Hymenoplasty

What is Hymenoplasty?

Hymenoplasty is a surgical procedure done to repair, restore, or reconstruct a torn or perforated hymen. It may also be done to create an opening in an imperforate or a completely closed hymen, which may interfere with menstruation or sexual activity, and this procedure is called hymenotomy.

Alternate names

Hymenorrhaphy, hymen reconstruction surgery, revirginization, revirgination

Is this procedure an elective or an emergency procedure?

Hymenoplasty is an elective procedure.

Types of procedure

Based on the technique, hymenoplasty surgery may be of the following types.

• Suturing
• Membrane creation
• Vaginal flap operation

Indications

Some indications for a hymenoplasty surgery may include the following.

• Cultural reasons: Revirgination
• Following a sexual assault
• Accidental rupture of the hymenal ring or a torn hymen due to physical activity such as cycling, horse riding, tampon insertion
• Enhancement of sexual pleasure
• Imperforate hymen: Impedes tampon use and sexual intercourse
• Septate hymen: Impedes tampon use and sexual intercourse
• Micro perforated hymen: To facilitate tampon insertion

Contraindications and Risk factors

Some contraindications and relative risk factors for a hymen repair surgery include

• Active vaginal and pelvic infections and inflammatory conditions
• Clotting and bleeding disorders
• Cancer
• Unrealistic expectations
• Severe cardiovascular disease or poor general health
• Uncontrolled diabetes

Investigations before the procedure

Some investigations that may be done before a hymenoplasty surgery include the following.

• Laboratory tests
  • CBP & ESR
  • Coagulation profile and blood typing
  • Basic Metabolic Profile
  • Liver and renal function tests
  • Complete urine examination
• Electrocardiography (ECG)
• Imaging tests
  • Chest X-ray
  • Ultrasound
• Gynecological Examination

Preoperative advice

Before a hymen repair surgery, the following is done.

• The risks and benefits of the procedure are explained.
• Anticoagulant medication may need to be stopped one week before the procedure.
• Antibiotic prophylaxis may be started a few days before the surgery.

Intraoperative details Duration: A Hymen repair surgery may last from 1-2 hours, depending on the procedure that is being done
Anesthesia: A hymenoplasty surgery may be done under local anesthesia or general anesthesia.

Description of Hymen Repair Surgery

The individual is in a lithotomy position (lying on the back with feet in the stirrups and buttocks at the edge of the table). The surgical site is thoroughly cleaned and draped in a sterile manner. An IV line is placed. After the anesthetic has taken effect, the labia majora (outer lips) and the labia minora (inner lips) on both sides are retracted. A local anesthetic with epinephrine is injected deep inside and under the hymen fragments. The hymen fragments are examined, and the epithelialized fragments are excised with scissors or a scalpel, leaving behind only the tips of the hymen fragments. These tips are then sutured by creating a hymenal ring. Once the hymenal ring is created, an optimal opening is left behind to accommodate menstruation. If the procedure is being done to treat an imperforate, septate, or microperforate hymen, then the size of the hymen is increased by first incising the hymen and then suturing it to create an optimal hymenal opening. If enough hymenal skin is not present or if the hymen is not present, either vaginal skin flaps or synthetic material may be used to create the hymen, and blood supply is added.
Hymen restoration surgery may also be done as a part of revirgination procedures. Revirgination procedures are done to restore the female genital system to its state before repeated sexual intercourse and include:

• Hymen reconstruction
• Vaginoplasty on the vaginal vault
• Valvoplasty for the reconstruction of the vaginal lips

Revirgination surgeries are usually done to enhance sexual pleasure, which may be reduced due to the laxity of the vaginal vault and for cosmetic or aesthetic reasons. No dressing or vaginal packing is required. Topical antibiotic ointment is applied to the suture lines.

Postoperative details

Most hymen repair surgery procedures are done as daycare procedures, and the individual can leave once the procedure is completed. If the surgery is done under general anesthesia, the individual is shifted to a recovery room and monitored until they regain consciousness and are stable. Common post-procedure occurrences

• Soreness and mild pain
• Slight blood-stained discharge

Medications: Antibiotics and pain-relieving medication may be prescribed.

Review: This is usually done 5-7 days after the procedure.

Resumption of normal activities: With some restrictions on the 3rd day after the procedure

Role of Diet/exercise/lifestyle changes

Some measures that may be taken after a hymen restoration surgery include

• To be watchful of infections for the first week after surgery
• To avoid using tampons for a month or two
• To abstain from sexual intercourse for 4 weeks after the surgery
• To avoid physical exertion and strenuous work for 1 week after the surgery

Complications

Some complications that may be seen after a hymenoplasty surgery include

• Bleeding
• Infections
• Severe pain that persists for an extended time
• Abnormal or foul-smelling discharge
• Intense itching
• Inflammation

Prognosis

The prognosis for hymenoplasty surgery is generally excellent, with complications being few and rare.  

Indications for hospitalization if required 

Hospitalization is not required for hymen restoration surgery.

Suggested clinical specialist/department to consult for the procedure

A hymenoplasty will be performed by specialists from the Department of Plastic Surgery, Cosmetology.