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Delayed Diagnosis of Microperforate Hymen Leading to Urethral Dilation Secondary to Coital Activity

Underwood, Porshia G., MD; Bauer, Jessica, MD; Huguelet, Patricia, MD; Alaniz, Veronica I., MD, MPH

doi: 10.1097/AOG.0000000000003118
Contents: Gynecology: Case Report

BACKGROUND: Urethral coitus can occur with vaginal and hymenal anomalies and typically presents with incontinence, dyspareunia, and recurrent urinary infections. Penetration of the urethra occurs unknowingly, and delayed diagnosis permits ongoing urethral coitus and dilation.

CASE: A 23-year-old woman presented to a specialty clinic for a possible vaginal anomaly after failed intrauterine device insertion owing to difficulty locating the cervix. She reported regular menses and satisfying intercourse. Clinical examination revealed a dilated urethra from presumed urethral intercourse and a microperforate hymen with a 1-mm opening.

CONCLUSION: This case highlights the importance of taking a thorough sexual history paired with careful examination of the external genitalia to correctly identify and diagnose vaginal and hymenal anomalies and to prevent long-term complications.

Detailed visual inspection of external genitalia is necessary to accurately diagnose vaginal and hymenal anomalies.

Department of Obstetrics and Gynecology, University of Colorado, Denver, Aurora, Colorado.

Corresponding author: Porshia Underwood, MD, 12631 E 17th Avenue B198-6, Room 4007, Aurora, CO 80045; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.