Closed vaginal opening often diagnosed late

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When a condition known as imperforate hymen occurs, the membrane that covers the entrance to the vagina blocks it completely instead of being partially open. New research indicates that this disorder, which blocks the normal flow of genital secretions, is often diagnosed late by doctors.

“Although it is detectable at all ages through inspection of the external genitalia, imperforate hymen is a diagnosis that is missed commonly,” Drs. Jill C. Posner and Philip R. Spandorfer from Children’s Hospital of Philadelphia note in the medical journal Pediatrics.

They conducted a review of 23 girls diagnosed with imperforate hymen during a 13-year period. While the researchers planned to compare girls diagnosed early at age 8 or younger with those diagnosed at age 8 or older—an age chosen to reflect the lower age of normal puberty—“a more striking dichotomy in age” emerged.

All 10 girls in the younger group were diagnosed before 4 years of age and all 13 girls in the older group were diagnosed at age 10 or older.

Nearly all of the girls in the younger group had no symptoms and were diagnosed incidentally during physical examination. In contrast, all of the girls in the older group had symptoms and a substantial number had incompletely documented histories and physical exam results and frequently lacked appropriate pubertal evaluations.

Nearly half of the girls in the older group received an incorrect preliminary diagnosis and often had unnecessary laboratory and radiographic studies, further delaying a correct diagnosis.

“By incorporating an examination of the external genitalia into their routine practice, clinicians caring for children can prevent the significant delays in diagnosis, misdiagnosis, and (problems) associated with late diagnosis,” Posner and Spandorfer conclude.

SOURCE: Pediatrics, April 2005.

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