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Summary

Hymen reconstruction involves rebuilding or restoring the hymen back to its original form. Hymen is a thin and stretchy membrane present at the opening of the vagina. It may rupture and bleed during the first penetrative sexual intercourse. However, some women may experience the rupturing of the hymen earlier because of activities such as cycling, horse riding or with the use of tampons. 

In some parts of the world, cultural and societal norms expect women to preserve their hymen until marriage. Due to this,or other personal reasons, some women choose to undergo a hymen reconstruction surgery.

Your doctor will conduct a pelvic exam before the procedure and ask you about your medical history. You may be asked to quit smoking for a few weeks before the surgery to promote recovery afterwards. Hymenorrhaphy does not require an overnight hospital stay but you may be asked to visit the doctor the next day and after a month to check how your wound is healing.

  1. What is hymen reconstruction surgery?
  2. Why is hymen reconstruction surgery recommended?
  3. Who can and cannot get hymen reconstruction surgery?
  4. What preparations are needed before hymen reconstruction surgery?
  5. How is hymen reconstruction surgery done?
  6. How to care for yourself after hymen reconstruction surgery?
  7. What are the possible complications/risks of hymen reconstruction surgery?
  8. When to follow up with your doctor after a hymen reconstruction surgery?

Hymen reconstruction, hymenoplasty or hymenorrhaphy involves surgically reconstructing or restoring the hymen. Hymen is a thin, flexible membrane that partly hides the opening of the vagina. It is usually undamaged or unharmed until the woman engages in sexual activity. During a woman’s first penetrative sexual intercourse (where the vagina is penetrated), the hymen may stretch or rupture, which could lead to bleeding. Hymen reconstruction is most often done due to the social beliefs that surround the hymen. 

The rupture of hymen is popularly associated with the loss of virginity. However, virginity is a social construct and has no medical definition. Therefore, the definition of a virgin varies as per individual point of view. Someone may consider themself a virgin until they have had penetrative sex, yet another person may consider any kind of sexual contact to be loss of virginity. Besides, a hymen could also break from other activities such as horse riding, cycling or even with the use of tampons.

A surgeon may perform this procedure by stitching up the hymen immediately after it breaks or, at a later time, by reconstructing a new hymen from the remnants of the old one. A woman may opt for hymenorrhaphy under the following circumstances:

  • Cultural reasons
  • Sexual violence 
  • Involuntary injuries to the hymen
  • To re-experience the feeling of first penetrative sex

A surgeon may not perform hymen reconstruction under the following conditions:

  • Untreated or ongoing infection in the pelvis (the area between the abdomen and the thighs)
  • Bleeding disorders 
  • Cancer
  • Vulvodynia (long-term pain or discomfort around the opening of the vagina)
  • Unrealistic expectations from the surgery

Before you undergo this surgery:

  • Your healthcare provider will examine your pelvic area and carefully review your medical history.
  • Tell your doctor if you are taking any medications, either prescribed, non-prescribed, or over-the-counter; minerals; herbal medicines; vitamins and supplements. If you are taking any blood-thinning medicines such as aspirin, ibuprofen, warfarin or clopidogrel, you will be asked to stop them for a few weeks before the procedure. 
  • If you smoke, your doctor may suggest you to quit this habit for a while before and after the surgery as it will help you recover quickly. 
  • Inform your doctor if you have any recent health problems or have a history of allergic reactions to food, iodine, adhesive tapes, latex or skin-cleaning solution.
  • Your doctor will ask you to fast (not eat or drink anything) for six to eight hours before the surgery and until he/she feels you are ready to consume food after the surgery.
  • You may be asked to carry sanitary napkins as they may be required after the surgery.
  • You will need to sign an approval or consent form, to give your consent for this procedure.

After you reach the hospital for your surgery and complete the necessary paperwork, the medical staff will ask you to change into a hospital gown. The doctor may use spinal anaesthesia for this procedure to relax your muscles; however, you may also choose to take local anaesthesia (to numb the area of surgery) and sedative medicines (to keep you relaxed during the surgery) instead. 

The surgery will be done in the following way:

  • You will be given a dose of antibiotic medicines (to prevent infection) right before the procedure and will be asked to lie on the operating table with your legs supported on a special equipment called stirrups. 
  • The surgeon will clean the area around your vagina with an antiseptic solution. 
  • He/she will identify the remnants of your hymen as fragments of tissue placed in a ring-like arrangement around the opening of your vagina and check the length of these fragments.
  • Next, the surgeon will give you an injection for anaesthesia in your vagina, deep into the hymenal tissue. 
  • He/she will trim the edges of the remenants of your hymen with scissors, keeping the tip intact.
  • The surgeon will stitch the fragments of your hymen together, starting at the tip, placing sutures internally as well as externally on the hymenal tissue. The fragments of hymen near the urethra; however, will not be sutured.
  • As the fragments get stitched together in a sequential manner, the opening of your vagina will reduce in size but can still allow the passage of vaginal secretions or menstrual blood.

You may be allowed to go home on the same day as the surgery.

You may experience some bleeding after the surgery and have to wear sanitary pads to prevent staining your clothes.

Once you are home, you will have to practice self-care in the following ways:

  • Medications: Your doctor may prescribe antibiotic medicines for five days after the surgery. Make sure to take the medications at the required time.
  • Wound care: 
    • The sutures will dissolve after 25-35 days.
    • You must wash your vagina at least four times a day or each time you visit the washroom.
  • Activities: 
    • Avoid stsrenous activities that can break the hymen, at least until you want the hymen to be intact.
    • Take a healthy diet to avoid constipation, for at least two months to avoid pressure on your abdomen and ensure proper healing of your wound.

When to see the doctor?

Call or visit your healthcare provider immediately if you experience the following symptoms after the surgery:

  • Fever
  • Foul or unpleasant discharge 
  • Problem while urinating 
  • Pain even after taking pain medicine 
  • Heavy flow of blood from the vagina

Hymen reconstruction surgery is known to have the following risks:

The medical team will schedule your follow-up appointment the next day of your surgery, and later after at least one month to check for the healing of the wound.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Saraiya HA. Surgical revirgination: Four vaginal mucosal flaps for reconstruction of a hymen. Indian J Plast Surg. 2015 May-Aug; 48(2):192–195. PMID: 26424986.
  2. Wei SY, Li Q, Li SK, Zhou CD, Li FY, Zhou Y. A new surgical technique of hymenoplasty. Int J Gynaecol Obstet. 2015 Jul;130(1):14-8. PMID: 25754141.
  3. National Health Service [Internet]. UK; Does a woman always bleed when she has sex for the first time?
  4. Vojvodic M, Lista F, Vastis PG, Ahmad J. Luminal Reduction Hymenoplasty: A Canadian Experience With Hymen Restoration. Aesthet Surg J. 2018 Jun 13;38(7):802-806. PMID: 29901714.
  5. Townsend Courtney, Beauchamp R. Daniel, Evers B. Mark, Mattox Kenneth. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017
  6. Smith Sandra F., Duell Donna J., Martin Barbara C., Gonzalez Laura, Aebersold Michelle. Clinical nursing skills: basic to advanced skills. 9th ed. New York, NY: Pearson; 2016
  7. Subrahmanyam M, Venugopal M. Perioperative fasting: A time to relook. Indian J Anaesth. 2010;54(5):374–375. PMID: 21189872.
  8. The Royal Marsden [Internet]. NHS Foundation Trust. National Health Service. UK; Consent for surgery
  9. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Preparing for Surgery: The Operating Room
  10. Nationwide Children's [internet]. Nationwide Children's Hospital. Ohio. US; hymenectomy
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