Hematocolpos

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Hematocolpos
Specialty Gynecology

Hematocolpos is a medical condition in which the vagina is pooled with menstrual blood due to multiple factors leading to the blockage of menstrual blood flow. The medical definition of hematocolpos is "an accumulation of blood within the vagina". It is often caused by the combination of menstruation with an imperforate hymen. [1] [2] It is sometimes seen in Robinow syndrome, uterus didelphys, or other vaginal anomalies.

Contents

A related disorder is hematometra, where the uterus fills with menstrual blood. [3] It presents after puberty as primary amenorrhea, recurrent pelvic pain with a pelvic mass. This can be caused by a congenital stenosis of the cervix, or by a complication of a surgical treatment. [4] Mucometrocolpos is the accumulation of mucous secretions behind an imperforate hymen. [5] [6] Mucometrocolpos can sometimes cause abdominal distention. [7] [8] [9] [10]

Symptoms

Causes

There are four possible causes of hematocolpos [12]

Treatment

As the causes for Hematocolpos are diverse, there are different surgical treatments which needs to be undertaken to cure it. Surgical interventions for congenital cervical atresia range from complete hysterectomy with canalization to conservative options, such as uterine cavity catheterization. [15]

For the women who have an imperforate hymen, a minor surgery is required incising the extra hymen membrane. It is generally treated surgically, with a hymenotomy or other surgery to remove any tissue that blocks the menstrual flow. Also, post surgery, the patient is required to insert dilators into the vagina for a few minutes each day for a few days post the surgery to avoid the incision being closed on its own. Once the patient has recovered from the surgery- that is, there are no burning sensation around the vaginal, they can have regular periods, normal sexual intercourse. Unlike an imperforate hymen which can be easily corrected, surgical correction of a transverse septum can be difficult if the surgery is not carefully planned. Postoperative complications, such as vaginal stenosis and re-obstruction can occur, especially when the septum is thick. The thickness and location of the septum is most commonly evaluated by transperineal ultrasound or MRI before attempting its resection.

Related Research Articles

<span class="mw-page-title-main">Hymen</span> Membrane that surrounds or partially covers the vaginal opening

The hymen is a thin piece of mucosal tissue that surrounds or partially covers the vaginal introitus. A small percentage are born with hymens that are imperforate and completely obstruct the vaginal canal. It forms part of the vulva and is similar in structure to the vagina. The term comes straight from the Greek, for 'membrane'.

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

Cryptomenorrhea or cryptomenorrhoea, is a medical condition in which menstrual bleeding occurs but remains hidden due to a congenital septum or atresia blocking the vagina, resulting in symptoms of menstruation without external bleeding. It is commonly seen in cases of imperforate hymen. Specifically the endometrium is shed, but a congenital obstruction such as a vaginal septum or on part of the hymen retains the menstrual flow. A patient with cryptomenorrhea will appear to have amenorrhea but will experience cyclic menstrual pain. The condition is surgically correctable.

<span class="mw-page-title-main">Uterine malformation</span> Female birth defect in which the uterus forms abnormally

A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.

An 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.

Atresia is a condition in which an orifice or passage in the body is closed or absent.

Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal septum. It results in uterovaginal outflow tract obstruction. This condition does not usually occur by itself within an individual, but coupled with other developmental disorders within the female. The disorders that are usually coupled with a female who has vaginal atresia are Mayer-Rokitansky-Küster-Hauser syndrome, Bardet-Biedl syndrome, or Fraser syndrome. One out of every 5,000 women have this abnormality.

<span class="mw-page-title-main">Reproductive medicine</span> Branch of medicine

Reproductive medicine is a branch of medicine concerning the male and female reproductive systems. It encompasses a variety of reproductive conditions, their prevention and assessment, as well as their subsequent treatment and prognosis.

