Microperforate hymen with vestibular blind tract: a rare infertility case report

Background: Microperforate hymen (MH) is a rare hymen anomaly, characterized by a microperforation too minute for visualization, leading to frequent misdiagnosis and oversight.

Case Description: A 28-year-old female presented with chronic dyspareunia and infertility as her primary complaints. The patient had dextrocardia and a history of neonatal anoplasty for congenital anal atresia. Menarche, menstrual cycle and menstrual volume were normal, without dysmenorrhea. Six years ago, the patient attended a local hospital due to unsuccessful intercourse. The gynecologist revealed a 0.5 cm perineal hole, regarded as the “vaginal introitus“. The hole incision exposed a 1 cm-wide, 7 cm-deep blind tract with rigid tissue, which was diagnosed “vaginal contracture and stenosis”. Post-surgery, vaginal dilators were employed for two years to enlarge the “vagina”, but dyspareunia persisted, reporting issues with penetration during intercourse. Although the sperm of the patient’s partner was tested and no abnormalities were found, the couple was not able to conceive. Two months ago, the couple, facing infertility, pursued assisted reproductive conception. Oocytes were successfully extracted through “vagina (the blind vestibular tract)” under abdominal ultrasound guidance at the local reproductive medicine clinic. However, physicians were unable to transfer embryos due to the cervix being undetectable. Thus, the patient was referred to ourinstitution. We revealed the presence of an MH above the orifice that was mistakenly considered a vagina. Hymenectomy exposed the native vagina, separated by 0.2 cm of tissue from the blind tract previously observed, and the cervix became accessible. At postoperative follow-up, the patient had normal vaginal intercourse, used condoms for contraception, and intended to conceive in coming year.

Conclusions: This report documents the first clinical case of a patient with MH complicated by a vestibular blind tract, dextrocardia and congenital anal atresia—a rare combination of genital and systemic congenital malformations that has not been previously described in the clinical literature. The initial failure to diagnose the MH resulted in six years of unnecessary patient suffering. It not only augments the current clinical understanding of MH but also serves as a critical clinical reminder that vigilance for rare anatomical anomalies is paramount to avoiding misdiagnosis.