Anatomical Variations of the Hymen and Congenital Anomalies of the External Genitalia in Female Newborns

ABSTRACT

The anatomical variations and shapes of the hymen with congenital anomalies of the external genitalia were investigated prospectively during the routine physical examination of 1,500 female infants born between March, 1992, and July, 1992, at the Taegu Fatima Hospital. All underwent a very careful inspection of external genitalia within the first 24 hours of life, and their external genitalia were photographed for confirmation. Abundant hymenal tissue that appeared redundant was observed in nearly all neonates. The annular hymen (89.1%) was the most common type. Of the annular hymens, 91.9% had a central orifice and the remainder had a ventral orifice. External ridges, intravaginal ridges, and clefts were the most frequent anatomical variations, representing 71.5%, 50.7%, and 40.5%, respectively. Congenital anomalies of the external genitalia were detected in 20 patients (1.4%). The anomalies were one case of imperforate hymen, one case of Skene's duct cyst, sixteen cases of hymenal cyst, and two cases of hymenal polyp. Imperforate hymen was incised and drained, and Skene's duct cyst was successfully treated with needle aspiration. Of 16 hymenal cysts, seven with a stalk were excised and the others without a stalk were managed with needle aspiration. Hymenal polyp, a larger form of tag with polypoid shape, was excised. All procedures were performed at the nursery without anesthesia. All the patients so treated were compeletely asymptomatic and had normal genitalia at follow-up. In conclusion, routine physical examination of the female newborn infant should include a careful inspection of the external genitalia with the knowledge of shapes and anatomical variations of the hymen. Longitudinal studies are necessary to understand developmental changes and the effects of estrogens.