A hymenotomy (sometimes called a hymenotomy) is a surgical procedure that creates a hole in the hymen. It is often used when a person's hymen is abnormally thick, septate, or obstructs menstruation (imperforate hymen) .
When the hymen has only a small opening (hymen microperforation), surgery may be used to relieve pain and discomfort.
Purpose of the procedure
The hymen is a membrane near the opening of the vagina . When formed normally, it is thin and easy to break. To facilitate normal menstruation, it is necessary to create a hole in the hymen before someone has their first period.
In most cases, hymen opening occurs naturally as a result of one of several common activities in a young person's life. The use of tampons, masturbation, and vaginal intercourse are the most common ways to "destroy" the hymen. In other cases, high-intensity physical activity, such as exercise or athletics, can cause the hymen to rupture.
Any injury or trauma to this area can also affect the membrane and can cause additional health problems, such as those associated with scar tissue.
Some people are born with a difficult hymen. If a person has an abnormally thickened or rigid hymen, the opening necessary for menstrual flow may not be created.
People can also be born with an imperforate hymen that completely covers the vaginal opening, or with a septum in which a strip of tissue prevents the membrane from fully separating to create a proper opening.
A person can also be born with a microperforation of the hymen, which has a hole, but is too small.
Often times, a congenital disorder that causes an imperforate hymen is diagnosed at birth. However, this is not always the case and the condition may not manifest itself until the person begins menstruating.
An intact hymen can make it difficult (if not impossible) to use a tampon or have painless vaginal intercourse.
Other symptoms that a person with a condition that affects the hymen may experience include:
- Amenorrhea (without menstruation)
- Back and / or pelvic pain
- Gastrointestinal symptoms such as nausea, bloating, constipation, or diarrhea.
- Painful urination or inability to urinate
If a person is diagnosed with a condition that affects the hymen, surgery is usually required.
Risks and contraindications.
Although hymenectomy is considered a minor surgical procedure, each surgery carries risk. Your healthcare team will discuss these risks with you prior to your procedure. If you have any questions or don't understand the risks, talk to your doctor and share your concerns.
You will receive anesthesia , sedation, and other medications. Your healthcare team will likely ask you about any medications you are taking, including vitamins or supplements, to make sure they are not affected by the medication needed for your surgery.
If you have other medical conditions, especially those that affect the clotting process in your body, you may need to take other precautions before surgery.
Before the procedure
If you get sick or have an infection, tell your doctor a few weeks and days before your surgery . You may not need to postpone surgery, but it is best to let them know if you are sick. It may take longer for your body to heal or you may need to take antibiotics before or after your procedure.
The operation itself usually takes less than an hour. However, you may need to plan to arrive at the hospital an hour or more before your scheduled surgery and stay for a while after you recover.
You will be sedated and anesthetized, which means you will need someone to drive you.
Your healthcare provider may perform the operation in a hospital operating room or in a treatment room in their office or clinic.
What to wear
You will be given a gown to change into when you get to the hospital, but you should still wear or bring something comfortable when you get home.
You will most likely feel weak and a little sore. Wearing button-free clothing, zippers, and slip-on shoes will make it easier for you to get dressed, go to the bathroom, and move around while you recover from your procedure.
Your medical team will give you specific instructions, but generally it's best to leave any valuable jewelry, watches, or other wearable devices at home. If there is an item that is rarely removed, such as an engagement ring, you can also transfer those valuables to the person who brought it in for safekeeping.
Food and drink
If you are taking anesthesia and sedatives, you will be asked to stop eating and drinking a few hours before the procedure. You may be advised to fast completely, beginning the night before surgery. If you need to take medicine the morning of your surgery, you may be allowed a sip of water.
It is important that you inform your healthcare team of any medications you are taking as they may ask you to wait until the surgery is complete or skip them altogether.
Cost and health insurance
You should check with your healthcare provider and insurance company if a hymenectomy is covered. Before making a decision, your health insurance company may need information from your doctor's office, such as whether the surgery is planned or medically necessary.
If you have questions, it is best to call your insurance company before your surgery. You can also find information on your insurance company's website, such as what services are covered, how much is covered, and whether the provider you see is considered in -network or out-of-network .
If you received a bill after your surgery and are concerned about how you will pay, you can also contact the billing department of the health care system where the procedure was performed.
In some cases, they may offer payment plans or charitable assistance, depending on your income level, insurance coverage, and other health care costs.
A week or two before your procedure, you will most likely receive an information packet or phone call from your healthcare provider's office or the hospital where you are to have the surgery.
They will tell you everything you need to know about when to arrive, what to expect, and what to take with you (or leave at home).
In general, it's best to leave valuables at home or schedule things like your cell phone to be given to the person who takes you to and from the hospital.
As for your personal belongings, such as your wallet, house keys, and whatever else you are busy with while you wait (such as a book or magazine), you will usually be given a bag to store those items, as well as your clothing. when you get to the hospital.
