External genital organs of female. The labia minora have been drawn apart.
The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina. The hymen does not seem to have a specific physiological function and has few, if any, nerve endings.
In children, a common appearance of the hymen is crescent-shaped, although many shapes are possible. During puberty, estrogen causes the hymen to change in appearance and become very elastic. Normal variations of the post-pubertal hymen range from thin and stretchy to thick and somewhat rigid; or it may instead be completely absent.
The hymen may rip or tear the first time a female engages in penetrative intercourse, which may cause temporary bleeding or slight discomfort, but sources differ on how common tearing and bleeding after first intercourse is. The hymen can stretch or tear as a result of various other behaviors; for example, it may be lacerated by disease, injury, medical examination, masturbation or physical exercise. For these reasons, the state of the hymen is not a reliable indicator of virginity, although it continues to be considered so in certain cultures, and virginity testing may be done. The hymen does not regenerate itself after it is torn, but it may be surgically restored in a procedure called hymenorrhaphy.
Development and histology
The genital tract develops during embryogenesis, from the third week of gestation to the second trimester, and the hymen is formed following the vagina. At week seven, the urorectal septum forms and separates the rectum from the urogenital sinus. At week nine, the Müllerian ducts move downwards to reach the urogenital sinus, forming the uterovaginal canal and inserting into the urogenital sinus. At week twelve, the Müllerian ducts fuse to create a primitive uterovaginal canal called unaleria. At month five, the vaginal canalization is complete and the fetal hymen is formed from the proliferation of the sinovaginal bulbs (where Müllerian ducts meet the urogenital sinus), and normally becomes perforate before or shortly after birth.
The hymen has no nerve innervation. In newborn babies, still under the influence of the mother's hormones, the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones that continue this effect. Their hymenal opening tends to be annular (circumferential).
Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age. During puberty, estrogen causes the hymen become very elastic and fimbriated.
The hymen can stretch or tear as a result of various behaviors, by tampon or menstrual cup use, pelvic examinations with a speculum, regular physical activity, sexual intercourse, insertion of multiple fingers or items into the vagina, and activities such as gymnastics (doing 'the splits'), or horseback riding. Remnants of the hymen are called carunculae myrtiformes.
A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called a Glaister Keen rod, is used for close examination of the hymen or the degree of its rupture. In forensic medicine, it is recommended by health authorities that a physician who must swab near this area of a prepubescent girl avoid the hymen and swab the outer vulval vestibule instead. In cases of suspected rape or child sexual abuse, a detailed examination of the hymen may be performed, but the condition of the hymen alone is often inconclusive.
Normal variations of the hymen range from thin and stretchy to thick and somewhat rigid; or it may also be completely absent. An imperforate hymen occurs in 1-2 out of 1,000 infants. The only variation that may require medical intervention is the imperforate hymen, which either completely prevents the passage of menstrual fluid or slows it significantly. In either case, surgical intervention may be needed to allow menstrual fluid to pass or intercourse to take place at all.
Prepubescent girls' hymenal openings come in many shapes, depending on hormonal and activity level, the most common being crescentic (posterior rim): no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1–2 to 10–11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on estrogen and activity levels, the hymenal tissue may be thicker, and the opening is often fimbriated or erratically shaped. In younger children, a torn hymen will typically heal very quickly. In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases.
- Imperforate: hymenal opening nonexistent; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape.
- Cribriform, or microperforate: sometimes confused for imperforate, the hymenal opening appears to be nonexistent, but has, under close examination, small perforations.
- Septate: the hymenal opening has one or more bands of tissue extending across the opening.
The hymen is often attributed important cultural significance in certain communities because of its association with a woman's virginity. In those cultures, an intact hymen is highly valued at marriage in the belief that this is a proof of virginity. Some women undergo hymenorrhaphy to restore their hymen for this reason.
The hymen is often referred to as the "cherry". A common idiom for a female having lost their virginity is to have "popped their cherry".
In the 16th and 17th centuries, medical researchers saw the presence or absence of the hymen as founding evidence of physical diseases such as "womb-fury", i.e., (female) hysteria. If not cured, womb-fury would, according to doctors practicing at the time, result in death.
- Heger, Astrid H.; Emans, S. Jean, eds. (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (PDF) (2nd ed.). New York: Oxford University Press. pp. 61–65. ISBN 9780195074253.
- Perlman, Sally E.; Nakajyma, Steven T.; Hertweck, S. Paige (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon. p. 131. ISBN 1-84214-199-6.
- Blank, Hanne (2008). Virgin: The Untouched History. Bloomsbury USA. p. 35. ISBN 978-1-59691-011-9.
- Lahoti, Sheela L.; McClain, Natalie; Girardet, Rebecca; McNeese, Margaret; Cheung, Kim (2001-03-01). "Evaluating the Child for Sexual Abuse". American Family Physician. 63 (5). ISSN 0002-838X.
- Heger, Astrid H.; Emans, S. Jean, eds. (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (PDF) (2nd ed.). New York: Oxford University Press. p. 122. ISBN 9780195074253.
