Hymenotomy is the surgical perforation of an imperforate hymen. There are several forms of imperforate anus and anorectal malformations. The most common vaginal anomaly is an imperforate hymen. This type of fistula can cause pediatricians to misdiagnose imperforate anus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum. An imperforate hymen is usually visible on vaginal inspection as a bulging blue membrane. There are other forms of anorectal malformations though imperforate anus is most common. Mucometrocolpos is the accumulation of mucous secretions behind an imperforate hymen. Other vaginal anomalies can have similar symptoms to an imperforate hymen. Correction of an imperforate hymen may be delayed until puberty. An imperforate hymen is the presence of tissue that completely covers the vaginal opening. The imperforate hymen is treated by excision and drainage. A permanent colostomy may be necessary in the case of imperforate anus. Its very commonly seen in a newborn with imperforate anus. It is often caused by the combination of menstruation with an imperforate hymen.