If you wish, you can also bring a large bag or backpack large enough for these items and leave them with your companion. Just like when you travel, attach a tag with your name and contact information in case it is accidentally lost or picked up by someone else.
Most likely, you will not be allowed to eat or drink anything before surgery. However, after completing the procedure, you can have a drink and some snacks. You can bring a reusable water bottle and something light like a muesli bar.
Generally, convalescent nurses can give you juice, ginger ale, or salt to help calm your stomach if you feel a little nauseous after anesthesia.
During the procedure
When you arrive at the hospital, you will be asked to change into a hospital gown. Depending on whether you are in a clinic or hospital, you may be sent to the waiting room or to the preoperative area, where there is usually a gurney separated by curtains.
Before the surgery
The nurse will insert an IV into your arm so that you can be given fluids and medications during the procedure. Your PCP, the surgeon performing the procedure, and the anesthesiologist will come to speak with you before the procedure. They can take an exam, ask you questions, or complete other preoperative tasks.
If you have any questions or concerns, now is the time to speak with them.
You may have to wait a bit. If someone is with you, they can distract you or comfort you if you are nervous. You may also find it helpful to read, do crossword puzzles or look up words, listen to music, or just relax.
Before starting the procedure, you will receive sedation and anesthesia, so you will not wake up and will remember what happens during the operation .
The surgeon and nurses will guide you to a position that will help them perform the operation. They will clean the area with disinfectant and cover most of your body with sterile sheets. This helps keep it clean and infection-free, and also helps the surgeon focus on the area where the procedure is being performed.
If you have not already received it, a local anesthetic will be injected near the vagina at this time to prevent pain.
During a hymenectomy, the surgeon will use special instruments to cut the hymen membrane and make a hole. The size of the opening will depend on the thickness of the hymen, the presence of a small opening, or other conditions to consider.
After making the hole, the surgeon will place small stitches (sutures) to secure these incisions. It is not necessary to remove these points; instead, they dissolve naturally as your body heals.
After your surgery, you will be transferred to the recovery area. The nurse will check your vital signs, such as blood pressure, when you wake up from the anesthesia.
When you first wake up, you may experience tears, nausea, or a little disorientation. You will be allowed to drink something and eat a little.
You will also need to use the bathroom before you leave. You are most likely still "numb" from the local anesthesia you received before surgery, but urination may be uncomfortable. In the first days of healing, this can be quite painful.
Your PCP or surgeon can come see how you are feeling after surgery and answer any questions you may have. They can give you an idea of when you can resume normal activities or return to work, or they can wait until they see you at your postoperative appointment in a week or two.
If no complications arise, you can go home the same day as your surgery.
Before you leave, the nurse will give you rest and healing instructions and everything you need to know to keep the healing area clean. If you have questions or don't understand the instructions, be sure to ask for clarification.
You can also ask the person who will drive you home to help you take notes. If you are overly tired and overwhelmed, ask the nurse to write down the number to call if you have questions or problems when you get home.
Your healthcare provider will tell you when you can return to work and resume your normal activities. You will usually feel good enough after about a week. In some cases, the discomfort can persist for several months.
You may experience some pain in the first few days after surgery, although it can usually be treated with over-the-counter pain relievers such as ibuprofen . Your doctor may also recommend that you take a warm sitz bath to ease post-operative discomfort.
If you experience any of the following symptoms, it could be a sign of infection. Call your doctor or get medical help right away if:
- You have a high fever
- A rash appears
- Experiencing vaginal bleeding or abnormal discharge
- You have blood in your urine, are unable to urinate, or have severe pain when urinating.
- You feel bad, suddenly feel weak and dizzy, or pass out.
If you are sexually active, your doctor will give you very important instructions on how to have sex after surgery. Generally, you must wait at least a month, and sometimes longer, after surgery to resume penetrative sexual activity.
You may also be advised not to insert anything, such as a tampon, menstrual cup, or diaphragm, into your vagina until you are well.
You will likely not notice a real difference until you are fully healed and can resume the activities that caused the pain, such as intercourse, or you may not be able to have a normal period if your period was not possible in the past.
One to two weeks after surgery, your healthcare provider will ask you to return to the office for a follow-up visit. They will ask how you feel and check your incisions to make sure they are healing well.
If you have any questions or concerns about your recovery, please contact your postoperative physician.
It may be too early to know if the symptoms that led to your hymenectomy have gone away, but your healthcare provider can probably give you an idea of when you should feel better.
Although each surgery carries risks and potential complications, most people who undergo hymenectomy recover from the surgery and recover without problems in the long term.
In some cases, people who become pregnant and have given birth after a hymenectomy can have complications, so it is important to tell your doctor if you plan to become pregnant.
If you become pregnant, be sure to tell your obstetrician that you have had a hymenectomy.
In rare cases, more severe cases (eg, complicated by urinary tract disease or trauma) may require additional surgery.
Most people who have not been able to have sex, use a tampon, or menstruate before a hymenectomy are relieved when these activities become a regular and painless part of their lives.