Choice A and B. This patient's suprapubic mass is due to hematocolpos and uterine enlargement and will resolve with hymenal incision and drainage. CA-125 and CEA levels can be elevated in benign gynecologic conditions and are nondiagnostic. If the pelvic mass and chronic pelvic pain do not resolve with incision and drainage, a diagnostic laparoscopy may be performed to evaluate for other pathologies (eg, endometriosis).
Choice C.


Blue-tinged bulge

Hematocolpos

Educational objective: Imperforate hymen is a defect in the female genital outflow tract resulting in hematocolpos. The accumulated material causes pain and sometimes difficulty with defecation. Treatment is with hymenal incision and drainage.
Choice D. Patients with an imperforate hymen cannot undergo a hysterosalpingogram as the hymen prevents access to the cervix and uterine cavity. A hysterosalpingogram can be used to evaluate for uterine anomalies (eg, unicornuate uterus); uterine anomalies are not associated with imperforate hymen.
Choice E. Karyotype analysis may be performed in patients with primary amenorrhea and either no uterus (eg, androgen insensitivity syndrome [46,XY]) or lack of secondary sexual characteristics (eg, Turner syndrome [45,XO]). This patient has a uterus and normal secondary sexual characteristics.
Choice F. A uterine myomectomy is performed in patients with uterine fibroids (ie, leiomyomas). Patients with fibroids may have bulk symptoms (eg, abdominal pain, bowel symptoms); however, fibroids are typically irregularly shaped pelvic masses with no associated blue-tinged vaginal bulge.