Hematocolpos is a congestion of blood in the vaginal area, usually related to menstruation and in most cases due to hymenal atresia. In many cases, a distinct hump forms on the lower abdomen of the patients, which is due to the distension. Treatment is surgical and removes the structure responsible for the reflux.
What is a hematocolpos?
Menstruation is periodic uterine bleeding, also known as menstrual bleeding or periods. Beginning on the first day of menstruation, maturation of the Graafian follicle takes place, eventually leading to ovulation. With menstruation, the uterus prepares for the implantation of a fertilized egg. On average, a woman secretes 65 to a maximum of 200 milliliters of fluid during menstruation. In addition to blood, the excreted fluid contains secretions and mucous membrane residues from the uterus. In the so-called hematocolpos, menstrual blood collects in the vagina. However, in hematocolpos, the blood does not back up toward the uterus. If the blood backs up into the lumen of the uterus, it is called hematometra or hematometrocolpos. Hematocolpos does not necessarily have to be related to menstruation, but can also be caused by other blood in the vagina. However, the accumulation of menstrual blood is the most common variant of the phenomenon.
Causes
Most often, hematocolpos is causally related to the so-called hymenal atresia. This phenomenon is a congenital malformation of the hymen. In hymenal atresia, the vagina of the woman is completely closed by the hymen. This phenomenon corresponds to a form of gynatresia, in which an inhibition malformation closes cavities and ducts of the female reproductive organs. The result is asymptomatic hydrocolpos, in which fluid accumulates in the vagina. The accumulated fluid usually consists of secretion from the vaginal mucosa. However, during menstruation, blood can also collect in the vagina in this context. In hematocolpos, menstrual blood accumulates only in the vagina due to the inhibition malformation. In hematometra, it backs up into the uterus. Hematocolpos is therefore caused by an obstruction of the vagina due to hymenal atresia or gynatresia. Causative associations also exist with Robinow syndrome, the so-called uterus didelphys, or any duplications of the vagina and uterus.
Symptoms, complaints, and signs
Women with hematocolpos suffer from an accumulation of blood within the vagina that otherwise remains relatively asymptomatic. Those affected sometimes complain of a palpable hump on the lower abdomen that feels like a tumor. This hump is actually a distension. In some cases, this widening is even clearly visible. Patients do not usually experience pain. Nevertheless, many of those affected feel clearly disturbed and are psychologically burdened accordingly. In exceptional cases, patients do not consult a doctor for a long time because they are ashamed of the blood stasis and want to hide their problem from the public. Still other women have been accustomed to blood stasis since their first menstruation and consider the condition to be physiological normality. Partly, only the hump in the area of the lower abdomen moves them to consult a doctor.
Diagnosis and course of the disease
The diagnosis of hymenal atresia usually exists even before hematocolpos is diagnosed. In most cases, it is an incidental finding. The hematocolpos itself is diagnosed by the physician by ultrasound. A hemorrhagic mass in the area of the lower abdomen must be differentiated. A collection of pus in the vagina in the sense of a pyocolpos must also be considered for differential diagnosis. The prognosis of patients with hematocolpos is favorable. Usually, the cause of hymenal atresia is well treatable.
Complications
Hematocolpos does not cause any particular complications or pain in the patient in most cases. In many cases, the condition remains undetected at first and only becomes apparent to the woman during menstruation. It is not uncommon for hematocolpos to be mistaken for a tumor, which can lead to a panic attack or general inner turmoil in many people.The quality of life is thus restricted for a short period of time and can lead to depression and further psychological complaints in many patients. It is not uncommon for the partners of those affected to suffer from the hematocolpos as well. In most cases, it is not possible to treat or remove the hematocolpos if there are no particular complaints. Complications can occur if there is inflammation of the genital organs. In the case of removal, a surgical procedure is used to remove the hematocolpos. There are no particular complications or pain in this process either. In case of psychological complaints, therapy is sometimes necessary. Life expectancy is not limited by the disease. There are usually no special complaints after treatment either.
When should one go to the doctor?
