Imperforate Hymen

What is an imperforate hymen?

An imperforate hymen is a rare condition when your hymen completely covers the opening to your vagina. It's considered a congenital anomaly (this means you were born with it). The hymen usually surrounds the opening of the vagina. If you have an imperforate hymen, this tissue blocks the opening so there is no hole present.

What is a hymen?

Your hymen is a small, thin membrane at the opening of your vagina. It's leftover fragments of tissue from when your vagina was formed during fetal development. No one is quite sure what purpose a hymen serves, but some think it developed to help prevent bacteria from getting into the vagina.

What does your hymen look like?

The hymen changes over time. It's thick at birth but loses its stretch over time due to hormones, physical activities or inserting tampons. Most hymens form a ring around your vaginal opening at birth, but then recede to just cover a small bottom portion of the vaginal opening. Your hymen is the same color as the skin around your vagina (flesh-colored). Hymens are more noticeable in infants because it hasn't had time to wear down.

How common is imperforate hymen?

An imperforate hymen is rare and only occurs in about .5% of people.

What happens if you have an imperforate hymen?

If you have an imperforate hymen, you may not know until you reach puberty and start having issues with menstruation. Blood becomes trapped inside your vagina during menstruation because your hymen covers the exit out of your uterus. This can cause pain and other symptoms because the period blood becomes trapped inside your vagina.

What are the symptoms of an imperforate hymen?

Symptoms are caused by blood backing up into your vagina, uterus or fallopian tubes and can include:

• Abdominal/pelvic pain.
• A feeling of fullness in your belly.
• Lack of menstruation (amenorrhea).
• Painful urination (dysuria).
• Painful bowel movements or constipation.

An imperforate hymen can be detected in infants during a physical exam of the vagina or in a person's teen years after puberty has occurred.

What causes an imperforate hymen?

No one knows why some people develop an imperforate hymen. It's something you are born with that happens while you are still in your mother's womb. The hymen should open during fetal development. In the case of an imperforate hymen, this doesn't occur.

Can you still have a period with an imperforate hymen?

If you have an imperforate hymen, you are usually still ovulating and menstruating, but the blood has nowhere to go. Blood becomes stuck in your vagina, and eventually, in your uterus or fallopian tubes. You don't have a typical period when you have an imperforate hymen because the blood is blocked from exiting your vagina.

How is it diagnosed?

An imperforate hymen is diagnosed during an exam. This can happen when a baby is a newborn or later during the teen years. When a newborn has an imperforate hymen, it can often be seen as a small bulge. In teens, imperforate hymens are diagnosed once symptoms start or during a routine gynecological exam.

Healthcare providers diagnose an imperforate hymen by performing a visual exam of the vulva, hymen and vaginal opening. They will be able to see the hymenal tissue covering the vaginal opening. An ultrasound may be ordered to see the tissue better and confirm the condition.

How is an imperforate hymen treated?

A minor surgery called a hymenectomy can open or remove your hymen. This is done under general anesthesia in a hospital or surgical center. If imperforate hymen is detected in a baby, most healthcare providers will wait until the person is older to perform the surgery.

During a hymenectomy, a gynecologist will use scissors or a scalpel to cut an opening in the hymen. The trapped blood will be drained. They will then use absorbable stitches to secure the hymenal tissue into the vaginal wall and create an opening.

In some cases, you are asked to wear a dilator in your vagina to prevent the hole from closing post-surgery. This is a tampon-shaped device worn in the vagina for several minutes a day or as prescribed by your healthcare provider.

There are no long-term complications of a hymenectomy, and most people will heal without any issues. You will get a menstrual period and be able to use tampons. Sex, pregnancy and childbirth are not affected by hymenectomy most of the time.

What are the possible complications of treatment?

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

• Inflammation or swelling.
• Heavy bleeding.
• Infection.
• Developing scar tissue.
• Injury to the area around the hymen.
• Allergic reaction to the medications used.

Are there any side effects of fixing an imperforate hymen?

Side effects of treating an imperforate hymen are mild and include pain and soreness in the area. You can relieve any pain or cramping you have with over-the-counter pain relievers. Your healthcare provider may prescribe an antibiotic as a precaution.

How can I prevent an imperforate hymen?

There is nothing you can do to control the shape of your hymen or how your vagina develops. It's formed when you are still in the womb. The exact reason it happens is still unknown, but some evidence has shown it can run in families.

Will I have normal periods after treatment?

Yes, you should be able to menstruate normally. There are no long-term effects after fixing an imperforate hymen. Those who have treatment are able to have sex, get pregnant and deliver a baby.

When should I see my healthcare provider?

Contact your healthcare provider if you experience pelvic pain, missed menstrual periods or other symptoms of imperforate hymen.

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

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

A note from Cleveland Clinic

An imperforate hymen is a rare congenital condition that is treatable with a safe, reliable surgery called a hymenectomy. Once your hymen has been fixed you will be able to have pain-free menstruation and use tampons if desired. People with imperforate hymens go on to have normal sex lives and pregnancies. Talk to your healthcare provider about any concerns or questions you have.