Deirdre Murphy, Ultrasound Training Academy, University Hospital Southampton NHS Trust

A 17-year-old patient was referred to the Ultrasound Department by her GP because, despite starting normal puberty development several years previously, she had not yet had a period. The patient did not suffer from any pelvic pain but occasionally noticed a painless swelling that would disappear after a few days. She had been investigated for an eating disorder despite having stable weight and normal BMI. The GP requested an ultrasound scan for primary amenorrhea. 

Case Report
A transabdominal pelvic ultrasound scan was performed, and demonstrated a distended vagina, containing diffuse low-level echoes measuring approximately 18 x 10 x 11cm. Appearances suggested a haematocolpos. An MRI scan was also performed and reported that the vagina was grossly distended, measuring approximately 20 x 10 x 10cm. The report confirmed a haematocolpos, showing good agreement with the ultrasound scan. 

The patient was admitted for a procedure to open the hymen or hymenotomy in order to allow normal menstruation. Examination under general anaesthetic revealed a thick transverse vaginal septum. This was excised and approximately 1000mls of old retained menstrual blood was drained. The consultant reported the reconstruction went well. This resulted in a complete resolution of her symptoms. Further management advised follow-up with physiotherapy for vaginal dilation consideration if needed to maintain the vaginal entrance.

Haematocolpos is a rare medical condition where the vagina is filled with menstrual blood. It is usually caused by a combination of menstruation with an imperforate hymen. Abnormalities in the development of the Müllerian ducts result in imperforate hymen.

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