[Imperforate hymen; importance of inspection of the external genitalia]

Three women aged 17, 12 and 13 years presented with intermittent abdominal pain. Secondary sexual characteristics, i.e. mammae and pubic hair, were developed, but menarche had not occurred. All were found to have imperforate hymen. After incision, the symptoms disappeared. Imperforate hymen causes clinical symptoms from the time of menarche. Pubertal girls presenting with abdominal symptoms must be examined, including observation of secondary sexual characteristics and inspection of the external genitalia. This examination is often omitted because the patient and the physician are embarrassed. However, it is essential and should be carried out in a considerate manner. Excision of the hymen must be performed under general anaesthesia using a technique that will prevent secondary stenosis.