Hymen is a ring of fine fleshy tissue in the shape of a fold mucous membrane partly closing the orifices or the opening of the vagina. It does come in many shapes and sizes. You may have heard about hymen breaks when a person has sex for the first time, especially a female living in an Asian household with strong belief that hymen is the precursor of a person’s virginity but truthfully this is not the entire case. In fact, not all females at birth are born with a hymen. The hymen can be stretched open causing small tears, not only from sexual activity but also after playing sport using tampons. In this DoctorOnCall’s article, we will be learning about hymenectomy, a procedure involving the hymen.
What exactly is hymenectomy? Hymenectomy is a minor medical procedure involving removal or opening of the hymen. You probably wonder, why would someone get such a procedure? Reasons lie in the hymen itself. As mentioned, hymen comes in many shapes and sizes. In some cases, the hymen formed is not normal which means it is a malformation of hymen that is present at birth. The problem with malformation of hymen is that it does actually lead to many issues as the female grows up especially during puberty or when reaching reproductive age.
Malformation of hymen can be in many types such as imperforate (hymen completely covers the vagina), microperforated (very thick hymen with single small opening), cribriform (hymen with many small holes) or septate (additional band of skin on the centre of vagina producing two small holes) hymen. Common issues with malformation of hymen are problems with urinating or feeling the lower abdomen is full even after urination (urinary retention), constipation and abdominal mass. Other issues include lack of menstruation, pain or discomfort during sexual intercourse and trouble inserting or removing tampons.
Hence, hymenectomy aims to solve these problems and make a female life better by allowing them to have a normal and pain-free life just as other females do. Before hymenectomy is recommended for patients, vaginal examinations and other examinations such as abdominal and perineal helps to determine the malformation of hymen and other possible problems which then helps the healthcare provider to determine which parts of the hymen to be focused on. What is usually found during vaginal examinations is dark-colour or blue tinged bulge in imperforate hymen and perforation of the hymen with a swab or presence of the septum in other hymens issues. If a swab cannot be done to assess the hymen, ultrasonography (USG) may be done by doctors to get a clear look of the hymen and the vagina.
Hymenectomy is done under local anaesthesia. This means a person undergoing hymenectomy is usually awake and alert. It is rare for hymenectomy to be done under general anaesthetic but in some circumstances may be done such as in children. Although hymenectomy does involve surgery, it is usually considered as minor surgery which means long hospitalisation is rare. In most cases, the patient only needs to be in the recovery area for observation for at least an hour before they are allowed to go home.
During the hymenectomy procedure, the type of surgery technique depends on the malformation of the hymen. For instance, in case of imperforate hymen, a scalpel or scissor is used to cut the excess tissue. The cut area is then sutured with absorbable sutures to prevent bleeding. In most cases, absorbable sutures are used as the stitches will be dissolved on its own meaning there is no need to remove the stitch.
After a hymenectomy, patients will be given topical cream to help fasten healing of the hymen. Apart from cream, painkillers are usually prescribed by doctors to prevent discomfort after surgery. Small bleeding might occur after the procedure and this is normal. For a week or two, the patient might have vaginal discharge after the procedure. Slight discomfort to the vaginal area can be expected and is usually settled with painkillers prescribed by doctor or over-the-counter medicine. Patients may even apply cold packs to ease the discomfort.
Just as with any other medical procedure, there will always be possible side effects or complications. Apart from feeling discomfort or pain should go away in one or two weeks, there are also dangerous signs that need to be paid attention to and to meet their healthcare provider soon before the next appointment. Dangerous signs include high fever, heavy vaginal bleeding, foul-smelling discharge or discharge lasts more than 2 weeks and difficulty to urinate. These could be signs of an ongoing infection or possible injury to the adjacent part of the vagina such as the urethra (the tube of the urine outlet).
It can be concluded that there is a reason why someone would get a hymenectomy. Hymenectomy aims to improve a female’s life such as enabling them to have sexual intercourse without pain and to be able to use tampons. It also helps to solve menstrual issues in imperforate hymen and in general lower the chances for bladder infections. In general , hymenectomy is optional and is usually recommended by doctors to help improve quality of life but can be medically necessary in case of imperforate hymen since it can lead to complications such as infection and menstrual blood blockage. Talk to a healthcare provider for more information on hymenectomy.