Hymenoplasty

The hymen (named after Hymenaeus, the ancient Greek god of marriage and weddings) is a membrane-like fold of tissue, about 2-3 mm thin, that partly covers the entrance of the external genitalia in women, sitting about 2-3 cm inside. This tissue can take a wide variety of shapes; it is usually crescent-shaped, located at the vaginal opening, and surrounded by fine capillary vessels. Despite its name, the hymen is not actually a true membrane.

What Is the Hymen?

It has no known anatomical function. It is thought to prevent microorganisms from entering the vagina before the reproductive years.

This tissue loses its integrity during the first sexual intercourse (also called the wedding night or first night), resulting in a small amount of bleeding. Rarely, this bleeding can be heavier. It can be stopped by locating the bleeding point with a mirror and applying pressure with cotton or gauze for 10-15 minutes. If it still does not stop, you may need to see a doctor. Sometimes there is no bleeding at all; this can happen when the hymen is elastic and structured in a way that allows intercourse without tearing.

The hymen can lose its integrity and bleed as a result of cycling, horseback riding, falling from a height, masturbation, or intercourse through friction.

The structure and shape of the hymen are determined during the embryonic period; 1 in every 1000 women is born without a hymen.

When couples are well informed about sexuality before their first intercourse, fears and prejudices around this subject diminish. One of the most important causes of vaginismus is the fear that the hymen will tear, bleed or hurt.

Types of Hymen

The hymen has many anatomical variations.

Annular Hymen (Round Ring)

The hymen is shaped like a round ring with a ring-shaped opening at its center. If the central opening is very large, the hymen may keep its integrity and not bleed even after penetration. In this case the hymen is described as "permissive to intercourse"; colloquially it is called an "elastic hymen".

Crescentic Hymen (Half-Moon)

The hymen is crescent-shaped. The tissue is thinner or absent at the top while remaining prominent at the back.

Septate Hymen (With a Central Band)

In the middle of the hymen there is an extra band of hymenal tissue dividing the opening.

Cribriform Hymen (Multiple Openings, Sieve-Like)

Instead of a single opening, the hymen has several small openings at its center, giving it the appearance of a sieve.

Imperforate Hymen (No Opening)

The hymen has no central opening and the vaginal entrance is completely closed. Girls with this type of hymen never see menstrual bleeding: the bleeding, which otherwise occurs normally, cannot leave the body and accumulates inside the vagina behind the hymen. It is a very painful condition and must be opened with a surgical procedure.

Microperforate Hymen (Tiny Opening)

The opening in the center of the hymen is very small. Sometimes surgical intervention is needed to widen it.

Multiparous Hymen (Seen After Childbirth)

In women who have given birth vaginally, the hymen tears during delivery, and the remaining fragments are called "carunculae (hymenal remnants)".

In addition, if the hymen develops in a very thick or inelastic form, it can prevent intercourse and may require intervention by a gynecologist.

Why Is Hymenoplasty Performed?

Hymen repair may be performed for many reasons. We doctors do not question why a patient wants it done; nor do we have the right to. In America the concept of virginity carries little importance, yet many women still came to us for hymenoplasty. The reason may be regret, a boyfriend having crossed a line, being pressured by a partner, or remorse over a past decision. Sometimes women feel that their bodily integrity has been disrupted and request the procedure as a form of healing. Others may seek it for psychological relief. Women who have had to undergo a vaginal examination for medical reasons are issued an official document, after which repair can be performed. A patient may simply wish to leave the past behind. The right to make decisions about one's own body belongs to each individual. Just as a person may choose breast or nose surgery, she may also choose an operation concerning the hymen.

How Is the Hymen Repaired?

If the tear is recent, the torn edges are brought together and sutured. If more than a week has passed since the hymen was torn, the repair can be performed using a different technique.

This repair can be carried out under local anesthesia using radiofrequency, and it is permanent.

Hymen Examination

If a patient requests this examination of her own free will and wishes to learn about the condition of her hymen, I perform the examination and inform her verbally and in private. I cannot issue an official document.

We do not perform hymen examinations on patients brought in by someone else (mother, father, husband, boyfriend, etc.) when it is unclear whether they have given their own consent. We never share this private information with anyone other than the patient. If the patient is under 18, we may still inform her directly.

For detailed information about hymen examination, temporary hymenoplasty and permanent hymenoplasty, you can visit our website Everything About the Hymen.

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