A urethral catheter should be placed preoperatively or intraoperatively to confirm the exact location of the urethra 1. To avoid the urethra, an initial cruciate or U-shaped incision is made using sharp dissection or needlepoint cautery Figure 5 , Figure 6.
The redundant hymenal mucosa should be excised, and the mucosal edges may be reapproximated using a or absorbable suture in an interrupted fashion for hemostasis. Aggressive irrigation of the dilated vagina should be avoided secondary to the risk of ascending infection 3. A hymenal septum may be managed in the office with topical anesthesia if the patient is able to tolerate the examination and agrees to the procedure.
A rapidly absorbable suture or free tie can be placed at the anterior and posterior aspects of the septal tissue, and the septum is resected between the two sutures. Topical emollient then may be applied. A topical emollient, such as zinc-based diaper cream, silver sulfadiazine, petroleum jelly, or coconut oil can be used several times a day during the recovery process. In the rare occasion the procedure is performed in a prepubertal patient, application of a short course of topical estrogen cream to the surgical site may be given to enhance healing and decrease the likelihood of stricture formation and subsequent stenosis 4.
Patients should be counseled to keep the introitus clean and dry. Pain management with nonsteroidal antiinflammatory drugs or a topical anesthetic jelly typically is sufficient.
Most patients will have little to no pain. After the hematometrocolpos has been drained, the patient can expect to have an extended bleeding cycle of approximately 2 weeks, which will allow for the involution of the uterus. Patients are at risk of ascending infection and pelvic inflammatory disease, and they should be advised to call their obstetrician—gynecologist or other gynecologic care provider if pain worsens or fever is present.
Tampon use and sexual activity should be avoided until vaginal distention and the initial bleeding and discharge have resolved. Most patients will have resolution of pain after hymenectomy.
Imperforate hymen is not associated with concomitant uterine anomalies 3 , and, therefore, in the absence of symptoms, postoperative uterine imaging usually is not required. Although stenosis and adhesions have been reported after hymenectomy, these complications are extremely rare. In these situations, dilator therapy may be considered 5.
If an adolescent is doing well after the procedure, she may not need additional care; however, because of the risk of endometriosis after hematometrocolpos, she should be encouraged to return if she experiences significant dysmenorrhea 6. An adolescent with atypical hymenal anatomy may present with abdominal and pelvic pain, difficulty placing tampons, a retained tampon, or inability to have penetrative vaginal intercourse.
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Diagnosis and management of hymenal variants. American College of Obstetricians and Gynecologists. Obstet Gynecol ;e—6. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician.
Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on acog.
ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Sexual intercourse and parturition child birth contrarily affect hymen for instance, if hymen is elastic it may recuperate its original position while in other cases only fragments are accessible or it may also wane after recurrent penile penetration.
A disease, an injury, medical examination, masturbation or any physical exercise may cast their undesirable shadow on this fragile membrane condemning the belief that it is pointer of virginity.
Glaister Keen rod can ascertain the presence and degree of hymen rift. Development of genital tract inaugurates from third week of gestation period to the second trimester where hymen conceals vagina of female fetus. Urorectal septum is formed separating the rectum from urogenital sinus in the seventh week. Hymen of the newborn babies is pale pink, thick and redundant due to action of mother's hormones which continues till the age of years as infant's body produces its own hormones making their hymenal opening annular.
With further advancement of age hymen becomes thin, smooth, delicate as well as translucent becoming very sensitive to touch and liable to be ruptured. Later, diameter of hymenal opening amplifies approximately 1 mm every year which at puberty can be further inflated by tampon, pelvic examinations, physical activity or sexual intercourse.
It is clear that once a girl reaches puberty the hymen becomes very elastic. Hymenal opening procures different shapes in prepubescent girls proposing that it is austerely under hormonal control and life style where most common shape is crescentic.
Estrogen and activity levels can make hymenal tissue thicker after puberty. In cases of rape or child sexual abuse, examination of hymen can be steered. Torn hymen heals hastily in younger children. After child birth vaginal opening often shows hymenal tags labeled as parousintroitus. Hypoplasia, canalization defects, lateral fusion and failure of resorption cause various complications detrimental to the female reproductive system.
Imperforate hymenal opening entails minor surgery if it fails to become perforated at puberty as it precludes escape of menstrual fluid. Cribriform or microperforate hymenal opening carries very small openings however, septate one bears countless tissue bands. Some cultures exceedingly value intact hymen at marriage as gage of virginity. Some women undertake hymenplasty to reinstate their dented hymen to verify they are virgins.
Medical experts of the sixteenth century employed hymen as a tool to pinpoint hysteria. Many mammals like chimapnazees, manatees, whales and horses too hold hymen. Even to this day, in many cultures, an intact hymen still indicates virginity, especially if there is the presence of blood upon first penile penetration. Clinically speaking, however, a torn or damaged hymen is not irrefutable confirmation of virginity loss by sexual hanky panky.
Depending on its rigidity, perforation of the hymen can be caused by normal everyday activities such as strenuous athletics, horseback or bicycle riding, a simple gynecological examination with speculum or gloved finger insertion or masturbation. Even placing a tampon into the vagina may rupture it. In some cases, a hymen may not be present at all, as approximately 1 in 1, women are born without one. Learn more! Hymenoplasty is a cosmetic fix for women who may wish to repair or reconstruct their hymen.
Their reasons for seeking this procedure are varied, and may be physical or psychological. Hymenoplasty is usually a simple outpatient procedure that can be done in our clinic under local anesthesia. Top agony aunts.
About Us. Sitemap Can the hymen be ruptured during a pelvic exam? Still feel a little discomfort, but it really does relax me. And my doctor is super-patient and cool with it all, as she tells me what I'll be feeling "you'll feel a little discomfort here" and makes my comfortableness paramount. In the country where I am from, virgins are not examined. If you have some problem they check you with an ultrasound.
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