Hymen repair & reduction
What is the hymen?
The hymen is a membranous structure that tends to cover the lower 2/3rds of the vaginal introitus. It will usually be patent (open) towards the top of the introitus where the urethra is situated, to allow voiding, and will open into the vagina just below to allow passage of menstrual flow. It is not universally present in all women and, rarely, the hymen may form so as to completely cover the vaginal introitus.
The hymen can be present in many different forms; perforated, torn, irregular, a single sheet, thin and thick. Whilst usually delicate, the hymen can sometimes present as being very thick and relatively inelastic. Even in these cases, there are usually fine perforations in the membrane that allow the passage of menstrual blood. If the membrane completely occludes the vaginal introitus and does not have any perforating passages, this is referred to as an imperforate hymen. The hymen can break or tear, spontaneously or as a result of exercise, digital penetration of the vagina, use of a tampon or from surgery.
The hymen is easily torn, most commonly, though, during vaginal intercourse. There is a common misconception that when the hymen is torn at first intercourse there will be a lot of bleeding. There are certain cultures where blood on the marital sheet is required as evidence of the woman being virgo intacta. In fact, the hymen has a very poor blood supply and when significant bleeding does occur during first intercourse this is more likely a result of the hymenal tear extending into the superficial vaginal epithelium.
The hymen has a vast variety of appearances and will appear differently in the same person at different times of their lives and, between individuals at the same age. Despite some cultural mythology, it is not actually possible to determine if a woman is a virgin based on the state of her hymen.
A prominent hymen with evidence of tearing particularly on the left side.
Upper right hymenal elongation. The base takes up the upper half of the right side of the hymen.
A ‘tongue’ of hymen protruding from the lower part of the hymen. The tissue is broad-based and hypertrophic.
Smaller base but longer hymen presenting much more distinctly outside the vagina.
Requests for hymen repair (restoration)
Fall into 3 categories:
“I am from India and most people here think a girl having sex before marriage or with anyone other than husband is an unpardonable crime, which now I have committed and am not bold enough to let my fiancee know about this. In any case he will know when we get married and that would immediately cause disasterous effect on our marriage and may even lead to divorce. Please help me.“
“Can you please send me information and a quotation for the tightening of my vagina, hymen reconstruction as I am now divorced and want to save myself for my next husband.“
“I am 25 years single and had sex with my previous boy friend and he cheated on me and left me. I was pregnant and had terminated my pregnancy and since then I did not have sex. Now I got someone really caring and he is a religious minded person and wants his Girl Friend to give Virginity as a gift to him. He loves and trusts me a lot and thinks that I’m a virgin. I love him truly and can‘t even think of hurting him. Please advise if you are having some technique to repair hymen and make him feel as if I‘m a virgin. Please help me.“
Dr Onuma only performs hymen restoration for cultural reasons. For women caught between the traditions of their past and the reality of their lives today, this procedure may offer an alternative to dishonour, or even death.
- Office procedure.
- Local anaesthesia; no sedation or general anaesthesia.
- Rapid return to normal work activities.
- Use of very fine dissolvable sutures that do not require removal.
- Once healing complete, no evidence of surgical reconstruction.
- No coitus for 6 weeks.
- No use of tampons.
- No digitation of the vagina.
- No strenuous activities for 6 weeks.
The restored hymen will behave like a ‘normal’ undisrupted hymen:
- There may or may not be vaginal bleeding at the time of intercourse.
- Infrequently, surgical division will be required to allow intercourse to take place.
- Visual inspection will not reveal evidence of prior surgery.
Potential complications are all rare but include:
- Partial or complete breakdown of reconstruction.
- Painful coitus.
- Surgical division of reconstruction required to achieve coitus.
- Recurrence or new hymen hypertrophic changes.
The amount of hymenal tissue removed depends on the indication for surgery and the clinical findings. Sometimes there will be only one area to refashion and reduce and other times it may be pertinent to reduce and reconstruct all of the hymen so as to lay it open without any scar tissue forming.
Requests for hymen reduction
Fall into 4 categories:
Hymenal remnants that either elongate or become thicker can result in painful intercourse as a function of the irritation of the hymenal tissue. Ongoing contact stimulation of this tissue results in hypertrophy and increased symptoms that, in some women, may result in avoidance behaviour.
Hymenal tags can become thicker and longer as they continue to rub against the inner and outer parts of the vagina. When moving in and out of the introitus this can result in introital or vulval irritation. Chronic irritation can result from ongoing movement over a prolonged period of time.
Hymenal remnants that hypertrophy and elongate have a greater surface area, and this, combined with increased physical stimulation can produce an increase in vaginal introital discharge. This may be more symptomatic for some women at lower volumes than a ‘normal’ vaginal discharge because the discharge, occurring at the introitus appears more easily external to the vagina.
Women may become aware of a change in the introital vaginal tissues after inspecting themselves, comments from a partner or feeling something that they had not noted to have been previously present. Not all women will be bothered by the visual changes unless they have physical symptoms. Others will have the impression that the vagina has changed and looks abnormal. Only those who are bothered by this will usually seek to have surgical correction.