Understanding an Imperforate Hymen

The hymen is a crescent-shaped skin flap that partially covers the vaginal opening of female babies, children and young adults. Hymens typically break or stretch by adulthood as the result of penetration from an injury or intercourse.

The hymen goes through several stages of development in the womb. Typically, the hymen "perforates" (or becomes punctured) during week 22 of embryonic development, allowing the natural flow of fluids from the vaginal opening.

As with other parts of the body, hymen anatomy can vary from person to person. Some of these variations include:

• Imperforate hymen, which fully covers the vagina, blocking the release of menstrual blood and discharge.
• Microperforate hymen, a hymen that covers the majority of the vagina, leaving only a tiny opening and restricting the passage of fluid.
• Septate hymen, where a band of tissue separates the hymen into two small openings.

Imperforate hymens are rare and with no known cause. Between 0.05% and 0.1% of female babies are born with an imperforate hymen. Fortunately, once diagnosed, imperforate hymens are relatively easy to fix.

Diagnosing an imperforate hymen

Imperforate hymens are sometimes diagnosed at birth. Other times, they go unnoticed until menstruation begins and uncomfortable symptoms develop.

In babies, an imperforate hymen appears as a bulge covering the vagina due to the obstruction of normal mucus drainage. A pediatrician may notice the lack of a vaginal opening during a routine physical exam.

Once the menstrual cycle starts, an imperforate hymen becomes more problematic, leading to symptoms from the backup of unreleased menstrual blood. Back and stomach pain, fullness in the lower belly, and urination and bowel issues are all possible signs of an imperforate hymen.

To rule out other anatomical issues and health conditions, your doctor may conduct imaging studies on the kidneys, a pelvic ultrasound or sometimes magnetic resonance imaging (MRI). A specialist may need to be called in to make the final diagnosis.

Treatment

A one-time minor surgery is usually all that's needed to address an imperforate hymen. It may seem like a simple incision would be sufficient to release the backup of fluids, but this could raise the risk of dangerous infections. Instead, a specialist in gynecological surgery should perform the operation.

Unless there are complications that warrant earlier intervention, most experts advise waiting until the start of puberty to operate. Ideally, doing the procedure just before puberty may reduce pain, but unfortunately, many people are unaware of an imperforate hymen until they menstruate and develop symptoms. During surgery, the excess hymen is removed to create an opening that allows menstrual blood to exit.

Recovering from hymen surgery

Recovery should take only a few days, but you may be required to insert a dilator for about 15 minutes a day to prevent the vagina from re-closing. Any signs of infection, like pus or fever, should be reported to your doctor right away.

Your surgeon will review with you the details of what to expect from the surgery. Generally, imperforate hymen surgery may involve urethral catheterization during and immediately after the procedure. You may be sent home with cream (such as coconut oil, petroleum jelly, a zinc-based diaper cream, silver sulfadiazine or topical estrogen) to apply to the area during the early stages of healing.

Pain is usually manageable with a topical anesthetic and NSAIDs. You'll need to keep the surgical site clean and dry. Plan to follow up with your surgeon within a few days of the operation for monitoring.

Outlook

Once you've recovered from surgery, the imperforate hymen shouldn't continue to be a cause for concern. The vast majority of people report no issues with future sexual function, tampon use, pregnancy or childbirth.

It's normal to feel uneasy upon learning that you or your child has an imperforate hymen. Painful symptoms, along with the prospect of surgery, can be unsettling. However, once correctly diagnosed, there's a high likelihood of a full recovery. Seeking treatment to uncover health concerns early will help you find answers and give you peace of mind.