Hymenectomy

Hymenectomy may be indicated in the presence of (1) an imperforate hymen creating a mucocolpos, a hematocolpos, or hematometra at menarche or (2) a perforated hymen with hymenal hypertrophy obstructing intercourse. The latter can be frightening and can be associated with major hemorrhage if the lateral pudendal artery is lacerated along with the hymen during initial attempted intercourse.

Hymenectomy is performed to open the hymen without hemorrhage and to leave a patent introitus.

Physiologic Changes. The procedure allows proper drainage of the vagina and permits the vaginal intercourse.

Points of Caution. If a mucocolpos or hematocolpos is present, the hymen should be incised as the initial procedure, but not removed in order to allow adequate drainage and to restore normal anatomy prior to reconstruction.

Caution should be observed in performing this operation in a clinic, office, or other outpatient facility where adequate resources are not available for control of hemorrhage.

Technique

The patient is placed in the dorsal lithotomy position. The perineum is prepped and draped. The labia are retracted.

The hymenal tags are grasped by tissue forceps, and a small Metzenbaum scissors is inserted through the opening. Stellate incisions are made to open the vaginal canal. If mucus is present, it is gently irrigated away with saline solution.

As each stellate tag is elevated with tissue forceps, it is excised at the introital level, and its base is sutured with interrupted 3-0 synthetic absorbable suture.