Hematocolpos

Among the gynecological problems is the accumulation of menstrual blood in the vagina - hematokolpos (Greek haima - blood, kolpos - vagina).

Epidemiology

There is no record of menstrual blood pooling in vaginas, but cases of female genitourinary anomalies account for just over 5% of the population.

Congenital defects in the form of hymenal atresia are rare: one case per 2,000 girls (according to other data, one case per 1000-10000 women), and this defect is the most common cause of vaginal obstruction of congenital origin.

The accuracy of statistics is questionable. Thus, according to one data, transvaginal (transverse vaginal) septum occurs in only one woman per 70,000; in other sources, the frequency of this anomaly is estimated at one case per 2,000-2,500 women.

Causes of the hematocolpos

The main causes of hematocolpos are vaginal anomalies of congenital nature: atresia of the hymen and transverse vaginal septum - connective tissue membrane. [1]

This condition can also occur when there is a severe narrowing of the lumen of the vagina (stricture) or its contraction (atresia), which can be either congenital or acquired.

Acquired vaginal stricture or vaginal stenosis is associated with episiotomy (dissection of the perineum and vaginal wall during childbirth), surgery for pelvic organ prolapse in women, and the distant effects of radiation therapy for uterine, cervical, vaginal, or colorectal cancer.

Risk factors

The risk of hematocolpos is increased in malformations of the vagina and uterus, in particular the above-mentioned congenital vaginal anomalies, which arise from abnormalities in the intrauterine development of the genitourinary organs of the fetus. In the female fetus, they develop from mesodermal (primary) rudiments - the so-called Müllerian (paramesonephric) ducts. And due to their incomplete fusion, lack of fusion with the urogenital sinus, as well as incomplete involution of their remnants, organogenesis is disturbed.

The etiologic factor for such abnormalities may be any teratogenic effect on the fetus in the first and early second trimester of pregnancy, as well as gestational diabetes.

In addition, vaginal anomalies can be part of genetically determined syndromes, such as Robinov syndrome (Robinov-Silverman-Smith syndrome), McKusick-Kaufman syndrome, and a rare congenital anomaly of the genitourinary system, Herlin-Werner-Wunderlich syndrome.

And congenital adrenal hyperplasia increases the risks of vaginal stenosis accompanied by hematocolpos.

Pathogenesis

The pathogenesis is due to the blockage in the vagina of secretions (blood with the detached part of the uterine mucosa - endometrium), which are discharged from the uterine cavity at each menstruation.

Hymenal atresia and hematocolpos share a causal relationship, as the continuous, non-naturally perforated membrane that surrounds the vaginal opening closes it completely and prevents the outflow of menstrual blood.

Symptoms of the hematocolpos

It should be borne in mind that the first signs in the accumulation of menstrual blood in the vagina can occur only after menarche. That is, in the presence of congenital vaginal anomalies, hematocolpos manifests itself in pubertal girls after the onset of menstruation.

Symptoms such as:

• cyclic pain with spasms in the suprapubic area;
• Back pain (low back pain) and intense pelvic pain with tenesmus (false urges to defecate);
• vomiting;
• abdominal bloating, constipation or diarrhea;
• problems with urination (urinary retention).

Some women with vaginal stenosis on the background of amenorrhea (absence of menses) may also have a painful mass in the abdominal region.

Hematocolpos and hematometra (hematometrocolpos), an accumulation of menstrual blood in the uterine cavity, may occur at the same time: due to the same hymenal atresia or stenosis of the cervical canal. [2], [3]

Complications and consequences

The most likely complications and consequences of hematocolpos are considered to be:

• Cryptomenorrhea (or retrograde menstruation with no menstrual discharge from the vagina);
• accumulation of menstrual discharge in the fallopian tubes (hematosalpinx);
• endometriosis;
• recurrent urinary tract infection;
• hydronephrosis and obstructive acute renal failure (resulting from ureteral compression);
• pelvic infections with abscess and peritonitis.

Diagnostics of the hematocolpos

For more information, see. - Diagnosis of vaginal and uterine malformations

Instrumental diagnostics is performed with the help of: transabdominal ultrasound of the pelvic organs and uterus; computer or magnetic resonance imaging of the pelvic organs.

Differential diagnosis

Differential diagnoses include pubertal dysmenorrhea, pelvic venous stasis syndrome with chronic pain, pyocolpos.

Treatment of the hematocolpos

Treatment of hematocolpos is surgical, and depending on the cause may consist of incision of the hymenal membrane (hymenotomy), complete hysterectomy, removal of the vaginal septum (with access through the perineum).

More details in the publication - Le treatment of vaginal and uterine malformations.

Prevention

Measures to prevent congenital vaginal anomalies have not yet been developed.

Forecast

With intervention to correct the anatomic causes of hematocolpos and hematometra, the prognosis of the disease is favorable.