Clinical features

Many patients remain asymptomatic until menarche when they present with cyclic abdominal pain and amenorrhea.

Hematocolpos or hematometra, the accumulation of menstrual blood in the vaginal or uterine cavities, can create a pelvic mass identified on physical exam as a blue, bulging perineal mass.

Neonates
Whitish bulging membranes between the labia

Palpable uterus at suprapubic area

Adolescents
Periodic lower abdominal pain which may be continuous.

Primary amenorrhea

Urinary symptoms such as Frequency, Dysuria, Urine retention of urine due to elongation of urethra

Lower Back pain.

Constipation

Suprapubic mass, which may be uterine or full bladder.

Tense bluish bulging membrane on vulva inspection

Bulged vagina on rectal examination