title: Hymenal stenosis and fibrosis in two adult women.
abstract: BACKGROUND
  Hymenal abnormalities are most commonly a result of incomplete apoptosis of the urogenital sinus during embryology. Infrequently, however, noncongenital abnormalities of the hymen can occur that can cause significant sequelae such as severe introital dyspareunia.
  
  
  METHODS
  We report on two adult women who developed severe introital dyspareunia secondary to hymenal stenosis and fibrosis in the absence of other vulvovaginal pathology. Neither woman had point tenderness of the vulvar vestibule, but their symptoms of searing pain on vaginal penetration was reproduced by stretching the hymen with two fingers. In both cases, conservative treatments with vaginal dilators in combination with topical hormonal therapy failed to relieve their symptoms, but both women were subsequently successfully treated with hymenectomy.
  
  
  CONCLUSIONS
  Hymenal stenosis and fibrosis can develop in the absence of identifiable vulvar dermatoses. If conservative treatment with topical hormonal therapy and vaginal dilators is unsuccessful, hymenectomy can restore normal coital function.
authors.affiliation: The Center for Vulvovaginal Disorders, and the Department of Obstetrics & Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC; the Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Neuropathology, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Goldstein
authors.forename: Sarah
authors.initials: S
authors.lastname: Todd
authors.forename: Sarah
authors.initials: S
authors.lastname: Bedell
authors.forename: Abeer
authors.initials: A
authors.lastname: Tabbarah
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy; D003251:Constriction, Pathologic; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D005355:Fibrosis; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D006924:Hymen / Q000473:pathology*; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole