Delayed Diagnosis of Imperforate Hymen Causing Hematocolpos and Hematometra in an Adolescent with Type II Female Genital Mutilation: A Case Report

Abstract

Background: Imperforate hymen is the most common congenital obstructive anomaly of the female genital tract and an important cause of primary amenorrhea; however, delayed diagnosis may occur in low-resource and culturally sensitive settings, especially when coexisting genital findings such as type II female genital mutilation (FGM) complicate clinical assessment. Case Presentation: A 17-year-old nulliparous adolescent from a rural area, married for two months, presented with primary amenorrhea since puberty, severe cyclic lower abdominal pain, and avoidance of sexual intercourse because of discomfort. She had normal secondary sexual characteristics, and genital examination demonstrated a tense, bluish bulging hymenal membrane, with coexisting type II FGM noted on examination. Pelvic ultrasonography confirmed hematocolpos and hematometra. The patient underwent hymenectomy using a cruciate incision, with evacuation of approximately 700 mL of retained menstrual blood. Her postoperative course was uneventful, and her symptoms resolved on follow-up. Conclusion: This case highlights that imperforate hymen should be suspected in adolescents presenting with primary amenorrhea and cyclic pelvic pain, particularly when diagnosis is delayed in rural or culturally complex settings. The coexistence of type II FGM adds clinical relevance to the case and should prompt careful genital examination and thoughtful surgical planning. Early recognition and timely hymenectomy are curative and help prevent avoidable physical and psychosocial complications.