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Pediatric Hematocolpos
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Omar M. Abuzeid, Mostafa I. Abuzeid
This condition presents in females who are in their late adolescence. Symptoms are similar to those of imperforate hymen due to the obstructive nature of the pathology. Therefore, the usual presentation is primary amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain. Some patients may have no pain depending on the location of the septum and the degree of hematocolpos. If the patient is sexually active, she may complain of some difficulty and pain during sexual intercourse. If there is a delay in making the diagnosis, patients may have symptoms related to endometriosis such as chronic pelvic pain. Some patients may notice a mass in their lower abdomen, while others may complain of urinary retention. Other symptoms may be related to concomitant genitourinary tract anomalies, musculoskeletal defects, and gastrointestinal tract anomalies.
Practice exam I: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Cryptomenorrhoea is a condition which describes women who are menstruating, but in whom bleeding is concealed. (1). It occurs in I in 4000 girls (1). The likeliest cause is an imperforate hymen (1). It usually presents as acute abdominal pain and is often confused with appendicitis (1). Associated symptoms include urinary retention, due to pressure of collected blood, and a mass (1). Examination findings include a mass arising from the pelvis and a bulging blue membrane on parting the labia due to the haematocolpos (2). Treatment of an imperforate hymen is surgical via a cruciate incision to allow drainage of the menstrual blood (1).
EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
H Imperforate hymenAn imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when menstrual blood accumulates in the vagina and sometimes also in the uterus. It is treated by surgical incision of the hymen. It is typically present with cyclical lower abdominal pain around the period of menarche followed by a bulge in the vagina and if untreated an abdominal mass may develop.
Contextualizing ovarian pain in the late 19th century — Part 2: Ovarian-based treatments of “hysteria”
Published in Journal of the History of the Neurosciences, 2021
John Jarrell, Frank W. Stahnisch
Emile Chairou (1832–1870), chief of service at L’Asile Impérialdu Vésinet in Paris, had published a thesis on the ovarian causes of hysteria, which was based on 26 detailed case studies and autopsy reports, incriminating ovarian pathologies as being associated with pelvic pain, dysmenorrhea, and amenorrhea (Chairou 1870, 61–69). He also presented a case of imperforate hymen, with a retrograde collection of intrauterine blood. The pain symptomatology revealed to him that the pelvic organs were the predominant source of the pain and the accompanying nervous phenomena. His treatment, applying leeches on the cervix and to iliac fossa, was directed at the ovary, and it physiologically served him as a counterirritant to lessen the discomfort. He confronted the preceding epidemiological report of Pierre Briquet (1796–1881) (Briquet 1859) and wondered why some women with hysteria seemed to improve clinically, following marriage, but his recognition of improvement was attributed to blood-loss during delivery and not to then unknown pregnancy-related suppression of ovarian function.