Hymenal Anomalies Interfering with Dilation in Women with Mullerian Agenesis: A Case Series

J Pediatr Adolesc Gynecol. 2023 Feb;36(1):86-88. doi: 10.1016/j.jpag.2022.07.012. Epub 2022 Jul 30.


Background: Women with Mullerian agenesis, also known as Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), have aplasia or hypoplasia of the uterus and vagina. Regular use of dilators can successfully create a functional vagina in up to 95% of cases. We present 3 women with Mullerian agenesis who failed dilation therapy due to pain and were subsequently found to have hymenal anomalies.

Cases: Patients presented at age 16 or 17 to initiate dilation. Initial attempts were discontinued due to pain. On examination, a septate hymen was identified in 2 patients and a microperforate hymen in 1 patient. All patients underwent hymenectomy and thereafter continued dilation with less discomfort.

Summary and conclusion: These cases illustrate the importance of recognizing and treating hymenal anomalies in women with Mullerian agenesis to prevent pain, leading to unsuccessful dilation.

Keywords: Hymenal anomalies; Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome; Mullerian agenesis; Vaginal dilation.

Publication types

  • Case Reports

MeSH terms

  • 46, XX Disorders of Sex Development* / complications
  • 46, XX Disorders of Sex Development* / diagnosis
  • 46, XX Disorders of Sex Development* / surgery
  • Adolescent
  • Congenital Abnormalities* / diagnosis
  • Dilatation
  • Female
  • Humans
  • Hymen / surgery
  • Mullerian Ducts / abnormalities
  • Vagina / abnormalities
  • Vagina / surgery

Supplementary concepts

  • Mullerian aplasia