Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

VCUAM:

Vagina Cervix Uterus Adnex-associated Malformation

CRL:

Crown–rump length

References

  1. Berenson A, Heger A, Andrews S (1991) Appearance of the hymen in newborns. Pediatrics 87:458–465

    PubMed  CAS  Google Scholar 

  2. Berenson AB (1995) A longitudinal study of hymenal morphology in the first 3 years of life. Pediatrics 95:490–496

    PubMed  CAS  Google Scholar 

  3. Berenson AB, Grady JJ (2002) A longitudinal study of hymenal development from 3 to 9 years of age. J Pediatr 140:600–607

    Article  PubMed  Google Scholar 

  4. Berkowitz CD, Elvik SL, McCann J, Reinhart MA, Strickland S, Chikuma J (1991) Septate hymen: variations and pitfalls in diagnosis. Adolesc Pediatr Gynecol 4:194–197

    Article  Google Scholar 

  5. Capraro VJ, Dillon WP, Gallego MB (1974) Microperforate hymen: a distinct clinical entity. Obstet Gynecol 44:903–905

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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. Edgardh K, Ormstad K (2002) The adolescent hymen. J Reprod Med 47:710–714

    PubMed  Google Scholar 

  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 125:153–160

    Article  PubMed  CAS  Google Scholar 

  10. Ergün SS, Babalioglu R, Aydin S, Ozmen N, Sidal B, Koser RM (2002) Vaginal stones with a pinpoint hymenal opening. Arch Gynecol Obstet 266:58–59

    Article  PubMed  Google Scholar 

  11. Goto K, Yoshinari H, Tajima K, Kotsuji F (2006) Microperforate hymen in a primigravida in active labor: a case report. J Reprod Med 51:584–586

    PubMed  Google Scholar 

  12. Hobbs CJ (2012) Physical evidence of child sexual abuse. Eur J Pediatr 171:751–755. doi:10.1007/s00431-011-1556-9

    Article  PubMed  Google Scholar 

  13. Jacquemyn Y, De Catte L, Vaerenberg M (1998) Fetal ascites associated with an imperforate hymen: sonographic observation. Ultrasound Obstet Gynecol 12:67–69

    Article  PubMed  CAS  Google Scholar 

  14. Jalůvka V (1966) Pregnancy following 4 years of marriage of a woman with a hymen septus intactus. Zentralbl Gynakol 88:32–34, German

    PubMed  Google Scholar 

  15. Lim YH, Ng SP, Jamil MA (2003) Imperforate hymen: report of an unusual familial occurrence. J Obstet Gynaecol Res 29:399–401

    Article  PubMed  Google Scholar 

  16. Ludwig KS (1998) The Mayer-Rokitansky-Küster syndrome. An analysis of its morphology and embryology. Part II: embryology. Arch Gynecol Obstet 262:27–42

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  18. McIlroy DL, Ward IV (1930) Three cases of imperforate hymen occurring in one family. Proc R Soc Med 23:633–634

    PubMed  CAS  PubMed Central  Google Scholar 

  19. Miller RJ, Breech LL (2008) Surgical correction of vaginal anomalies. Clin Obstet Gynecol 51:223–236. doi:10.1097/GRF.0b013e31816d2181

    Article  PubMed  Google Scholar 

  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 84:1493–1497

    Article  PubMed  Google Scholar 

  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. Parazzini F, Cecchetti G (1990) The frequency of imperforate hymen in northern Italy. Int J Epidemiol 19:763–764

    Article  PubMed  CAS  Google Scholar 

  23. Pokorny SF (1987) Configuration of the prepubertal hymen. Am J Obstet Gynecol 157:950–956

    Article  PubMed  CAS  Google Scholar 

  24. Posner JC, Spandorfer PR (2005) Early detection of imperforate hymen prevents morbidity from delays in diagnosis. Pediatrics 115:1008–1012

    Article  PubMed  Google Scholar 

  25. Rabinerson D, Kaplan B, Dekel A (2003) Pregnancy with a microperforated hymen. Int J Gynaecol Obstet 80:171–172

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  27. Sakalkale R, Samarakkody U (2005) Familial occurrence of imperforate hymen. J Pediatr Adolesc Gynecol 18:427–429

    Article  PubMed  CAS  Google Scholar 

  28. Sanfilippo AM, Mansuria SM (2006) Microperforate hymen resulting in pelvic abscess. J Pediatr Adolesc Gynecol 19:95–98

    Article  PubMed  Google Scholar 

  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 34:394–404

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shaw LM, Jones WA, Brereton RJ (1983) Imperforate hymen and vaginal atresia and their associated anomalies. J R Soc Med 76:560–566

    PubMed  CAS  PubMed Central  Google Scholar 

  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 264:49–50

    Article  PubMed  CAS  Google Scholar 

  32. Stelling JR, Gray MR, Davis AJ, Cowan JM, Reindollar RH (2000) Dominant transmission of imperforate hymen. Fertil Steril 74:1241–1244

    Article  PubMed  CAS  Google Scholar 

  33. Usta IM, Awwad JT, Usta JA, Makarem MM, Karam KS (1993) Imperforate hymen: report of an unusual familial occurrence. Obstet Gynecol 82:655–656

    PubMed  CAS  Google Scholar 

  34. Winderl LM, Silverman RK (1995) Prenatal diagnosis of congenital imperforate hymen. Obstet Gynecol 85:857–860

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Ulrich Lattermann, MD for the critical review of the manuscript.

Conflict of interest

The authors have no disclosures with respect to this article.

Author information

Authors and Affiliations

  1. Division of Gynecology and Obstetrics, St. Josefskrankenhaus, Academic Teaching Hospital of the University of Freiburg, Sautierstr.1, 79104, Freiburg, Germany

    Rafal Watrowski, Christoph Jäger, Monika Gerber & Catherina Klein

Authors
  1. Rafal Watrowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Jäger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monika Gerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherina Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rafal Watrowski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Watrowski, R., Jäger, C., Gerber, M. et al. Hymenal anomalies in twins—review of the literature and case report. Eur J Pediatr 173, 1407–1412 (2014). https://doi.org/10.1007/s00431-013-2123-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-013-2123-3

Keywords

Search

Navigation