Partial imperforate hymen mimicking urethrovaginal fistula: a diagnostic pitfall

Abstract

Partial imperforate hymen, a rare congenital anomaly, often evades diagnosis until adulthood, presenting atypically as infertility, menouria, or dyspareunia. Misdiagnosis risks unnecessary investigations and delays in fertility care. This case report emphasizes the importance of recognizing atypical presentation of partial imperforate hymen, which may mimic as urethrovaginal fistula and to demonstrate how thorough clinical evaluation and vaginoscopy can lead to accurate diagnosis and successful management. A woman in her thirties presented with infertility, menouria, and dyspareunia. Initial assessment suggested urethrovaginal fistula, but magnetic resonance imaging (MRI) excluded fistulous communication. Detailed gynaecological examination combined with vaginoscopy led to the identification of a normal vaginal pouch, behind the lower fused hymenal membrane consistent with the diagnosis of a partial imperforate hymen, which was managed surgically. The patient recovered well and resumed normal sexual activity, with improvement in symptoms and plans for natural conception. This case highlights the importance of careful genital examination and office vaginoscopy in women presenting with menouria, to avoid misdiagnosis of genitourinary fistula and unnecessary investigations.