Reproductive health challenges of an African school girl: a case report on non-bulging imperforate hymen with haematocolpometra during Covid-19 pandemic

Abstract

Background: Several schoolgirls attain reproductive age with undiagnosed gynaecological problems which pose challenges in their livelihood. These conditions include precocious puberty, congenital reproductive tract abnormalities, and delayed sexual development. Many children with these conditions face additional challenges including physical pain, psychological trauma and delayed diagnosis.

Methods: A 14-year-old girl presented with acute on chronic pelvic pain and haematocolpometra due to imperforate hymen during COVID-19 pandemic. She has not undergone cultural virginity test in her community. The hymenal membrane was unusually non-bulging despite the haematocolpometra. A partial hymenotomy with a narrow margin of excision was performed.

Results: The hymenal orifice later obliterated and resulted in a repeat partial hymenectomy where a wide surgical margin of the hymen was excised.

Conclusions: A wide rather than narrow partial hymenectomy prevents obliteration of the hymenal orifice after surgery for imperforate hymen. There is a need for timely interventions such as counselling and community awareness that prevent undue consequences of an imperforate hymen and its treatment including pain and possible inability to pass cultural virginity test in some African communities.

Keywords: African schoolgirl; cryptomenorrhea; haematocolpometra; hydrometrocolpos; impact of COVID-19; non-bulging imperforate hymen.

Figure 1

Twenty weeks uterine size abdominopelvic mass (A), urethra (dashed arrow) and non-bulging imperforate hymenal membrane (solid arrow) despite the presence of haematocolpos with the image also showing a short distance between the urethra and the hymen (B), drainage of haematocolpometra following hymenectomy (C), and hymenal orifice after second hymenectomy, (D)