Question:easy
A mother brings her 16-year-old daughter to the gynaecology OPD with a complaint of not attaining menarche. There is a history of cyclical lower abdominal pain. On examination there is a midline abdominal swelling, and per-rectal examination reveals a bulging mass in the vagina. What is the most common cause?
A mother brings her 16-year-old daughter to the gynaecology OPD with a complaint of not attaining menarche. There is a history of cyclical lower abdominal pain. On examination there is a midline abdominal swelling, and per-rectal examination reveals a bulging mass in the vagina. What is the most common cause?
Show Hint
Cyclical pain plus a bulging bluish membrane at the introitus is the giveaway.
Updated On: Jun 23, 2026
- Imperforate hymen
- Transverse vaginal septum
- Vaginal agenesis
- MRKH syndrome
Show Solution
The Correct Option is A
Solution and Explanation
Clinical reasoning: the triad of primary amenorrhea + cyclical pain + bulging vaginal mass = obstructed menstrual outflow with hematocolpos.
The question asks for the MOST COMMON cause, so frequency decides:
Imperforate hymen is the commonest congenital lower-genital obstruction. The retained menses bulge the hymen into a tense bluish membrane and form a palpable midline mass. Best fit and commonest, so it wins.
Transverse vaginal septum gives a near-identical story but is rare; not the most common.
Vaginal agenesis and MRKH: here the lower tract is absent, and in MRKH the uterus is rudimentary, so there is typically no functional menstrual blood to accumulate behind a membrane in this classic bulging-introitus way.
Spot diagnosis cue: 'tense bluish membrane at the introitus' is taught verbatim for imperforate hymen. Choose option a.
The question asks for the MOST COMMON cause, so frequency decides:
Imperforate hymen is the commonest congenital lower-genital obstruction. The retained menses bulge the hymen into a tense bluish membrane and form a palpable midline mass. Best fit and commonest, so it wins.
Transverse vaginal septum gives a near-identical story but is rare; not the most common.
Vaginal agenesis and MRKH: here the lower tract is absent, and in MRKH the uterus is rudimentary, so there is typically no functional menstrual blood to accumulate behind a membrane in this classic bulging-introitus way.
Spot diagnosis cue: 'tense bluish membrane at the introitus' is taught verbatim for imperforate hymen. Choose option a.
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