Definition and Overview

A hymenotomy is a surgical procedure wherein the hymen is opened or removed to treat certain medical conditions that are mostly related to the hymen’s structural problems. Such conditions may cause, among many others, genital obstruction, making the procedure a necessity in the majority of cases.

The hymen is a thin membrane located near the lower part of the vagina. It has a large hole that allows menstrual blood to flow through. It is usually broken due to sexual intercourse, masturbation, or the use of tampons. Some medical professionals also believe that the hymen can be affected by certain exercises and sports.

Who Should Undergo and Expected Results

Hymenotomy is recommended for those who suffer from the following conditions:

  • Imperforate hymen – This refers to a congenital condition wherein the hymen completely obstructs the vagina due to the organ’s failure to perforate during embryologic development. Since the hymen does not have an opening, the patient faces an increased risk of mucocolpos, wherein mucus becomes trapped in the vagina, and hematocolpos, wherein menstrual blood becomes trapped in the vagina or the uterus.

  • Septate hymen – This is a condition characterised by the presence of a band of excess tissue in the middle of the thin hymenal membrane. This means that the patient has two, albeit smaller, openings instead of just one big opening in the hymen. In some cases, these bands may restrict access to the vaginal opening.

  • Microperforated hymen – This is a condition wherein the opening in the patient’s hymen is too small.

  • Tough hymen, or conditions that cause the hymen to become too thick or rigid

Patients who suffer from the above conditions may experience:

  • Pain when inserting and removing tampons
  • Back pain
  • Pelvic pain
  • Amenorrhea
  • Urinary retention
  • Constipation
  • Nausea
  • Diarrhea
  • Bloated feeling
    In most cases, a hymen opening surgery effectively treats the main problem and relieves the symptoms it causes.

Aside from its medical uses, the procedure may also be done electively to make sexual intercourse more comfortable, in cases where the patient complains of chronic pain during such activity.

How Does the Procedure Work?

A hymenotomy is performed by a surgeon either in a clinic’s procedure room or a hospital operating room. The procedure, which does not take more than an hour, requires the use of sedatives and local anesthetics. It is easy for women to recover from a hymenotomy, with most patients resuming their normal activities a few days after the surgery. Most women are also able to have sexual intercourse 2 to 4 weeks following the procedure.

During a hymenotomy, the surgeon administers anaesthetics and proceeds by cutting a part or all of the membrane that covers the vaginal opening. The size of the incision depends on what is required by the patient’s condition.

Once the incision is made, the wounds are closed using absorbable sutures that prevent bleeding during the recovery process. Due to the sensitive nature of genital surgeries, it is important for patients to follow their doctors’ post-surgical instructions, including how to keep the genital area clean and dry. Patients are usually asked to stay in the recovery room for around an hour, but are often discharged on the same day.

Possible Risks and Complications

A hymenotomy is associated with some risks, such as:

  • Inflammation
  • Infection
  • Bleeding
  • Scar tissue – It is possible for some fibrous tissue to form over the area where the incision was made.
  • Injury to the urethra – Since the hymen is connected to the urethra, there is a small risk that some trauma to the urethra will occur. Such an injury may cause serious complications such as the inability to urinate, urinary retention, or hematuria.
  • Allergic reactions to the anesthesia
    It is normal for a patient to experience pain and discomfort while recovering from the procedure. If so, they are advised to take warm sitz baths twice or thrice in a day over the first few days following the procedure. This helps relieve any discomfort and speed up healing.

On the other hand, patients are advised to seek medical care if they experience the following symptoms after a hymen opening surgery:

  • Fever higher than 102 degrees F or 38.9 degrees C
  • Abnormal vaginal discharge, such as bloody or pus-like
  • Rashes
  • Sudden weakness
  • Feeling like you are about to pass out
  • Painful or bloody urination

    References:

  • Emans SJ, Laufer MR, Goldstein DP. Pediatric and Adolescent Gynecology. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2005.

  • Katz VL, Lentz GM. Congenital abnormalities of the female reproductive tract. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 12.

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