  • Catherina Klein
Review

Abstract

Subocclusive hymenal variants, such as microperforate or septate hymen, impair somatic functions (e.g., vaginal intercourse or menstrual hygiene) and can negatively impact the quality of life of young women. We know little about the prevalence and inheritance of subocclusive hymenal variants. So far, eight cases of familial occurrence of occlusive hymenal anomalies (imperforate hymen) have been reported. In one of these cases, monozygotic twins were affected. We are reporting the first case of subocclusive hymenal variants (microperforate hymen and septate hymen) in 16-year-old white dizygotic twins. In addition, we review and discuss the current evidence. Conclusion: The mode of inheritance of hymenal variants has not been determined so far. Because surgical corrections of hymenal variants should be carried out in asymptomatic patients (before menarche), gynecologists and pediatricians should keep in mind that familial occurrences may occur.

Keywords

Hymenal anomalies Microperforate hymen Septate hymen Imperforate hymen Genital anomalies in twins 

Abbreviations

VCUAM

Vagina Cervix Uterus Adnex-associated Malformation

CRL

Crown–rump length

References

  1. 1.
    Berenson A, Heger A, Andrews S (1991) Appearance of the hymen in newborns. Pediatrics 87:458–465PubMedGoogle Scholar
  2. 2.
    Berenson AB (1995) A longitudinal study of hymenal morphology in the first 3 years of life. Pediatrics 95:490–496PubMedGoogle Scholar
  3. 3.
    Berenson AB, Grady JJ (2002) A longitudinal study of hymenal development from 3 to 9 years of age. J Pediatr 140:600–607PubMedCrossRefGoogle Scholar
  4. 4.
    Berkowitz CD, Elvik SL, McCann J, Reinhart MA, Strickland S, Chikuma J (1991) Septate hymen: variations and pitfalls in diagnosis. Adolesc Pediatr Gynecol 4:194–197CrossRefGoogle Scholar
  5. 5.
    Capraro VJ, Dillon WP, Gallego MB (1974) Microperforate hymen: a distinct clinical entity. Obstet Gynecol 44:903–905PubMedGoogle Scholar
  6. 6.
    Di Donato V, Manci N, Palaia I, Bellati F, Perniola G, Panici PB (2008) Urethral coitus in a patient with a microperforate hymen. J Minim Invasive Gynecol 15:642–643. doi:10.1016/j.jmig.2008.05.002 PubMedCrossRefGoogle Scholar
  7. 7.
    Dubuis-Grieder C (2007) Development of the internal genital organs. In: Human embryology. Online course in embryology for medicine students developed by the universities of Fribourg, Lausanne and Bern. http://www.embryology.ch/anglais/ugenital/genitinterne05.html. Accessed 7 Apr 2013
  8. 8.
    Edgardh K, Ormstad K (2002) The adolescent hymen. J Reprod Med 47:710–714PubMedGoogle Scholar
  9. 9.
    Emans SJ, Woods ER, Allred EN, Grace E (1994) Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr 125:153–160PubMedCrossRefGoogle Scholar
  10. 10.
    Ergün SS, Babalioglu R, Aydin S, Ozmen N, Sidal B, Koser RM (2002) Vaginal stones with a pinpoint hymenal opening. Arch Gynecol Obstet 266:58–59PubMedCrossRefGoogle Scholar
  11. 11.
    Goto K, Yoshinari H, Tajima K, Kotsuji F (2006) Microperforate hymen in a primigravida in active labor: a case report. J Reprod Med 51:584–586PubMedGoogle Scholar
  12. 12.
    Hobbs CJ (2012) Physical evidence of child sexual abuse. Eur J Pediatr 171:751–755. doi:10.1007/s00431-011-1556-9 PubMedCrossRefGoogle Scholar
  13. 13.
    Jacquemyn Y, De Catte L, Vaerenberg M (1998) Fetal ascites associated with an imperforate hymen: sonographic observation. Ultrasound Obstet Gynecol 12:67–69PubMedCrossRefGoogle Scholar
  14. 14.
    Jalůvka V (1966) Pregnancy following 4 years of marriage of a woman with a hymen septus intactus. Zentralbl Gynakol 88:32–34, GermanPubMedGoogle Scholar
  15. 15.
    Lim YH, Ng SP, Jamil MA (2003) Imperforate hymen: report of an unusual familial occurrence. J Obstet Gynaecol Res 29:399–401PubMedCrossRefGoogle Scholar
  16. 16.
