A 17-year-old girl presents with primary amenorrhea. She has normal secondary sexual characteristics with Tanner V breast development and pubic hair. She reports cyclic lower abdominal pain every month. Examination reveals a bluish membrane at the vaginal introitus with no vaginal opening. What is the MOST likely diagnosis and treatment?

• A Imperforate hymen with hematocolpos; hymenectomy ✓
• B Mayer-Rokitansky-Kuster-Hauser syndrome; vaginoplasty
• C Transverse vaginal septum; surgical resection of septum
• D Androgen insensitivity syndrome; gonadectomy and hormone replacement

Explanation

An imperforate hymen presents as primary amenorrhea with normal secondary sexual characteristics and cyclic cryptomenorrhea pain. The classic finding on examination is a bluish, bulging membrane at the introitus due to accumulated menstrual blood (hematocolpos). Treatment is a cruciate hymenectomy, which provides immediate drainage and resolution. It must be distinguished from a transverse vaginal septum, which does not have the characteristic blue bulge at the introitus.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.