Sleeve Hymen as a Penetrate Problem in a Newly Married Woman: A Rare Case Report

Introduction: Imperforate hymen (IH), an uncommon congenital anomaly, is a failure to completely canalize the hymen. This report aims to describe a sleeve hymen in a newly married woman and the surgical approach to the patient. Case Illustration: A 24-year-old newly married woman came to the gynecology polyclinic complaining of difficulty in sexual intercourse in the last 6 months. She felt painful and hard penile penetration since the first time of sexual intercourse. Inspection of external genitalia showed there was a hymen covering all vaginal introitus without an erythematous surface. The diagnosis indicated that the patient had a sleeve hymen. The patient underwent a U-shaped incision far away from the urethra as a hymenectomy. Discussion: Most of the IH patients are asymptomatic until menarche. Excess of estrogen status can cause the thickening of the hymen, called the sleeve hymen or “redundant” hymen. Meanwhile, epithelial cells’ failure in the center of the hymen to degenerate or excess cell proliferation may cause a microperforate hymen. There are several choices of treatment for IH, including hymenectomy (cruciate incision or hymen excision), hymen-preserving surgeries (simple vertical incision and annular hymenotomy), carbon dioxide laser, or insertion of a Foley catheter. Conclusion: Good anamnesis and physical examination can lead to the correct diagnosis of sleeve hymen. Hymenectomy is one of the alternative treatments for married women who have less concern about hymen-preserving surgery.