Primary amenorrhea with cyclic lower abdominal pain during menarche age. An imperforate hymen can be diagnosed at physical examination upon identification of a bulging, bluish membrane that allows positive transillumination at the introitus; consequently, imaging is rarely indicated. 

It occurs due to failure of the recanalization process of the distal end of the vagina. The hymen indicates the junction between the urogenital sinus and sinovaginal bulb. Imperforate hymen occurs due to a failure of recanalization of this membranous vestige.