Microperforate Hymen

What is a microperforate hymen?

A microperforate hymen is when your hymen has one small hole in it, but otherwise, it covers your entire vaginal opening. It's a rare, congenital condition (you're born with). The hymen is a ring-like piece of tissue that surrounds the opening of the vagina (but does not cover it). If you have a microperforate hymen, your hymen covers your vagina other than a small opening. This hole can allow for menstruation but may cause other painful symptoms.

A microperforate hymen is a variation of an imperforate hymen. An imperforate hymen is where your hymen completely covers the opening to your vagina. The word "micro" describes the small hole in your hymen.

What is a hymen?

Your hymen is a tissue membrane at the opening of your vagina. It's formed during fetal development from leftover remnants of your vagina. It's thin, elastic and located at the entrance of your vagina.

What does your hymen look like?

Your hymen is thick at birth but wears and loses its elasticity due to hormones, physical activities or inserting tampons. Most hymens form a ring around your vaginal opening at birth. Your hymen recedes and eventually tears, often causing no symptoms. Your hymen is the same color as the skin around your vagina.

Is a microperforate hymen normal?

It's rare to be diagnosed with a microperforate hymen. It's an uncommon condition that isn't diagnosed often.

What are the symptoms of a microperforate hymen?

The hole in your hymen may or may not be large enough for menstrual blood and vaginal fluids to flow out of the vagina. This can cause symptoms such as:

• Periods that last longer than seven days (blood flows slowly).
• Absence of periods (amenorrhea).
• Difficulties inserting/removing a tampon.
• Abdominal/pelvic pain.
• Infection caused by bacteria entering the vagina.

You may not realize you have a microperforate hymen until you begin having sexual intercourse. Being unable to have vaginal intercourse or experiencing pain and bleeding during intercourse are signs of a microperforate hymen.

What causes a microperforate hymen?

You are born with a microperforate hymen. No one is entirely sure why this occurs, but healthcare providers know it happens during fetal development when your vagina forms.

Can you still have a period with a microperforate hymen?

Yes, you can still have a period if you have a microperforate hymen. One small hole in your hymen allows for blood to flow out the vagina during menstruation. In some cases, the hole is not large enough for blood to flow out, and therefore, you may not get a period.

How is it diagnosed?

Healthcare providers diagnose a microperforate hymen during a visual exam of the vulva, hymen and vaginal opening. There will be extra tissue surrounding the entrance to the vagina and one small hole in the hymen.

Some pediatricians will detect a microperforate hymen in infants; however, it's more commonly diagnosed in puberty when symptoms appear due to difficulties with menstruation.

How is a microperforate hymen treated?

The small hole in the hymen can stretch and tear on its own sometime around puberty. This happens as you age and as hormones increase in your body. Your hymen can tear after trying to use tampons or having vaginal intercourse. If your hymen rips or expands on its own, there may be no treatment necessary. Most people will resume typical menstruation, use tampons and have pain-free sexual intercourse once the extra tissue is gone.

Hymenectomy

A minor surgery called a hymenectomy removes extra hymenal tissue. This is performed under general anesthesia in a hospital or surgical center.

During a hymenectomy, a gynecologist will use scissors or a scalpel to cut away excess hymenal tissue. They will then use absorbable stitches to secure the edges of the hymen into the vaginal wall. This creates a typical hymen and exposes the vaginal opening.

There are no long-term complications of a hymenectomy, and most people will heal without any issues.

What are the possible complications of treatment?

Like most surgical procedures, there are risks associated with a hymenectomy:

• Inflammation or swelling.
• Infection.
• Excess bleeding.
• Developing scar tissue.
• Injury to the area around the hymen.
• Allergic reaction to anesthesia.

Are there any side effects of fixing a microperforate hymen?

Side effects of treating a microperforate hymen are pain and soreness in the vulvar area of your vagina. Your healthcare provider may prescribe an antibiotic to prevent infection. You can relieve any pain or cramping you have with over-the-counter pain relievers.

How can I prevent a microperforate hymen?

There is nothing you can do to control the shape of your hymen. It's formed when you are still in the womb. A microperforate hymen occurs when the hymen doesn't fully open during embryonic development.

Will I have normal periods after treatment?

Yes, you should be able to menstruate without issues after treatment. You will also be able to use tampons if desired.

What should I do if I have a microperforate hymen?

Call your healthcare provider if you think you have a microperforate hymen. The first symptoms are typically long or painful periods. If you have been diagnosed with a microperforate hymen, it can be corrected with surgery. In some cases, it resolves over time on its own.

When should I see my healthcare provider?

Contact your healthcare provider if you experience pelvic pain, long and slow menstrual periods or other symptoms of microperforate hymen.

If you've had surgery to repair microperforate hymen, you should call your healthcare provider if:

• You have a fever, pus-like discharge, redness or other signs of infection.
• You think your vagina is closing.

A note from Cleveland Clinic

A microperforate hymen is a rare but treatable condition. Talk to your healthcare provider about any concerns or questions you have. They can explain how a microperforate hymen is fixed and what you can expect afterward. Once your hymen is removed you should have pain-free menstruation and sexual intercourse.