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Primary amenorrhoea due to imperforate hymen — DRCOG MCQ

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HardGynaecologyPrimary amenorrhoea due to imperforate hymenDRCOG

A 16-year-old girl has never had a period. She has normal breast development, normal pubic hair and cyclical lower abdominal pain. Examination shows a bluish bulge at the introitus. What is the most likely diagnosis?

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Correct answer: D — Imperforate hymen

Primary amenorrhoea with normal secondary sexual characteristics, cyclical pain and a bluish bulge suggests haematocolpos from an imperforate hymen. Turner syndrome usually has delayed pubertal development. Androgen insensitivity has breast development but scant pubic hair and absent uterus. The pearl is that outflow obstruction should be considered when cyclical pain accompanies primary amenorrhoea.

Reference: NICE CKS amenorrhoea; RCOG adolescent gynaecology guidance