- "The Hymen". University of California, Santa Barbara. Retrieved 2009-02-09.
The hymen oftentimes, though not always, rips or tears the first time a female engages in penetrative intercourse, which may cause some temporary bleeding and slight discomfort.
- Rogers, Deborah J; Stark, Margaret (1998-08-08). "The hymen is not necessarily torn after sexual intercourse". BMJ : British Medical Journal. 317 (7155): 414. ISSN 0959-8138. PMC . PMID 9694770.
- Emma Curtis, Camille San Lazaro (1999-02-27). "Appearance of the hymen in adolescents is not well documented" (PDF). BMJ : British Medical Journal. 318 (7183).
We agree with Rogers and Stark that so called rupture and bleeding of the hymen is not to be routinely expected after first sexual intercourse.
- Knight, Bernard (1997). Simpson's Forensic Medicine (11th ed.). London: Arnold. p. 114. ISBN 0-7131-4452-1.
- Dr Justin J. Lehmiller (February 6, 2015). "Sex Question Friday: Is It Possible For A Woman To Become A Virgin Again?". Retrieved 2016-11-24.
- Healey, Andrew (2012). "Embryology of the female reproductive tract". In Mann, Gurdeep S.; Blair, Joanne C.; Garden, Anne S. Imaging of Gynecological Disorders in Infants and Children. Springer. pp. 21–30. doi:10.1007/978-3-540-85602-3. ISBN 978-3-540-85602-3.
- McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, a)p.453, b)p.455 c)p.460.
- Heger, Astrid; Emans, S. Jean; Muram, David (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (Second ed.). Oxford University Press. p. 116. ISBN 0-19-507425-4.
- "Imperforate Hymen". WebMD. Retrieved 2009-02-02.
Different normal variants in hymenal configuration are described, varying from the common annular, to crescentic, to navicular ("boatlike" with an anteriorly displaced hymenal orifice). Hymenal variations are rarely clinically significant before menarche. In the case of a navicular configuration, urinary complaints (e.g., dribbling, retention, urinary tract infections) may result. Sometimes, a cribriform (fenestrated), septate, or navicular configuration to the hymen can be associated with retention of vaginal secretions and prolongation of the common condition of a mixed bacterial vulvovaginitis.
- Callahan, Tamara L.; Caughey, Aaron B. (2009). Blueprints Obstetrics and Gynecology. Lippincott Williams & Wilkins. ISBN 9780781782494.
- Lardenoije, Céline; Aardenburg, Robert; Mertens, Helen (2009-05-26). "Imperforate hymen: a cause of abdominal pain in female adolescents". BMJ Case Reports. 2009. doi:10.1136/bcr.08.2008.0722. ISSN 1757-790X. PMC . PMID 21686660.
- Steinberg, Avraham; Rosner, Fred (2003). Encyclopedia of Jewish Medical Ethics. ISBN 1-58330-592-0.
Occasionally, the hymen is harder than normal or it is complete and sealed without there being ... This condition is called imperforate hymen and, at times ...
- DeCherney, Alan H.; Pernoll, Martin L.; Nathan, Lauren (2002). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 602. ISBN 0-8385-1401-4.
Imperforate hymen represents a persistent portion of the urogenital membrane ... It is one of the most common obstructive lesions of the female genital tract. ...
- "Muslim women in France regain virginity in clinics". Reuters. April 30, 2007.
'Many of my patients are caught between two worlds,' said Abecassis. They have had sex already but are expected to be virgins at marriage according to a custom that he called 'cultural and traditional, with enormous family pressure'.
- Sciolino, Elaine; Mekhennet, Souad (June 11, 2008). "In Europe, Debate Over Islam and Virginity". The New York Times. Retrieved 2008-06-13.
'In my culture, not to be a virgin is to be dirt,' said the student, perched on a hospital bed as she awaited surgery on Thursday. 'Right now, virginity is more important to me than life.'
- Berrios GE, Rivière L. (2006) 'Madness from the womb'. History of Psychiatry. 17:223-35.
- The linkage between the hymen and social elements of control has been taken up in Marie Loughlin's book Hymeneutics: Interpreting Virginity on the Early Modern Stage published in 1997
- Blank, Hanne (2007). Virgin: The Untouched History. Bloomsbury Publishing. p. 23. ISBN 1-59691-010-0. Retrieved 2013-11-09.
- Blackledge, Catherine (2004). The Story of V. Rutgers University Press. ISBN 0-8135-3455-0.
Hymens, or vaginal closure membranes or vaginal constrictions, as they are often referred to, are found in a number of mammals, including llamas, ...
- Magical Cups and Bloody Brides—the historical context of virginity
- 20 Questions About Virginity—Interview with Hanne Blank, author of Virgin: The Untouched History. Discusses relationship between hymen and concept of virginity.
- Putting tampon in painlessly Radiology (US - ultrasound) of Hydrocolpos
- Evaluating the Child for Sexual Abuse at the American Family Physician
- My Corona: The Anatomy Formerly Known as the Hymen & the Myths That Surround It Scarleteen, Sex education for the real world
- The Hymen Myth
- Vaginal Corona