Hymenectomy
| Hymenectomy | |
|---|---|
| Other names | Hymenotomy (incision without full excision) |
| Specialty | Gynaecology; paediatric and adolescent gynaecology |
| Uses | Relief of obstructive or symptomatic hymenal variants (e.g., imperforate, microperforate, cribriform, rigid or septate hymen) |
| Outcomes | Resolution of obstruction and symptoms; normal sexual function and fertility expected |
A hymenectomy is a minor surgical procedure to incise or excise hymenal tissue in patients with symptomatic hymenal variants, most commonly an imperforate hymen causing outflow obstruction (e.g., hematocolpos) or a microperforate hymen or rigid/septate configuration causing difficulty with tampon use or penetrative intercourse. Guideline-level sources describe outpatient management with local or general anaesthesia, low complication rates, and excellent prognosis; fertility and sexual function are not expected to be impaired once obstruction is relieved.[1][2]
Indications
[edit]Common indications include obstructive anomalies (imperforate or cribriform hymen) presenting with primary amenorrhoea, cyclic pelvic pain, urinary retention, and a bulging, bluish hymenal membrane due to retained menstrual blood (hematocolpos/hematometra). Non-obstructive but symptomatic variants (microperforate or rigid hymen; some septate hymens) may present with retained tampon, difficulty with tampon insertion or removal, or dyspareunia.[3][4][5]
Pre-operative evaluation
[edit]Evaluation aims to confirm the level of obstruction, exclude a distal or transverse vaginal septum or distal vaginal atresia, and assess for complications such as hematocolpos or hydronephrosis. Abdominal and perineal examination are essential; pelvic ultrasonography is used when diagnosis is uncertain or when a proximal anomaly is suspected. Analgesia and anaesthetic planning should consider patient age and anxiety; prophylactic antibiotics are not routinely required in uncomplicated cases.[2][4]
Techniques
[edit]Several techniques are described, with choice guided by age, anatomy, and whether obstruction is present:
Cruciate (X-shaped) incision with marsupialisation
[edit]A cruciate hymenotomy is performed to drain retained blood, followed by trimming redundant tissue and suturing mucosal edges to prevent re-adhesion. This approach is widely recommended for imperforate hymen with hematocolpos.[1][3]
Circular hymenectomy (excision of a rim)
[edit]A circumferential excision of obstructing membrane (with mucosal edge approximation) is used in some centres; available evidence does not show clear superiority of complete excision over incision with marsupialisation for outcomes.[3]
Hymen-sparing vertical incision
[edit]In adolescents wishing to preserve a hymenal ring for cultural reasons, a midline vertical incision with limited excision and anti-adhesion sutures has been described, with uneventful healing in small series.[6]
Interdigitating Y-flap
[edit]A mucosa-to-mucosa “Y-flap” has been proposed to reduce stenosis and improve cosmesis; evidence consists of case reports and small series.[7]
Non-operative serial dilation (selected microperforate cases)
[edit]Progressive dilation with Hegar dilators can resolve symptoms without excision in carefully selected adolescents; this is not used for obstructive imperforate hymen with hematocolpos.[8]
Outcomes and complications
[edit]When performed with drainage and mucosal edge apposition, outcomes are favourable with rapid symptom resolution. A systematic review reported low rates of restenosis or recurrence and did not demonstrate a clear difference in outcomes between hymenotomy and hymenectomy approaches.[3] Reported complications include infection, refusion/stenosis, and rarely ascending infection or iatrogenic injury; careful technique and aftercare minimise these risks.[9] Guideline summaries note that, after relief of obstruction, future sexual function, menstruation, and fertility are expected to be normal.[1]
Post-operative care
[edit]Post-operative instructions typically include external hygiene, use of topical emollients, simple analgesia, and temporary avoidance of tampon use and penetrative intercourse until discomfort and discharge resolve. Routine antibiotics are not indicated in uncomplicated cases; follow-up assesses healing and symptom resolution.[2][4]
Society and culture
[edit]Clinical guidance emphasises that hymenal appearance is not a reliable indicator of sexual history and that medical terminology should describe specific anatomy rather than concepts such as “intact” or “broken”. Technique selection may be individualised for cultural preferences (e.g., hymen-sparing incision) when consistent with effective care.[6][2]
See also
[edit]References
[edit]- ^ a b c "Diagnosis and Management of Hymenal Variants: ACOG Committee Opinion, Number 780". Obstetrics & Gynecology. 133 (6). American College of Obstetricians and Gynecologists: e372 – e376. June 2019. doi:10.1097/AOG.0000000000003283. PMID 31135763.
