Imperforate Hymen Repair

Imperforate hymen repair

An imperforate hymen is a congenital disorder in which the hymen is completely closed off blocking the flow of menstruation and, in rare cases, urine. The only treatment is surgery and the results are good.

What Is Imperforate Hymen Repair?

• Imperforate hymen repair (hymenotomy/hymenectomy) is a simple surgical procedure performed under local or general anesthesia to open the hymen and to allow the menstrual flow and other symptoms such as urinary retention or abdominal pain from having an imperforate hymen.
• The condition generally becomes evident at puberty, when the menstrual flow is blocked and what is known as hematocolpos (collection of blood in the vagina) develops.

Imperforate hymen surgery

Hymenectomy is the last resort option for the young girl or adolescent who laments that her hymen is completely covering her vagina opening. It is a safe, simple, day care procedure and has good results.

What Is Imperforate Hymen?

An imperforate hymen is a birth defect where the hymen has no opening. At puberty onset, menstrual blood cannot leave and it results in:

• Cyclic lower abdominal pain
• No amenorrhea (primary amenorrhea)
• Urinary difficulty/retention
• Abdominal or back pain
• An inward blue veil of the vagina.
• Surgery is done to relieve obstruction and allow normal flow of menstrual flow.

Indications for Surgery

Surgery is advised in case a patient presents with:

• Examiner hymen reported as imperfect.
• Hematocolpos (accumulation of blood in the vagina)
• Intermittent pain or urinary difficulty.
• No menstrual period although there were signs of puberty.

Imperforate Hymen Surgery Procedure 

Evaluation before Surgery

• Physical examination
• Confirmation to confirm blood collection by pelvic ultrasound.
• Rule out other vaginal defects (eg, vaginal septum) 
• Basic blood tests if needed

Anaesthesia

• Usually general anaesthesia
• Sedation can also be done using local anaesthesia.

Surgical Technique

Main techniques include:

Cruciate Incision (Most Common)

• An incision is made in the shape of cross in the hymen.    
• Blood left behind is emptied gradually and in a soft manner.
• The hymen is shaved with trimming and their edges are sewed to avoid re-closing.

Circumferential Hymenectomy

• Whole hymenal tissue is ablated.
• Desired in case the hymen is thick, fibrous, or recurrent.

Annular or Vertical Incision

• Applied to keep skin cosmetic more natural.
• Nothing like sewing using absorbable stitches (such as 4-0 Vicryl)

Drainage & Cleaning

• The blood that is trapped by the menstruation is expelled in bits.
• Vaginal canal is sprayed to clear up clots.
• Drains are not generally needed.

Completion

• The opening is ensured of being of sufficient size.
• Eat-up stitches are installed.
• The patient is put on recovery and is usually discharged within the same day.

Postoperative outcome in patients of imperforate hymen

Hospital Stay

• Typically day-care (no stay over required).

Recovery Timeline

• Pain minimal → 1–2 days
• Regular activities → 2–3 days
• Complete healing → 4–6 weeks

Post-Op Care

• Keep area clean and dry
• Warm sitz baths for comfort
• No menstrual cups and intercourse until clear (4-6 weeks)
• Follow-up 1-2 weeks to assess healing.

Success Rate

• >95% success
• Menstruation returns to normal.
• Normal sexual performance and potency anticipated.

Imperforate hymen treatment

Imperforate hymen is a birth defect whereby the hymen completely covers the vaginal exit so that the blood could not be discharged during menstruation. Surgical correction is the only effective treatment that resumes normal menstrual flow and removes the symptoms.

Why Treatment Is Needed

Impregnable hymen can give rise to:

• None of the menstrual periods (primary amenorrhea)
• Pain in the abdomen/ pelvis, cyclic.
• Retained or difficulty in urinating.
• Backache or constipation in the lower back.
• Bulging bluish hymenal membrane.
• Menstrual accumulation in the vagina (hematocolpos)
• It may cause infection, acute pain or permanent problems of the reproductive tract in the case of no treatment.

Therapies of Imperforate Hymen

Surgical Treatment (Definitive and Standard Treatment)

→ Hymenotomy / Hymenectomy

• A small medical operation to do a hole in the hymen.

Procedure Steps:

• Under general or local anaesthesia.
• A little cut (cruciate/ X -shaped) is done on the hymen.
• Stagnant menstrual blood is emptied slowly.
• Absorbent stitches are placed filling the hymenal edges.
• Vagina is washed and cleared of clots.
• Discharge for the patient is usually on the same day.

