This chapter describes how to perform a hymenectomy. Hymenectomy may be indicated in the presence of an imperforate hymen causing mucocolpos, hematocolpos, hematometrocolpos at menarche; or in the case of a septate, microperforate, or cribriform hymen – which prevents tampon insertion or penetrative vaginal intercourse.
An imperforate hymen typically presents either in the newborn period when there is increased mucus production from in utero maternal estrogens exposure, or at the time of puberty – with delayed menarche or acute pelvic pain and possibly urinary complaints. An imperforate hymen rarely requires surgical intervention in the newborn period, as the vaginal mucus will resolve with time in the absence of ongoing maternal estrogen exposure. The imperforate hymen that is asymptomatic in a premenarchal girl can be observed and addressed as an adolescent.
In the pubertal patient, symptoms of an imperforate hymen may include amenorrhea, cyclic abdominal pain, and an abdominal mass secondary to hematocolpos or hematometrocolpos. Introital examination may show a bulging membrane with bluish discoloration behind it due to hematocolpos. These patients require surgical intervention to relieve the obstruction. Obstructive anomalies increase the risk of retrograde menstruation and endometriosis.
Patients may also present with a septate, microperforate, or cribriform hymen. These patients will menstruate, but will report difficulty with tampon use and/or penetrative vaginal intercourse. Excision of the excess hymenal tissue is indicated.