Hydrocolpos is the distension of the vagina caused by accumulation of fluid due to congenital vaginal obstruction. The obstruction is often caused by an imperforate hymen or less commonly a transverse vaginal septum. The fluid consists of cervical and endometrial mucus or in rare instances urine accumulated through a vesicovaginal fistula proximal to the obstruction. In some cases, it is associated with Bardet-Biedl Syndrome. If it occurs in prepubertal girls, it may show up as abdominal swelling. It may be detected by using ultrasound. Prenatal diagnosis and early newborn imaging studies leads to early detection and treatment of these cases. It may also present at birth as a distended lower abdomen and vagina. It also associated with vaginal atresia. A high index of suspicion for hydrocolpos in a newborn presenting with fetal diagnosis of infraumbilical abdominal mass will facilitate timely intervention and prevention of complications.

<span class="mw-page-title-main">Vaginal hypoplasia</span> Birth defect in which the vagina fails to completely form

Vaginal hypoplasia is the underdevelopment or incomplete development of the vagina. It is a birth defect or congenital abnormality of the female genitourinary system.

<span class="mw-page-title-main">Hematometra</span> Medical condition

Hematometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum.

<span class="mw-page-title-main">Vaginal septum</span> Medical condition

A vaginal septum is a vaginal anomaly that is partition within the vagina; such a septum could be either longitudinal or transverse. In some affected women, the septum is partial or does not extend the length or width of the vagina. Pain during intercourse can be a symptom. A longitudinal vaginal septum develops during embryogenesis when there is an incomplete fusion of the lower parts of the two Müllerian ducts. As a result, there may appear to be two openings to the vagina. There may be associated duplications of the more cranial parts of the Müllerian derivatives, a double cervix, and either a uterine septum or uterus didelphys. A transverse septum forms during embryogenesis when the Müllerian ducts do not fuse to the urogenital sinus. A complete transverse septum can occur across the vagina at different levels. Menstrual flow can be blocked, and is a cause of primary amenorrhea. The accumulation of menstrual debris behind the septum is termed cryptomenorrhea. Some transverse septa are incomplete and may lead to dyspareunia or obstruction in labour.

A vaginal disease is a pathological condition that affects part or all of the vagina.

<span class="mw-page-title-main">Postcoital bleeding</span> Non-menstrual vaginal bleeding during or after sexual intercourse

Postcoital bleeding (PCB) is non-menstrual vaginal bleeding that occurs during or after sexual intercourse. Though some causes are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.

Cervical agenesis is a congenital disorder of the female genital system that manifests itself in the absence of a cervix, the connecting structure between the uterus and vagina. Milder forms of the condition, in which the cervix is present but deformed and nonfunctional, are known as cervical atresia or cervical dysgenesis.

<span class="mw-page-title-main">OHVIRA</span> Medical condition

Herlyn–Werner–Wunderlich syndrome, also known as OHVIRA is an extremely rare syndrome characterized by a congenital birth defect of the lower abdominal and pelvic organs. It is a type of abnormality of the Müllerian ducts.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

Mucometrocolpos is the abnormal accumulation of genital secretions (mucous) that occurs as a result of an imperforate hymen and the build up of these secretions behind the hymen. The secretions originate from uterine and cervical glands. It is a rare, congenital condition and usually occurs independent of other abnormal structures though inheritance can play a part in its occurrence. It also occurs with McKusick–Kaufman syndrome (MKS). Polydactyly and heart disease are associated with this condition. Diagnosis is challenging because symptoms also occur in a variety of other syndromes. Secretions can build up and extend as far as the uterus and abdomen. Mucometrocolpos can sometimes cause abdominal distention. The build up of mucous secretions can occur prior to adolescence unrelated to menstruation. Many cases can be detected prenatally. Treatment is surgical and is specific for each case. After treatment, many females are still able to conceive and carry a pregnancy to term.

<span class="mw-page-title-main">Vaginal cysts</span> Benign growths of the vaginal epithelium

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Some cysts can be distinguished visually but most will need a biopsy to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.

