Continuing the topic of reproductive problems associated with certain anatomical features of the genital organs, in this article we will discuss a condition known as hematocolpos. Hematocolpos is a condition characterized by the accumulation of blood in the vagina due to the inability of menstrual blood to drain. It occurs in the context of an anatomical obstruction, most commonly at the time of the first menstruation in association with an imperforate hymen. However, the underlying causes may vary and can also be acquired later in life.
Why Does Hematocolpos Occur?
Vaginal atresia is a congenital defect that develops during fetal life when the caudal portion of the vagina fails to form and is replaced by fibrous tissue. Due to this anomaly, menstrual blood cannot drain from the vagina, eventually leading to blood accumulation.
A transverse vaginal septum is a vertical fusion defect resulting from varying degrees of impaired tissue resorption between the vaginal plate and the caudal portion of the Müllerian ducts during embryonic development. It should be noted that the hymenal opening may be normal in this condition, but a tissue membrane blocks access to the vaginal canal. A small opening in the septum may allow menstrual blood to pass through, although the process takes longer than during a normal menstrual period. In women without such an opening, blood accumulates in the upper vagina, causing severe abdominal pain.
As mentioned above, the leading cause of hematocolpos is an imperforate hymen. This is a congenital pathological condition in which the hymen lacks an opening and completely blocks the passage between the posterior vaginal wall and the vaginal vestibule. When a girl reaches puberty, this type of hymen prevents menstrual blood from draining.
It is important to understand that hematocolpos can develop at virtually any age due to gynecological disorders complicated by cicatricial obliteration of the cervix and uterine os or by stenosis that impairs the patency of the vaginal opening.
How Does Hematocolpos Manifest?
Symptoms include:
• absence of menstrual bleeding;
• intense, cyclical lower abdominal pain lasting more than a week and potentially accompanied by uterine cramps;
• vomiting without blood or bile;
• constipation and changes in urination.
Hematocolpos may also cause swelling and damage to the vaginal epithelium, potentially progressing to necrosis.
The diagnosis of hematocolpos can often be established through a simple gynecological examination. In cases where the cause is unclear or unknown, biopsy samples may be taken from the endocervical canal to rule out malignant neoplasms.
What Are the Complications?
One of the most serious complications associated with hematocolpos is hematometra, a condition in which the uterus fills with menstrual blood. Common symptoms of hematometra include amenorrhea and abdominal pain, as well as enlargement of the uterus, which may appear tense and distended. In cases of incomplete vaginal occlusion, dark brown blood-stained discharge may be present.
Specialists at MC “Bogolyuby” point out that in postmenopausal women, hematometra may be completely asymptomatic and therefore remain undiagnosed for a prolonged period.
How Is It Treated?
The surgical treatment of hematocolpos varies depending on the underlying cause. In cases of an imperforate hymen, a minor surgical procedure is required to incise the hymen and create an opening that allows menstrual blood to drain.
If congenital cervical atresia is present, treatment options range from conservative approaches, such as catheterization of the uterine cavity, to total hysterectomy with canalization procedures. Regardless of the type of surgery, the goal of treatment is to restore the natural outflow of blood.
Number of views: 5
