ESPE Abstracts

Background: Hematocolpos is a rare condition in young girls that can be caused by imperforated hymen or vaginal agenesis. It is usually diagnosed at early puberty with cyclic abdominal pain and amenorrhoea. Menarche is usually observed two years after the start of puberty; sometimes pre-menarcheal bleeding can occur, ranging from isolated premature menarche to spotting in course of puberty. In case of imperforated hymen or vaginal anomaly, a pre-menarcheal uterine bleeding can cause hematocolpos, making diagnosis difficult.

Objective and hypotheses: We describe here the clinical case of a 12.8 years old teenage girl who experienced hematocolpos in the course of her puberty.

Method: Complete clinical history, clinical and biological phenotypes were collected.

Results: Patient described recurrent episodes of very intense lower-back pain that started 3 months before, lasting few hours, 3 days a week, every week. She never had any genital bleeding. She was Tanner stage III. Abdominal palpation found a pelvic mass. Vulvar inspection revealed an imperforated and tensed but not bulging hymen. Ultrasound imaging and magnetic resonance imaging showed a 45×25 mm uterus without malformation, a 6.5-mm thick endometrium with a 6.4-mm hematometra, 4.8 and 6.0 ml ovaries and no hematosalpinx. A collection of 111×76×78 mm filled the vagina. There were two normal kidneys. Gonadotropins were in the normal range for mid-puberty (FSH 3.73 UI/l, LH 1.22 UI/l, estradiol (E2) 23 pg/ml). The GnRH hormone test showed ongoing physiologic central puberty. Surgery (radial hymenotomy) confirmed the diagnosis of hematocolpos (aspiration of 400 ml of old blood). Additional hysteroscopy found no uterine or vaginal malformation.

Conclusion: Hematocolpos should be considered even with non-typical symptoms in a pre-menarcheal girl, and can be the consequence of uterine pre-menarcheal bleeding.