- ^ a b c d "Diagnosis and Management of Hymenal Variants". American College of Obstetricians and Gynecologists. Washington, D.C.: ACOG. June 2019. Retrieved 22 September 2025.
- ^ a b c d Lee, Kyu Hwan; Hong, Jung Min; Choi, Young Ok; Kim, Seung Joo (3 January 2019). "Imperforate Hymen: A Comprehensive Systematic Review". Journal of Clinical Medicine. 8 (1). MDPI: 56. doi:10.3390/jcm8010056. PMC 6352236. PMID 30621064.
- ^ a b c "Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779". Obstetrics & Gynecology. 133 (6). American College of Obstetricians and Gynecologists: e363 – e371. June 2019. doi:10.1097/AOG.0000000000003281. PMID 31135762. Retrieved 22 September 2025.
- ^ Segal, Tal R.; Downey, Jessica; Sanchez, Jessica (2015). "Treatment of Microperforate Hymen With Serial Dilation". Journal of Pediatric and Adolescent Gynecology. 28 (1). Elsevier: e21-2. doi:10.1016/j.jpag.2014.08.006. PMID 25444056.
- ^ a b Basaran, Mehmet; Karakaya, Bercem Karaca; Kuvvetli, Aysen (2009). "Hymen Sparing Surgery for Imperforate Hymen: Case Reports and Review of Literature". Journal of Pediatric and Adolescent Gynecology. 22 (6). Elsevier: e61 – e64. doi:10.1016/j.jpag.2009.04.008. PMID 19646660.
- ^ Meutia, Andhika P.; Yonathan, Kenn; Hidayah, Gita N.; Moegni, Fajri (June 2022). "The Use of Interdigitating Y-Flap Technique for Imperforate Hymen". JPRAS Open. 32. Elsevier: 43–47. doi:10.1016/j.jpra.2022.02.001. PMC 8891615. PMID 35252524.
- ^ Segal, Tal R.; Downey, Jessica; Sanchez, Jessica (2015). "Treatment of Microperforate Hymen With Serial Dilation". Journal of Pediatric and Adolescent Gynecology. 28 (1). Elsevier: 209–214. doi:10.1016/j.jpag.2014.08.006. PMID 26026219. Retrieved 22 September 2025.
- ^ Wong, Jennifer W. H.; Siarezi, Sherry (2019). "The Dangers of Hymenotomy for Imperforate Hymen". Journal of Pediatric and Adolescent Gynecology. 32 (4). Elsevier: 432–435. doi:10.1016/j.jpag.2019.04.002. PMID 30974214.
Further reading
[edit]- "Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779". Obstetrics & Gynecology. 133 (6). American College of Obstetricians and Gynecologists: e363 – e371. June 2019. doi:10.1097/AOG.0000000000003281. PMID 31135762. Retrieved 22 September 2025.
- Wong, Jennifer W. H.; Siarezi, Sherry (2019). "The Dangers of Hymenotomy for Imperforate Hymen". Journal of Pediatric and Adolescent Gynecology. 32 (4). Elsevier: 432–435. doi:10.1016/j.jpag.2019.04.002. PMID 30974214. Retrieved 22 September 2025.
- Meutia, Andhika P.; Yonathan, Kenn; Hidayah, Gita N.; Moegni, Fajri (June 2022). "The Use of Interdigitating Y-Flap Technique for Imperforate Hymen". JPRAS Open. 32. Elsevier: 43–47. doi:10.1016/j.jpra.2022.02.001. PMC 8891615. PMID 35252524.