Cryptomenorrhea or cryptomenorrhoea, is a medical condition in which menstrual bleeding occurs but remains hidden due to a congenital septum or

atresia Atresia is a condition in which an orifice or passage in the body is (usually abnormally) closed or absent. Types Anotia Anotia is characterized by the complete absence of the ear and is extremely rare. This condition may affect one or both ...

blocking the vagina, resulting in symptoms of menstruation without external bleeding. It is commonly seen in cases of

imperforate hymen An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when men ...

. Specifically the

endometrium The endometrium is the inner epithelium, 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 funct ...

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 vaginal opening. A small percentage of females are born with hymens that are imperforate and completely obstruct the vaginal canal. It forms part of the vulva ...

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

amenorrhea Amenorrhea or amenorrhoea is the absence of a menstrual period in a female organism who has reached reproductive age. Physiological states of amenorrhoea are most commonly seen during pregnancy and lactation (breastfeeding). In humans, it is wher ...

but will experience cyclic menstrual pain. The condition is surgically 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. The only symptoms that may occur in some cases are

dysmenorrhea Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in th ...

or cyclic

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...

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 (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 in which Tissue (biology), tissue similar to the endometrium, the lining of the uterus, grows in other places in the body, outside the uterus. It occurs in women and a limited number of other female mammals. Endomet ...

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