What is a Hymen?
Hymen is an anatomical component of the genitourinary tract in females. Males do not have this. In a female’s vulva or external genitalia, there is a thin or thick tissue of mucus membrane surrounding the vaginal opening that is about the size of your finger . That structure is the hymen.
Anatomical Location of the Hymen
The vulva or the female’s external genitalia has a few visible structures surrounding the vaginal opening. Let’s start from the outside and up going inside.
Picture of the anatomical structure of a female genitalia.
- The labia majora is the outer lips of the vulva
- The inner lips is called labia minora.
- The clitoral shaft is found beneath the mons pubis (the uppermost and outermost part of the inguinal area).
- Below the shaft is the clitoral hood which partly covers the clitoris.
- The very small opening above the vaginal opening is the urethra where the urine flows through.
- In the center is where the vaginal opening is.
- Surrounding it is the hymen, showing itself as moist flaps of tissue that partly covers the vaginal opening.
Functions of Hymen
Every structure in our body has its functions. You must be wondering what hymen is for. Well, physiologically, its function is not very well appreciated. Truthfully speaking, its presence will only be acknowledged when it is too thick that it interferes with normal physiologic functions of the reproductive system or when it is being torn.
Contrary to what you may think, sexual intercourse is not the only reason why a hymen tears. It could also be due to physical injury, trauma, abuse, childbirth and even exercise.
Going back to its functions, it serves as a protection for the vagina, especially for female newborns and infants  whose hymens are thicker than the adults. It also allows proper flow of menstruation in puberty.
In legal cases, a girl with a torn hymen can also be a physical living evidence of child abuse, sexual harassment, and violence.
Facts on Hymen
- The word “hymen” is Greek, meaning “thin skin or membrane.”
- “Hymen” is the Greek god of marriage.
- In 1000 females, one born with no hymen.
- Not everybody bleeds in their first sexual intercourse. 44% of women don’t.
- The hymen may naturally rupture during sports or any physical activity.
- Once a girl menstruates, the perforations present in the hymen gets bigger.
- Usage of tampons can break the hymen.
- Sometimes, small or elastic hymens do not break. Pregnancy can occur even in intact hymens.
- It is not necessary that a hymen bleeds when broken.
- Hymen repair and restoration is mostly done due to sociocultural factors. [3, 4, 5, 6, 7, 8]
This is a picture of a normal hymen. Compare this with the succeeding pictures to determine their anomaly.
Anatomical Anomalies 
1. Imperforate Hymen
The hymen only covers the vagina partially to allow menstrual blood to flow freely. Imperforate hymen is the situation wherein the hymen is completely closed. This stops the menstrual blood from flowing out.
This poses a problem because obviously, menstruation is a normal physiologic function in women and no one can stop it. Not even this imperforate hymen. Menstrual blood has to get out of the body because wastes cannot be contained for a long time or else, serious health consequences would occur.
Image of imperforate hymen.
Causes of Imperforate Hymen
Imperforate hymen generally occurs during the teenage years. However, this could also be diagnosed during a neonatal examination.
It is evident that the imperforate hymen is often inherent, and could also be due to the failure of central epithelial cells of hymen to progress anatomically. Inflammatory causes could also be the reason of such problems. In the growing age, increased size of the vagina and uterus shift can result in the increase of cystic mass in the abdominal tract.
Signs and Symptoms of Imperforate Hymen
- No menstrual bleeding
- Lower abdominal pain
- Abnormalities in the epithelial cells of the hymen; this results in back flow and accumulation of blood in the vagina
- Urinary problems
- Presence of bluish or reddish mass between two outer folds of the vulva
- Constipation can be there in some cases
Surgery for Imperforate Hymen
If a lady or a woman is suffering from imperforate hymen, then surgery can be done to solve the problem.
Surgery helps in removing the hymenal tissue in order to create a normal vaginal opening size. When this minor surgery is done, the menstrual blood can now freely pass through the vagina.
During childhood, the surgical procedures involving vagina and hymen might effect in scarring for consequent surgical revisions. Therefore, surgery during this time (when the endogenous estrogen levels are low) is avoided as much as possible.
However, during childhood, if there is any imperforate hymen suspected, then, after the onset of breast development, re-examination should be performed for indicating the fabrication of estrogen.
The surgery can be performed after the healing procedure and before the growth of hematocolpos (buildup of menstrual blood in the vagina).
2. Microperforate Hymen
A microperforate hymen is a thin tissue, which almost covers the entire mouth of vagina except a very small hole. This will not stop menstrual blood to flow out completely, but it will make it difficult, slow and painful. Women with microperforate hymen experience longer menstrual periods due to slow passage of blood through small perforations present in the hymen.
Using a tampons in microperforate hymen is not advisable, as one may successfully insert an empty tampon, but then, it would become very difficult for them to remove it when it’s filled.
Sometimes, teenagers do not even realize that they have a microperforate hymen. It can be treated with a minor surgery and normal size opening is made.
Image of microperforate hymen.
3. Septate Hymen
A septate hymen is a condition where the regular hymen has extra layer of tissues in the middle, which causes two small openings instead of one.
This type is rare compared to the other types, and is seen in 1 out of 2000 women.
This causes the same issues as with microperforate hymen. One can get these extra tissues removed with the help of a minor surgery at a local clinic to create a large orifice. It is generally a 15 to 20 minute surgery; hence, it is a fast and effective surgery. One can get discharged from the hospital the same day. The area will be sore for a day or two, and then it becomes normal.
Image of septate hymen.
See the separate article on torn hymen
Hymen Repair and Restoration
Hymen repair and restoration surgery is generally asked for the ethnic, cultural, or religious reasons as most of the times the unbroken hymen gets related to the virginity of a female.
Hymen repair or restoration surgery, also called hymenoplasty, is designed for repairing and reconstructing the thin, ring- like skin membrane that partially covers the vaginal opening. 
Restoration of hymen consists of closing the tear by bringing together the remnants. It is a simple procedure in which the tissues are pulled together. However, the results may be temporary, and healing takes place rarely, as the hymen is an avascular structure, meaning there is no blood flow in that part, hence there will be minimal or no healing.
Another temporary measure carried out is the insertion of a tear-through bio-material in the vaginal opening.
Hymenoplasty or Hymenorraphy
Hymenoplasty or hymen restoration is also known as hymenorraphy.
In hymenoplasty, local anesthesia is administered. The tissues are dissected and the surgeon makes sure that there is only minimal bleeding by working on the small arteries. When the torn areas are denuded, the edges are stitched together in order to reshape the star-shaped ring, just as it was before the sexual incidences, accidents, or whatever that caused the tearing.
The hymen is restored in such a way that, when sexual intercourse is experienced, the hymen tears again and there will be minor pain and bleeding as well.
Hymen surgery is generally done in case of hymen restoration or hymen repair, which is required when a woman has anatomical anomalies in her hymen.
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