A 13-year-old female is brought to the emergency department with a complaint of severe, deep pelvic discomfort. Physical examination reveals that the patient has an intact hymen. Incision of the hymen reveals hematocolpos. Which of the following conditions is associated with hematocolpos?

## **Core Concept**
Hematocolpos refers to the accumulation of blood in the vagina, often due to an obstruction that prevents menstrual blood from exiting. This condition can arise from various causes, including **imperforate hymen**, which is a congenital anomaly where the hymen completely covers the vaginal opening.

## **Why the Correct Answer is Right**
The presence of an intact hymen and the finding of hematocolpos upon incision strongly suggests that the patient has an **imperforate hymen**. This condition leads to the accumulation of menstrual blood in the vagina (hematocolpos), causing pelvic pain due to the distension of the vagina. The imperforate hymen acts as a physical barrier, preventing menstrual blood from flowing out of the vagina.

## **Why Each Wrong Option is Incorrect**
- **Option A:** While certain **uterine anomalies** can be associated with menstrual abnormalities, they are not directly linked to hematocolpos due to an intact hymen.
- **Option B:** **Vaginal agenesis** (Mayer-Rokitansky-Küster-Hauser syndrome) involves the congenital absence of the vagina and uterus, which does not match the clinical presentation of an intact hymen and hematocolpos.
- **Option D:** **Ovarian cysts** can cause pelvic pain but are not directly associated with hematocolpos or an intact hymen causing menstrual blood accumulation.

## **Clinical Pearl / High-Yield Fact**
A key clinical correlation to remember is that **imperforate hymen** often presents with **cyclic pelvic pain** in adolescents with primary amenorrhea. A physical examination finding of a bulging, intact hymen with a bluish discoloration (due to the accumulated blood) is highly suggestive of this diagnosis. Timely surgical intervention, such as hymenotomy or hymenoplasty, can relieve symptoms and prevent complications.

## **Correct Answer:** . Imperforate hymen.

✓ Correct Answer: C. Imperforate hymen