[Imperforate hymen: Can it be treated without damaging the hymenal structure?].
Imperforate hymen is a rare congenital anomaly, with an incidence of about 1 in 2000 female births. It is generally diagnosed during puberty. Treatment generally consists of a hymenotomy or a hymenectomy. Because the hymen is a symbol of virginity in some communities, its destruction can be source of social problems for some girls.


OBJECTIVE
We discuss the diagnostic but especially therapeutic aspects of imperforate hymens and possible surgical techniques, in particular those that preserve the hymen.


METHODS
We describe the cases of 5 girls treated in our department for imperforate hymen between 2001 and 2007. Two of them required the safeguarding of the normal architecture of their hymen to preserve the appearance of virginity. We analysed diagnostic features and surgical techniques.


RESULTS
The average age of our patients was 14.8 years (range: 11 and 17 years). The most frequent reason for consultation was pelvic pain with primary amenorrhea. Inspection of the vulva revealed in all cases a dome-shaped purplish-red hymeneal membrane. Hymeneal incision allowed drainage of old previously blocked menstrual blood. Three patients were treated by radial incisions of the hymen. The parents of 2 patients demanded that their hymens be preserved. Accordingly, one had a simple excision of a central flange of the hymen and the other was treated by a similar technique that also used a Foley catheter . All five patients did well after surgical treatment. The techniques used to preserve the hymen resulted in an apparently intact annular hymen.


CONCLUSIONS
Imperforate hymen is a rare anomaly. Its diagnosis is simple. The traditional technique of radial incisions is a simple procedure that yields good results. The technique using the Foley catheter is an adequate alternative when preservation of the hymen is required.
Chelli
Dalenda
D
Service de gynécologie-obstétrique A, Centre de maternité et de néonatalogie de Tunis 1007 La Rabta, Tunisie. dalendac@yahoo.fr
Kehila
M
M
Sfar
Ezzeddine
E
Zouaoui
Béchir
B
Chelli
Héla
H
Chanoufi
Badis
B
D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006399:Hematocolpos / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D006924:Hymen / Q000002:abnormalities* / Q000601:surgery*; D017699:Pelvic Pain / Q000209:etiology; D012746:Sexual Abstinence; D013997:Time Factors; D016896:Treatment Outcome; D014416:Tunisia; D014463:Ultrasonography