Hematocolpos

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

Epidemiology

Records of cases of accumulation of menstrual blood in the vagina are not kept, but cases of anomalies of the genitourinary system of women account for just over 5% of the population.

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

The accuracy of the statistics is questionable. So, according to some data, a transvaginal (transverse vaginal) septum occurs in only one woman in 70 thousand; in other sources, the frequency of this anomaly is estimated at one case per 2-2.5 thousand women.

Causes of the hematocolpos

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

Also, this condition can be observed with a strong narrowing of the lumen of the  vagina  (stricture) or its infection (atresia), which are both congenital and acquired.

Acquired vaginal stricture or vaginal stenosis has been associated with episiotomy (incision of the perineum and vaginal wall during childbirth), surgery for pelvic organ prolapse in women, and long-term effects of radiation therapy for cancer of the uterus, cervix, vagina, or colorectal cancer.

Risk factors

The risk of hematocolpos increases with  malformations of the vagina and uterus , in particular, the above-mentioned congenital vaginal anomalies that occur due to violations of the intrauterine  development of the urogenital organs of the  fetus. In the female fetus, they develop from the mesodermal (primary) rudiments - the so-called Mullerian (paramesonephric) ducts. And due to their incomplete fusion, the lack of fusion with the urogenital sinus, as well as the incomplete involution of their residues, a violation of organogenesis occurs.

The etiological factor of such disorders can 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, for example, Robinow syndrome (Robinov-Silverman-Smith syndrome), McKusick-Kaufman syndrome, a rare congenital anomaly of the genitourinary system - Herlin-Werner-Wunderlich syndrome.

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

Pathogenesis

The pathogenesis is due to blockage in the vagina of secretions (blood with an exfoliated part of the mucous membrane of the uterus - endometrium), which are removed from the uterine cavity during each menstruation.

Atresia of the hymen and hematocolpos are united by a causal relationship, since a continuous membrane that does not have natural perforation that surrounds the opening in the vagina completely closes it and prevents the outflow of menstrual blood.

Symptoms of the hematocolpos

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

In this case, symptoms such as:

• cyclic pain with spasms in the suprapubic region;
• back pain (in the lumbar region) and intense pelvic pain with tenesmus (false urge to defecate);
• vomit;
• bloating, constipation or diarrhea;
• urinary problems (urinary retention).

Some women with vaginal stenosis associated with amenorrhea (absence of menstruation) may also have a painful abdominal mass.

At the same time, hematocolpos and hematometra (hematometrocolpos) can be observed - the accumulation of menstrual blood in the uterine cavity: due to the same hymen atresia or  stenosis of the cervical canal . [2], [3]

Complications and consequences

The most likely complications and consequences of hematocolpos are:

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

Diagnostics of the hematocolpos

For more details, see -  Diagnosis of malformations of the vagina and uterus

Instrumental diagnostics is carried out using: transabdominal  ultrasound of the pelvic organs and uterus ; computer or magnetic resonance imaging of the pelvic organs.

Differential diagnosis

Differential diagnosis includes  pubertal dysmenorrhea , pelvic venous stasis syndrome with chronic pain,  pyocolpos .

Treatment of the hematocolpos

Treatment of hematocolpos is surgical, and depending on the causes, it may consist of an incision in the membrane of the hymen (hymenotomy), a complete hysterectomy, and removal of the vaginal septum (with access through the perineum).

More details in the publication - Treatment of malformations of the vagina and uterus .

Prevention

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

Forecast

With intervention to eliminate the anatomical causes of hematocolpos and hematometers, the prognosis of the disease is favorable.