Primary amenorrhea + cyclic pelvic pain, suspected hematometra / imperforate hymen
Recommended: Transabdominal Pelvic Ultrasound is the preferred imaging study for primary amenorrhea + cyclic pelvic pain, suspected hematometra / imperforate hymen. Distended uterus + blood.
Recommended study
Transabdominal Pelvic Ultrasound
Distended uterus + blood. Imperforate hymen, transverse vaginal septum, cervical agenesis, or imperforate cervix.
If the default doesn't apply
Complex anatomy / surgical planning
MRI
MRI Pelvis
No contrast
Watch-outs
Bulging hymenal membrane on exam
Imperforate hymen is the most common cause; bedside diagnosis + hymenotomy curative.
Pearls
- Hematocolpos: vaginal blood; hematometra: uterine blood; hematosalpinx: tubal blood — often all coexist.
- MRI clarifies obstruction level (hymenal vs vaginal septum vs cervical).
- Adolescent with cyclic pain + no menarche → think obstruction.