Case Report: Surgical and cultural approaches to managing hematocolpos in adolescents: A Tunisian case report with video insights

Résumé

Hematocolpos is a gynecological disorder characterized by the accumulation of menstrual blood in the vagina due to anatomical obstruction, often resulting from an imperforate hymen (IH), the most common etiology in approximately 90% of cases. This condition can remain undiagnosed until adolescence, when menarche triggers clinical symptoms such as cyclical lower abdominal pain, primary amenorrhea, and in severe cases, a rapidly enlarging pelvic mass. Complications may include urinary retention, constipation, and infection if not promptly treated. Early diagnosis and intervention are crucial to prevent long-term consequences such as endometriosis, retrograde menstruation, and infertility. In Tunisia, the hymen holds significant cultural and social value, symbolizing virginity and moral purity, complicating the surgical management of hematocolpos. This case report discusses the surgical and cultural considerations involved in the treatment of a 13-year-old Tunisian girl diagnosed with hematocolpos. A hymen-sparing hymenotomy was selected, preserving the hymenal ring while creating an adequate orifice for menstrual flow, ensuring a balance between medical treatment and cultural sensitivities. The procedure, which included drainage of 600 ml of retained blood and meticulous suturing to maintain the hymen’s appearance, was successful. The patient experienced regular menstrual cycles and expressed satisfaction with the outcome 12 months postoperatively. This case highlights the importance of providing culturally sensitive care in regions where the hymen holds symbolic value. Virginity-sparing surgical techniques offer a suitable approach that addresses both medical and social concerns, ensuring patient well-being while respecting cultural beliefs.

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