Question

A 16-year-old girl presents with cyclical pelvic pain every month. She has not achieved menarche yet. On examination, a suprapubic bulge can be seen in the lower abdomen. PR examination reveals a bulging swelling in the anterior aspect. What is the most likely diagnosis?

• A. Transverse vaginal septum above the vagina
• B. Vaginal atresia
• C. Imperforate hymen
• D. Cervical agenesis

Answer 1

The Correct Option is C

A 16-year-old girl experiences cyclical pelvic pain every month but has not yet had her first menstrual period (menarche). During examination, a suprapubic bulge is noticeable in the lower abdomen, alongside a bulging swelling observed during a PR examination in the anterior region. These clinical findings are indicative of an obstructive condition that prevents menstrual blood from exiting the body, leading to its accumulation and causing both the cyclical pain and observable bulges.

The most likely diagnosis in this scenario is an imperforate hymen. This condition is characterized by a hymenal membrane that lacks an opening, obstructing the outflow of menstrual blood (hematocolpos), which results in the symptoms observed:

• Cyclical pelvic pain: Occurs monthly as menstrual blood accumulates.
• Suprapubic bulge: Represents the distended uterus and/or vagina filled with menstrual blood.
• Bulging in the anterior aspect during PR examination: Indicates accumulated menstrual fluid behind the hymenal barrier.

Other options such as transverse vaginal septum, vaginal atresia, and cervical agenesis are less likely given the specific symptoms and physical findings:

• Transverse vaginal septum: Typically presents differently and can sometimes allow for partial menstrual flow.
• Vaginal atresia: Generally involves absence or closure of the vaginal canal which would affect vaginal development.
• Cervical agenesis: Usually associated with structural abnormalities that may present differently and later.

Thus, the accumulation of menstrual blood due to an imperforate hymen provides the best explanation for the presented symptoms and examination findings.