References

  1. ↑ Kloss, Brian T.; Nacca, Nicholas E.; Cantor, Richard M. (6 May 2010). "Hematocolpos secondary to imperforate hymen". International Journal of Emergency Medicine. 3 (4): 481–482. doi:10.1007/s12245-010-0171-2. PMC   3047835 . PMID   21373333.
  2. ↑ TOMPKINS, PENDLETON (2 September 1939). "The Treatment of Imperforate Hymen with Hematocolpos". Journal of the American Medical Association. 113 (10): 913–916. doi:10.1001/jama.1939.02800350023007.
  3. ↑ Smith, Roger Perry (2008-01-01). Netter's Obstetrics and Gynecology. Elsevier Health Sciences. ISBN   978-1416056829.
  4. ↑ Verma, SK; Baltarowich, OH; Lev-Toaff, AS; Mitchell, DG; Verma, M; Batzer, F (Jul 2009). "Hematocolpos secondary to acquired vaginal scarring after radiation therapy for colorectal carcinoma" (PDF). Journal of Ultrasound in Medicine. 28 (7): 949–53. doi: 10.7863/jum.2009.28.7.949 . PMID   19546336. S2CID   11759668.
  5. ↑ Yapar, E. G.; Ekici, E.; Aydogdu, T.; Senses, E.; Gökmen, O. (1996-12-18). "Diagnostic problems in a case with mucometrocolpos, polydactyly, congenital heart disease, and skeletal dysplasia". American Journal of Medical Genetics. 66 (3): 343–346. doi:10.1002/(SICI)1096-8628(19961218)66:3<343::AID-AJMG19>3.0.CO;2-M. ISSN   0148-7299. PMID   8985498.
  6. ↑ Babcock, Diane S. (January 1989). Neonatal and pediatric ultrasonography. Churchill Livingstone. ISBN   9780443086069.
  7. ↑ Saclarides, Theodore J.; Myers, Jonathan A.; Millikan, Keith W. (2015-01-02). Common Surgical Diseases: An Algorithmic Approach to Problem Solving. Springer. ISBN   9781493915651.
  8. ↑ Kaiser, Georges L. (2012-12-13). Symptoms and Signs in Pediatric Surgery. Springer Science & Business Media. ISBN   9783642311611.
  9. ↑ Stevenson, Roger E. (2015-10-27). Human Malformations and Related Anomalies. Oxford University Press. ISBN   9780199386031.
  10. ↑ Dosedla, Erik; Kacerovsky, Marian; Calda, Pavel (2011-03-01). "Prenatal diagnosis of hydrometrocolpos in a down syndrome fetus". Journal of Clinical Ultrasound. 39 (3): 169–171. doi:10.1002/jcu.20785. ISSN   1097-0096. PMID   21387330. S2CID   11211408.
  11. 1 2 3 4 5 6 7 Kotter, Haleigh; Weingrow, Daniel; Canders, Caleb (2017-07-28). "Hematometrocolpos in a Pubescent Girl with Abdominal Pain". Clinical Practice and Cases in Emergency Medicine. 1 (3): 218–220. doi:10.5811/cpcem.2017.3.33369. ISSN   2474-252X. PMC   5965174 . PMID   29849312.
  12. ↑ "Most common cause of hematocolpos (LQ)A cervical atresiaB vaginal atresiaC transverse vaginal septumD imperforate hymen - Flash cards Miscellaneous - Dr. Bhatia Medical Coaching Institute Pvt. Ltd. - Dr Bhatia Medical Coaching Institute". GradeStack Courses. Retrieved 2018-10-27.
  13. ↑ "Imperforate hymen: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-09-21.
  14. ↑ Piersma DJ, Lashley EELO, Hellebrekers BWJ. Uitblijvende menses na gebruik van vaginale kruiden.|journal=Nederlands Tijdschrift voor Obstetrie & Gynaecologie. 2012;125:305-6
  15. 1 2 Xie, Zhihong; Zhang, Xiaoping; Liu, Jiandong; Zhang, Ningzhi; Xiao, Hong; Liu, Yongying; Li, Liang; Liu, Xiaoying (2014-02-21). "Clinical characteristics of congenital cervical atresia based on anatomy and ultrasound: a retrospective study of 32 cases". European Journal of Medical Research. 19 (1): 10. doi: 10.1186/2047-783X-19-10 . ISSN   0949-2321. PMC   3996070 . PMID   24555664.
  16. ↑ Saxena, Amulya K (2021-11-09). "Vaginal Atresia: Practice Essentials, Anatomy, Pathophysiology". Medscape Reference. Retrieved 2024-08-06.
  17. ↑ "Transverse Vaginal Septum | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2019-09-21.
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