Introduction : Imperforate hymen is a rare congenital malformation that causes vulvar obstruction, leading to vaginal retention of menstrual blood. Early diagnosis and management are essential to preserve the patient’s future fertility.

Materials and methods : We conducted a retrospective analysis of four cases of imperforate hymen managed in our department over a three-year period. The objective of this study was to evaluate the diagnostic characteristics and therapeutic approaches associated with this condition
Results : The mean age at diagnosis was 14 years. All patients were unmarried and presented with primary amenorrhea. No familial history of similar congenital anomalies was identified. The primary presenting symptom was pelvic pain. Secondary sexual characteristics were present and normally developed in all cases. Clinical examination of the vulvar region enabled the diagnosis of imperforate hymen in each patient. Suprapubic ultrasonography demonstrated hematocolpos in all cases, associated with hematometra and a Douglas pouch effusion in two patients. Surgical management was performed in all cases and consisted of hymenotomy under oxytocin infusion using radial incisions. The volume of hematocolpos ranged from 250 to 800 mL. One patient required surgical revision due to hymenal restenosis.

Conclusion : Systematic screening for imperforate hymen at birth and early diagnosis in cases of painful primary amenorrhea are essential to prevent potential complications.

Dr. Anas Selmi is a resident in Obstetrics and Gynecology at the Ministry of Public Health in Tunisia. He completed complementary certificates in Senology. His residency training includes rotations in Obstetrics and Gynecology at Sidi Bouzid University Hospital , Mongi Slim University Hospital in Tunis, and Kasserine University Hospital. He has participated in national and international gynecology and obstetrics conferences, including AGOB and STGO.