Center for Congenital Anomalies of the Reproductive Tract
Congenital Anomalies of the Hymen
The Center for Congenital Anomalies of the Reproductive Tract at Boston Children's Hospital treats 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.
When no hymenal opening is present, a membrane covers the area of the hymen and is called an imperforate hymen. An imperforate hymen needs to be surgically corrected. Diagnosis is 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 normal mucus from the baby's vagina being unable to drain. The baby has mucus production due to the mother's hormones which are still circulating within the baby's bloodstream. Due to the blockage, the mucus cannot drain and 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 hymen can be corrected at the time of diagnosis in childhood or during the time of the first menstrual period.
The correction is normally a "day surgery" type of procedure and excess hymeneal tissue is usually removed and sutures are used to avoid scar tissue formation and a reblockage of the hymeneal hole. 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 the ability to have future children will be normal.
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. This is 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. A young woman, for example, who has a microperforate hymen may attempt to insert a tampon and 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.
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, creating a normal hymeneal orifice.