UNASSIGNED: Several schoolgirls attain reproductive age with undiagnosed gynaecological problems which pose challenges in their livelihood. These conditions include precocious puberty, congenital reproductive tract abnormalities, and delayed sexual development. Many children with these conditions face additional challenges including physical pain, psychological trauma and delayed diagnosis.
UNASSIGNED: A 14-year-old girl presented with acute on chronic pelvic pain and haematocolpometra due to imperforate hymen during COVID-19 pandemic. She has not undergone cultural virginity test in her community. The hymenal membrane was unusually non-bulging despite the haematocolpometra. A partial hymenotomy with a narrow margin of excision was performed.
UNASSIGNED: The hymenal orifice later obliterated and resulted in a repeat partial hymenectomy where a wide surgical margin of the hymen was excised.
UNASSIGNED: A wide rather than narrow partial hymenectomy prevents obliteration of the hymenal orifice after surgery for imperforate hymen. There is a need for timely interventions such as counselling and community awareness that prevent undue consequences of an imperforate hymen and its treatment including pain and possible inability to pass cultural virginity test in some African communities.

Herein, we present a case of cryptomenorrhea due to imperforate hymen where approximately 3400 ml of retained menstrual blood was drained in a 16-year-old girl who presented with primary amenorrhea, cyclical abdominal pain, mass abdomen and acute pain abdomen for 15 days. Magnetic resonance imaging revealed hematocolpos due to imperforate hymen with grossly distended vagina measuring 28.6 × 9.9 × 11.3 cm. Surgical drainage of hematocolpos was done by performing hymenotomy with a cruciate-shaped incision. The post-operative period was uneventful and patient was discharged the next day in stable condition. To our knowledge, this is the first case of hematocolpos reported in literature where more than 3 liters of retained menstrual blood was drained.

Access to the uterine cavity can sometimes be a challenge or even impossible because of various causes such as prior surgery. We report our experience with a novel approach to this problem in 8 cases using ultrasound-guided transmural injection of dye; afterward, the cavity was successfully found in all cases by ultrasound-guided hysteroscopy following the colored epithelium.