Imperforate Hymen as a Cause of Primary Amenorrhea in an Adolescent: A Case Report and Clinical Review

ABSTRACT Imperforate hymen is an uncommon congenital anomaly of the distal female genital tract resulting from failed hymenal canalization. Although present since birth, the condition frequently remains undetected until adolescence, when menstrual blood retention leads to hematocolpos and associated symptoms. Early recognition is essential to prevent long-term gynecologic complications. We report a case of a 12-year-old girl presenting with primary amenorrhea and recurrent cyclic lower abdominal pain. The patient had normal secondary sexual development but experienced progressive suprapubic discomfort accompanied by urinary and bowel symptoms. Physical examination revealed a tense, bulging hymenal membrane without a visible vaginal opening. Pelvic ultrasonography demonstrated a markedly distended fluid-filled vaginal cavity with displacement of the uterus, supporting the diagnosis of hematocolpos secondary to distal genital tract obstruction. The patient underwent hymenotomy under general anesthesia with successful evacuation of retained menstrual blood. Postoperative recovery was uneventful, with complete symptom resolution and restoration of expected menstrual function. This case emphasizes the importance of thorough genital examination and appropriate imaging in adolescents presenting with primary amenorrhea and cyclic pelvic pain. Prompt surgical correction provides excellent clinical outcomes, prevents complications such as endometriosis and chronic pelvic pain, and preserves future reproductive potential. Increased awareness among clinicians is crucial to avoid diagnostic delay and reduce morbidity. Keywords: Imperforate Hymen, Amenorrhea, Adolescent.