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This is commonly caused by the failure of the central epithelial cells of the hymenal membrane to degenerate. It can also arise as the result of an inflammatory reaction in the hymen after birth, presenting with a build‐up of fluid behind the membrane (mucocolpos). This can lead to renal failure secondary to urethral obstruction [59].

Imperforate hymen does not usually present until puberty where a membrane, sometimes with a bluish tinge if thin, is seen at the distal end of the vagina and the hymen may be separate. Unusual variations include extension of the membrane into the vagina which can rarely obstruct one side if the vagina is septate.

Other rare hymenal abnormalities include a cribriform, microperforate, or septate hymen (see Chapter 51).