Cryptomenorrhea or cryptomenorrhoea, also known as

hematocolpos Hematocolpos is a medical condition in which the vagina is pooled with menstrual blood due to multiple factors leading to the blockage of menstrual blood flow. The medical definition of hematocolpos is'' 'an accumulation of blood within the vagina' ...

, is a condition where

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...

occurs but is not visible due to an obstruction of the outflow tract. Specifically the

endometrium The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional laye ...

is shed, but a congenital obstruction such as a

vaginal septum A vaginal septum is a vaginal anomaly that is partition within the vagina; such a septum could be either longitudinal or transverse. In some affected women, the septum is partial or does not extend the length or width of the vagina. Pain during ...

or on part of the

hymen The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina. In children, a common appearance of the h ...

retains the menstrual flow. A patient with cryptomenorrhea will appear to have

amenorrhea Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation (breastfeeding). Outside the reproductive years, there is absence of menses ...

but will experience cyclic menstrual pain. The condition is

surgically Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

correctable. The patient usually presents at the age of puberty when the commencement of menstruation blood gets collected in the vagina and gives rise to symptoms.

Symptoms

Eugonadotropic primary amenorrhea and cyclical lower abdominal pain are the chief presenting complaints of hematocolpos. Patient may be brought in emergency urinary retention.

Signs

* Abdominal examination: swelling is felt on palpation. * On vulval inspection: a tense, bulging, bluish membrane is seen, this finding varies according to the thickness of the obstructing membrane. It may be absent in patients with complete or partial vaginal agenesis. * On rectal examination: a large bulging mass is felt.

Complications

hematometra Hematometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum. Signs and symptoms Hematometra typically presents as cyclic, cramping p ...

(collection of blood in the uterine cavity) *

hematosalpinx Hematosalpinx (sometimes also hemosalpinx) is a medical condition involving bleeding into the fallopian tubes. Symptoms A hematosalpinx from a tubal pregnancy may be associated with pelvic pain and uterine bleeding. A gynecologic ultrasound will ...

(collection of blood in fallopian tubes) *

endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...

in long-standing cases * in severe, untreated forms, infertility and urinary retention

Diagnosis

Cryptomenorrhea can be easily diagnosed using ultrasound. The vagina is commonly seen filled with blood and the uterus usually appears pushed upward.

Treatment

A simple cruciate incision followed by excision of tags of hymen allows drainage of the retained menstrual blood. A thicker transverse vaginal septum can be treated with Z-plasty. A blind vagina will require a partial or complete vaginoplasty. Hematosalpinx may require laparotomy or laparoscopy for removal and reconstruction of affected tube. Infertility may require assisted reproductive techniques.

References

External links

{{Female congenital malformations of genital organs Gynaecologic disorders