Hymenectomy

A hymenectomy is a minor surgical procedure to incise or excise hymenal tissue in patients with symptomatic hymenal variants, most commonly an imperforate hymen causing outflow obstruction (e.g., hematocolpos) or a microperforate hymen or rigid/septate configuration causing difficulty with tampon use or penetrative intercourse. Guideline-level sources describe outpatient management with local or general anaesthesia, low complication rates, and excellent prognosis; fertility and sexual function are not expected to be impaired once obstruction is relieved.^[1][2]

Hymenectomy
Other names	Hymenotomy (incision without full excision)
Specialty	Gynaecology; paediatric and adolescent gynaecology
Uses	Relief of obstructive or symptomatic hymenal variants (e.g., imperforate, microperforate, cribriform, rigid or septate hymen)
Outcomes	Resolution of obstruction and symptoms; normal sexual function and fertility expected

Indications

Common indications include obstructive anomalies (imperforate or cribriform hymen) presenting with primary amenorrhoea, cyclic pelvic pain, urinary retention, and a bulging, bluish hymenal membrane due to retained menstrual blood (hematocolpos/hematometra). Non-obstructive but symptomatic variants (microperforate or rigid hymen; some septate hymens) may present with retained tampon, difficulty with tampon insertion or removal, or dyspareunia.^[3][4][5]

Pre-operative evaluation

Evaluation aims to confirm the level of obstruction, exclude a distal or transverse vaginal septum or distal vaginal atresia, and assess for complications such as hematocolpos or hydronephrosis. Abdominal and perineal examination are essential; pelvic ultrasonography is used when diagnosis is uncertain or when a proximal anomaly is suspected. Analgesia and anaesthetic planning should consider patient age and anxiety; prophylactic antibiotics are not routinely required in uncomplicated cases.^[2][4]

Techniques

Several techniques are described, with choice guided by age, anatomy, and whether obstruction is present:

Cruciate (X-shaped) incision with marsupialisation

A cruciate hymenotomy is performed to drain retained blood, followed by trimming redundant tissue and suturing mucosal edges to prevent re-adhesion. This approach is widely recommended for imperforate hymen with hematocolpos.^[1][3]

Circular hymenectomy (excision of a rim)

A circumferential excision of obstructing membrane (with mucosal edge approximation) is used in some centres; available evidence does not show clear superiority of complete excision over incision with marsupialisation for outcomes.^[3]

Hymen-sparing vertical incision

In adolescents wishing to preserve a hymenal ring for cultural reasons, a midline vertical incision with limited excision and anti-adhesion sutures has been described, with uneventful healing in small series.^[6]

Interdigitating Y-flap

A mucosa-to-mucosa “Y-flap” has been proposed to reduce stenosis and improve cosmesis; evidence consists of case reports and small series.^[7]

Non-operative serial dilation (selected microperforate cases)

Progressive dilation with Hegar dilators can resolve symptoms without excision in carefully selected adolescents; this is not used for obstructive imperforate hymen with hematocolpos.^[8]

Outcomes and complications

When performed with drainage and mucosal edge apposition, outcomes are favourable with rapid symptom resolution. A systematic review reported low rates of restenosis or recurrence and did not demonstrate a clear difference in outcomes between hymenotomy and hymenectomy approaches.^[3] Reported complications include infection, refusion/stenosis, and rarely ascending infection or iatrogenic injury; careful technique and aftercare minimise these risks.^[9] Guideline summaries note that, after relief of obstruction, future sexual function, menstruation, and fertility are expected to be normal.^[1]

Post-operative care

Post-operative instructions typically include external hygiene, use of topical emollients, simple analgesia, and temporary avoidance of tampon use and penetrative intercourse until discomfort and discharge resolve. Routine antibiotics are not indicated in uncomplicated cases; follow-up assesses healing and symptom resolution.^[2][4]

Society and culture

Clinical guidance emphasises that hymenal appearance is not a reliable indicator of sexual history and that medical terminology should describe specific anatomy rather than concepts such as “intact” or “broken”. Technique selection may be individualised for cultural preferences (e.g., hymen-sparing incision) when consistent with effective care.^[6][2]

See also

• Hymen
• Imperforate hymen
• Microperforate hymen
• Vaginal septum