Get Educated About the Hymen

A lot of confusion surrounds the hymen. Some of this misinformation is from the schoolyard, while other myths may have come from your parents.

What exactly is it? What is its purpose? Is it really a mark of virginity?

Here is what you should know about the hymen, its purpose and how it really breaks.

What is a hymen?

The hymen is a small piece of tissue that forms a ring around the vagina and marks the boundary between the skin of the perineum (the area between the vulva and anus) and the mucosa (mucus membranes) of the vagina, according to Julia Arnold VanRooyen, M.D., a gynecologic surgeon who practices in Boston.

Like most body parts, not all hymens are the same, VanRooyen explained.

"The shape of the hymen and the amount of tissue present is highly variable in different individuals. The tissue can be thicker in some and thinner in others, or may be absent altogether," she said.

The hymen can be crescent-shaped on one side or have holes in it. In rare cases, the hymen can be a solid sheet of tissue that is referred to as an imperforate hymen, VanRooyen explained.

"It is unclear why we have hymens," she said. "The hymen is a remnant from embryological development. It does not serve a biological purpose."

The imperforate hymen

An imperforate hymen can prevent blood from flowing from the uterus and out of the vagina during menstruation, which can cause pelvic pain, urinary retention, constipation or pain with bowel movements. Usually, these types of hymens are detected during puberty when someone begins menstruating and can be treated with a minor surgical procedure to open the blockage, VanRooyen said.

In some cases, however, an infant or very young girl may be diagnosed with an imperforate hymen.

"In these cases, the fluid causing the mass is mucous, not blood," VanRooyen explained. "Unless the child is symptomatic, the imperforate hymen is not treated until puberty because it is possible the hymen may open spontaneously as the child grows. Additionally, if surgical correction is required, it is better to wait until puberty when the patient's ovaries have begun producing estrogen. Estrogenized tissues will heal faster with less risk of complications."

Since the vagina is between the bladder and rectum, an imperforate hymen can lead to urinary or bowel issues, such as a mass of fluid pressing on those areas.

"In the case of a totally imperforate hymen, menstrual blood from the uterus cannot flow out of the vagina. It builds up in the vaginal canal and can create a bulge of fluid that can cause discomfort," VanRooyen said. "These symptoms can worsen over several menstrual cycles as the amount of fluid builds up. These symptoms of cramping, pain and pressure but no menstrual flow in an adolescent are what typically lead the patient to seek treatment."

There is a simple surgical procedure to correct imperforate hymens by removing excess tissues. It is performed as an outpatient procedure with anesthesia, according to VanRooyen, doesn't take long and involves minimal risk of complications. Usually, any postoperative pain can be handled with over-the-counter medicine.

The different types of hymens

Hymens that don't open normally are identified as one of three types: microperforate, cribriform and septate.

The difference between these types of hymens and an imperforate hymen is that the openings in microperforate, cribriform and septate hymens typically allow for some blood flow from the vagina, but may not allow for complete blood flow.

"This can cause symptoms similar to those [in people] with imperforate hymens and can lead to malodorous vaginal discharge," VanRooyen said.

Microperforate, cribriform and septate hymens can stay asymptomatic until the person has problems placing or removing a tampon or difficulties when attempting to be sexually active, VanRooyen explained.

How does a hymen break?

"The hymen can tear from vigorous physical activity or from the insertion of an object into the vagina: tampon, finger, penis," VanRooyen said. "Conversely, 50 percent of teenagers who report being sexually active have intact hymens."

It is a common misconception that an "intact" hymen is a sign of virginity. Since hymens can vary in appearance, tear during exercise, remain during sexual activity or even be entirely absent, the hymen is not an indicator of sexual status, VanRooyen stressed.

When should you seek medical attention for your hymen?

Unless you have a microperforate, cribriform, septate or imperforate hymen and it is causing problems, there is no other reason to seek medical attention for a hymen.

"It is truly a very minimal, residual, inconsequential bit of tissue. It is often hard to even identify as a person ages," VanRooyen said.

If you suspect you may have a hymen issue that is causing you discomfort or blood flow irregularities, you should see a doctor. Telehealth has made that simple. Video visits have become a viable option for most people, and more physicians have added them as a service. Giddy telehealth makes it easy to get connected to qualified healthcare professionals, including OB-GYNs, who can help with a variety of conditions.