Congenital Anomalies of the Hymen

The hymen is an area of tissue that represents the opening to the vagina. The hymenal tissue is a ring-like form of tissue which has a hole within the center, present at birth.

Imperforate Hymen

When no hymenal opening is present, a membrane covers the area of the hymen and this is called an imperforate hymen. An imperforate hymen needs to be surgically corrected. An imperforate hymen is usually diagnosed either in the newborn baby or at the time of menarche (the first period). In the newborn period there may be a bulge of the hymenal membrane due to a blockage of the drainage of normal mucus from the baby’s vagina. The baby has mucus production due to the mother’s hormones which are still circulating within the baby’s bloodstream.

The mother’s estrogen stimulates the production of mucus within the baby’s vagina. Due to the blockage, the mucus cannot drain and thus a white bulge may appear at the location of the normal opening to the vagina. Alternatively, an imperforate hymen may not be identified until some point in childhood or at the time of a normal first menstrual period. A young woman with an imperforate hymen which has not been surgically corrected will not have a normal menstrual period as there is a blockage and the blood cannot come out of the vagina. This blockage may be associated with abdominal pain, back pain, or difficulty with urination.

An imperforate hymen can be surgically corrected in the newborn period with a resection of the excess hymeneal tissue. Alternatively an imperforate can be corrected at the time of diagnosis in childhood or during the time of the first menstrual period. The procedure is normally a “day surgery” type of procedure and it is my practice to remove the excess hymeneal tissue and place sutures to avoid scar tissue formation and a reblockage of the hymeneal orifice. Once the imperforate hymen has been surgically removed there should be no long term issues. The vagina will function normally, the woman will be able to have sexual intercourse and her history of having an imperforate hymen does not interfere with her ability to have future children.

Microperforate Hymen

A microperforate hymen is essentially an imperforate hymen with a very small hole within it. The hole may be large enough for mucus and/or blood to come through the hymeneal opening, but instead of having a regular menstrual period lasting 4-7 days, the woman may have a period which lasts longer due to the fact that the blood cannot come out at a normal rate. A microperforate hymen may resolve spontaneously and the opening may get larger as a child becomes older, alternatively if a young woman who has a microperforate hymen attempts to insert a tampon she may have pain or the inability to insert the tampon. If she attempts to have sexual intercourse, she may have pain and the excess hymeneal tissue may tear. A surgical approach can be undertaken to resect the excess hymeneal tissue.

Septate Hymen

A septate hymen refers to a band of extra hymeneal tissue running vertically in the area of the normal hymen. A hymeneal septum may interfere with a woman’s ability to insert a tampon or she may find that she can insert the tampon but once it expands with blood, she cannot remove the tampon.

A hymeneal septum does not have to be surgically removed and if a woman attempts to have sexual intercourse with a septate hymen it will usually tear. This may be associated with some discomfort, pain, or bleeding. A simple surgical approach can be undertaken to remove the septate hymen, thus creating a normal hymeneal orifice.

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