What Is an Imperforate Hymen and What Can You Do About It?

Facts

The hymen is a thin fold or flap of skin around the opening of the vagina. Most girls are born with a hymen, but it doesn’t serve any particular purpose. Typically, the hymen is a membrane that encircles the vaginal opening or only partially covers the vaginal opening in a crescent moon or half-moon shape. In some cases, however, babies are born with a hymen that fully covers the vaginal opening. This anomaly is called an imperforate hymen. 

Imperforate hymens can affect anywhere between 1 in 1,000 and 1 in 10,000 girls. Often, doctors will notice an imperforate hymen when they’re examining newborn babies. If the imperforate hymen goes undetected, it can cause some uncomfortable symptoms as the girl ages and starts to go through puberty. The only way to correct an imperforate hymen is with minor surgery. The procedure is very common and shouldn’t cause any long-term health complications.

Symptoms

When babies are born, the doctor does a full medical exam to check that they are healthy and have reached all the typical developmental milestones. During this exam, if they notice a small bulge sticking out of the baby’s vagina, they may diagnose them with an imperforate hymen. In this case, the imperforate hymen is blocking the normal vaginal mucus from exiting their body.

If the doctor doesn’t notice an imperforate hymen at birth, it may be several more years before any imperforate hymen symptoms appear. 

In the years leading up to and during puberty, having an imperforate hymen can cause some physical symptoms, including: 

• Blocked menstrual flow 
• Abdominal pain caused by a build-up of menstrual fluid
• Feeling full, bloated, or pressure in the lower belly 
• Back pain
• Difficulty urinating or passing stool

It’s essential to get treatment right away if you’re experiencing any imperforate hymen symptoms. The body is meant to naturally expel fluids like menstrual blood, urine, and poop. If the opening to your vagina is blocked, there’s no way for menstrual waste to leave your body, so it accumulates inside. 

If you have an imperforate hymen, you won’t be able to have penetrative vaginal sex, because the hymen is blocking your vagina.

Diagnosis

Once you notice imperforate hymen symptoms, the first thing you should do is make an appointment with a doctor who can examine you and confirm the diagnosis.

During your doctor’s appointment, they’ll likely ask you questions about your medical history and any changes you experienced during puberty. If you go to your appointment with a guardian or family member, your doctor might also ask them about their medical history. 

Your doctor will want to know if you’ve had your period yet. If you have an imperforate hymen, you may have gotten your period, but it’s unlikely that you will have seen any menstrual blood flow. For other hymen anomalies such as a cribriform hymen (a hymen that covers the vagina but still has small holes in) or a microperforate (a hymen that covers the vagina almost fully but there is one small hole in it), there may be a little bit of blood passing through during your period. 

Your doctor will then do a physical exam. Once they are finished, they’ll take a look at your vagina and check for an imperforate hymen. It’s unlikely that they would need to do an internal pelvic exam.

In most cases, your doctor will be able to see whether or not your hymen is covering your vagina. If they’re unsure or suspect that the vagina may only be partially blocked (cribriform, microperforate, or septate), they may suggest more tests (such as an MRI) to get a closer look at your pelvis.

Treatment

If your doctor diagnoses you with an imperforate hymen, they will recommend that you have surgery to correct it. This surgery can happen at your doctor’s office since you don’t need to have general anesthesia. They’ll apply a localized anesthetic to numb the area.

The surgery, which is called a hymenectomy or hymenotomy, only takes one or two hours. During the procedure, the doctor will cut your hymen open and remove any excess tissue. Once they’re finished, they’ll close up the wound, often using stitches that dissolve as the wound heals so that you don’t have to come back to have them removed. 

After the hymenectomy, your doctor will give you instructions about how to help the healing process and keep the wound clean. They might also make recommendations such as: 

• Not lifting anything heavier than five pounds 
• Taking warm sitz baths (using a special tub that you sit on like a toilet)
• Taking over-the-counter pain medication to reduce swelling, pain, or inflammation
• Applying a cream or ointment to the wound

In most cases, you’ll recover and be back to your usual self within a few days. Your doctor might schedule a follow-up appointment a few weeks after the surgery to make sure that everything has healed properly.

Once you’ve had your hymenectomy, you’ll be able to have a normal period and can begin using tampons. You’ll also be able to have sex whenever you’re ready.

Summary

An imperforate hymen is a rare congenital condition where the hymen completely covers the vaginal opening. The condition is usually discovered when babies are born. Otherwise, people with an imperforate hymen will start to notice symptoms when they get older and have their first period. There is a simple surgical procedure to fix an imperforate hymen. If you think you’re experiencing any imperforate hymen symptoms, check with your doctor to confirm the right treatment option for you.