Women who notice an elevation on the lower abdomen should consult a gynecologist. The gynecologist can perform an examination and clearly diagnose or rule out hematocolpos. If it is indeed a congestion of blood, treatment is usually initiated immediately. If the symptoms are due to another cause, the elevation should be carefully observed. If it increases in size, further examination by a specialist is indicated. In some cases, a hematocolpos poses no risk to the patient. Treatment is required only if the hematocolpos causes pain or general discomfort. If signs of inflammation are noticed, the hematocolpos must be treated immediately. Women suffering from hymenal atresia are prone to developing hematocolpos. Blood stasis in the vaginal area may also occur in association with Robinow syndrome and any duplications of the vagina and uterus. If these risk factors are present, a precautionary examination should be performed by the responsible gynecologist.
Treatment and therapy
Hematocolpos does not necessarily require therapy as long as it does not cause distress to the patient. However, if the patient feels impaired or burdened by the hematocolpos, therapy is indicated to rule out secondary psychological symptoms. In addition, therapy may be necessary if regular blood stasis promotes inflammation or bacterial colonization of the genital organs. Medicinal conservative solutions are not available for therapy. The only option for treatment is invasive causal therapy, which resolves the particular cause of the blood stasis through surgery. Since the cause is usually an anomaly of the hymen, this structure is opened during surgery. Accordingly, the causal treatment corresponds to surgical transection of the anomalous hymen or the pathologically obstructing membrane. If acquired scarring closure of the vagina has been identified as the primary cause of the phenomenon, surgical removal of the scar tissue takes place. The surgery is performed under general anesthesia and requires hospitalization. Mild pain is expected in the aftermath, but this can be well controlled by the administration of analgesics. If the hematocolpos has already caused psychological discomfort, patients are advised to undergo psychotherapy. In case of inflammation due to the phenomenon, symptomatic therapy must take place before causative therapy, in which the inflammation is brought to a decline. In fact, in case of inflammation in the abdomen, there is a contraindication to surgery.
Prevention
In most cases, hematocolpos is due to hymenal atresia. Since this is usually a prenatal inhibitory malformation, it is difficult to prevent the phenomenon.
Follow-up
The extent to which follow-up care is of concern depends on the treatment method and the extent of the condition. In many cases, hematocolpos does not need to be treated at all because the affected women find the distress marginal. The physician informs his patient of the harmlessness of a small accumulation of blood during the initial diagnosis. There are no restrictions. If, on the other hand, the affected women find the accumulation of menstrual blood in the vagina distressing, a surgical intervention can provide relief. In most cases, this achieves a satisfactory result. Aftercare immediately after surgery includes, among other things, taking painkillers. The medication reduces the short-term consequences of the operation.An ultrasound image is taken to confirm the success of the treatment. In practice, scheduled follow-up examinations after a successful procedure have no significant relevance. In this way, hematocolpos differs from cancer. This is because neoplasm is not possible; either the blood collection exists or it does not. Nor is it a life-threatening disease. Some women delay treatment out of shame, which can lead to psychological problems. Even after it has subsided, these psychological signs may persist. Psychotherapy can then be used to boost self-confidence and discuss difficulties.
This is what you can do yourself
As a rule, no direct self-help is possible in the case of hematocolpos. In any case, medical treatment must be given for this condition to prevent further complications and discomfort. Since in most cases there is no pain or other discomfort with this complaint, there is no need to take painkillers. In many cases, the condition is mistaken for a tumor, as swelling also develops. However, those affected should remain calm and have an examination performed by a gynecologist to clarify the exact cause of the swelling. As a rule, this is a hematocolpos, which can be removed easily and without complications. If the patient possibly suffers from psychological discomfort, the support of friends and acquaintances is very helpful, and of course psychological treatment can also be provided. No special therapy is necessary after the treatment. The patient can usually continue to live after the procedure and is not bound by any restrictions. Sexual intercourse can also be resumed afterwards without further ado. However, treatment by a physician is definitely necessary for hematocolpos.