    Ludwig KS (1998) The Mayer-Rokitansky-Küster syndrome. An analysis of its morphology and embryology. Part II: embryology. Arch Gynecol Obstet 262:27–42PubMedCrossRefGoogle Scholar
  17. 17.
    Massé J, Watrin T, Laurent A, Deschamps S, Guerrier D, Pellerin I (2009) The developing female genital tract: from genetics to epigenetics. Int J Dev Biol 53:411–424. doi:10.1387/ijdb.082680jm PubMedCrossRefGoogle Scholar
  18. 18.
    McIlroy DL, Ward IV (1930) Three cases of imperforate hymen occurring in one family. Proc R Soc Med 23:633–634PubMedPubMedCentralGoogle Scholar
  19. 19.
    Miller RJ, Breech LL (2008) Surgical correction of vaginal anomalies. Clin Obstet Gynecol 51:223–236. doi:10.1097/GRF.0b013e31816d2181 PubMedCrossRefGoogle Scholar
  20. 20.
    Oppelt P, Renner SP, Brucker S, Strissel PL, Strick R, Oppelt PG, Doerr HG, Schott GE, Hucke J, Wallwiener D, Beckmann MW (2005) The VCUAM (Vagina Cervix Uterus Adnex-associated Malformation) classification: a new classification for genital malformations. Fertil Steril 84:1493–1497PubMedCrossRefGoogle Scholar
  21. 21.
    Oppelt P, Anthuber C, Anthuber S et al (2010) Weibliche genitale Fehlbildungen. Interdisziplinäre S1-Leitlinie der DGGG. AWMF 015/064. http://www.dggg.de/fileadmin/public_docs/Leitlinien/1-1-4--Weiblichegenitale-Fehlbildungen-2010.pdf. Accessed 30 Mar 2012
  22. 22.
    Parazzini F, Cecchetti G (1990) The frequency of imperforate hymen in northern Italy. Int J Epidemiol 19:763–764PubMedCrossRefGoogle Scholar
  23. 23.
    Pokorny SF (1987) Configuration of the prepubertal hymen. Am J Obstet Gynecol 157:950–956PubMedCrossRefGoogle Scholar
  24. 24.
    Posner JC, Spandorfer PR (2005) Early detection of imperforate hymen prevents morbidity from delays in diagnosis. Pediatrics 115:1008–1012PubMedCrossRefGoogle Scholar
  25. 25.
    Rabinerson D, Kaplan B, Dekel A (2003) Pregnancy with a microperforated hymen. Int J Gynaecol Obstet 80:171–172PubMedCrossRefGoogle Scholar
  26. 26.
    Reddy J, Laufer MR (2009) Congenital anomalies of the female reproductive tract in a patient with Goltz syndrome. J Pediatr Adolesc Gynecol 22:e71–e72. doi:10.1016/j.jpag.2008.05.009 PubMedCrossRefGoogle Scholar
  27. 27.
    Sakalkale R, Samarakkody U (2005) Familial occurrence of imperforate hymen. J Pediatr Adolesc Gynecol 18:427–429PubMedCrossRefGoogle Scholar
  28. 28.
    Sanfilippo AM, Mansuria SM (2006) Microperforate hymen resulting in pelvic abscess. J Pediatr Adolesc Gynecol 19:95–98PubMedCrossRefGoogle Scholar
  29. 29.
    Schick VR, Calabrese SK, Rima BN, Zucker AN (2010) Genital appearance dissatisfaction: implications for women's genital image self-consciousness, sexual esteem, sexual satisfaction, and sexual risk. Psychol Women Q 34:394–404PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Shaw LM, Jones WA, Brereton RJ (1983) Imperforate hymen and vaginal atresia and their associated anomalies. J R Soc Med 76:560–566PubMedPubMedCentralGoogle Scholar
  31. 31.
    Shukunami K, Kaneshima M, Kurokawa T, Kubo M, Kotsuji F (2000) Microperforate hymen at 27 years of age diagnosed with withdrawal bleeding and hysterofiberscopy. Arch Gynecol Obstet 264:49–50PubMedCrossRefGoogle Scholar
  32. 32.
    Stelling JR, Gray MR, Davis AJ, Cowan JM, Reindollar RH (2000) Dominant transmission of imperforate hymen. Fertil Steril 74:1241–1244PubMedCrossRefGoogle Scholar
  33. 33.
    Usta IM, Awwad JT, Usta JA, Makarem MM, Karam KS (1993) Imperforate hymen: report of an unusual familial occurrence. Obstet Gynecol 82:655–656PubMedGoogle Scholar
  34. 34.
    Winderl LM, Silverman RK (1995) Prenatal diagnosis of congenital imperforate hymen. Obstet Gynecol 85:857–860PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rafal Watrowski
    • 1
  • Christoph Jäger
    • 1
  • Monika Gerber
    • 1
  • Catherina Klein
    • 1
  1. 1.Division of Gynecology and ObstetricsSt. Josefskrankenhaus, Academic Teaching Hospital of the University of FreiburgFreiburgGermany

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