Types of Surgical Procedures: 

• Cruciate Incision (Most Common)
• Circumferential Hymenectomy (thick hymen)
• Annular / Vertical Incision (cosmetic preservation)

Medical Treatment

• No drug exists that can pierce a hymen that is imperforate. Medicine may be used only for:
• Pain relief
• Managing infection (rare)
• Preoperative care

Emergency Management 

• In case of severe urinary retention in the patient, or extreme pain caused by blood build-up, surgical draining is urgent.

Factors Affecting Imperforate hymen repair cost

The variables that have an effect on the cost of surgery on Imperforate Hymen:

Type of Hospital/Facility and Location

• A private hospital with multi-specialty in big city would be costlier than a small clinic or a hospital owned by the state. 
• In premium centres, operating room rates, nursing care, recovery room, and hospital overhead are more.
• Certain sources indicate different prices depending on the city, in India: e.g. on procedures related to their hymen, cheaper in smaller cities/in hospitals, more expensive in metros. 
• In case of travel/accommodation (outpatient patient), this is additional.

Experience and reputations of the Surgeon

• A gynaecologist or surgeon who has a long history of practice charges much more.
• Cases of a more complicated nature (e.g. large hematocolpos, co-occurring anomalies) might demand the presence of a more advanced surgeon.

Linking Complicatedness and Surgical Intensity

• In case the hymen is totally imperforate with big amount of blood (hematocolpos/hematometra) - more time and resources needed.
• Costs are increased by need of further procedures (e.g., to drain accumulated blood, test other anomalies)
• Sophisticated surgical or equipment (e.g. special sutures, microscopes) could be added.

Anaesthesia & Operating Time

• General anaesthesia is more costly, compared to local or regional.
• Operating theatre time (longer surgery = expensive).
• Post anaesthesia recovery could be on top of pre-anaesthesia checks.

Pre-operative Investigations & Imaging

• Ultrasound, perhaps MRI or any other imaging to determine anatomy.
• Blood tests, cardiographic examination, anaesthesia fitness.
• These examinations tend to be superimposed on base surgery price.

Hospital Hospitalization / post-operative

• In case it is indeed a day-care surgery (same day discharge) is cheaper.
• However, when hospital stay (over night or more) is necessary (e.g. complications etc.) that is more expensive.
• The medications, dressing, follow-ups, and so on after the surgery are cumulative.

Supplies, Equipment and Material

• Consumable quality (e.g. absorbable sutures vs. low-cost sutures).
• Special irrigation, suction, monitoring equipment.
• Does the removal of clots and special tools are required.

Follow-Up and potential complications

• There are those that have follow ups in some packages; whereas some consider them as add-ons.
• In case of complication (infection, re-closure) then extra expense might be incurred.

Best hospital for imperforate hymen repair India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Hymenectomy for imperforate hymen is an easy, low-risk surgery that is highly successful in correcting abnormal hymens such that there is a normal vaginal opening and normal menstrual flow. It is an immediate treatment of following symptoms: pain in abdomen, difficult micturation, and menstrual stasis. Contemporary surgical procedures lead to quick recovery, limited morbidity, and good long-term results (menstruation, sexual function, and fertility). This procedure is the ultimate and proven cure of imperforate hymen as early diagnosis and surgical intervention are the best treatment to guarantee optimal outcomes.

Affordable imperforate hymen repair India GetWellGo

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• Language Support
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FAQ

What is the time-frame to get my period after the surgery?

• Periods tend to begin again in a few weeks after the buildup of blood has been removed and the body restarts its normal menstrual cycle.

Can surgery make your hymen close up again?

• There is such a thing as re-closure, but is very rare. Proper edge approximation at suturing and adherence to post-op care result in satisfactory tissue healing and makes re-closure.

Will this affect my virginity in any way?

• No Medical management of an imperforate hymen is unrelated to virginity. Virginity is not determined by the hymen.

Can I have children later on in life?

• Yes. Imperforate hymen repair does not impair fertility.

What can I not do after surgery?

• Do not use tampons, or menstrual cups, or douche, or have intercourse until your doctor says you’re healing (which is typically in 4–6 weeks).

Do I need a scan before surgery?

• Yes. An ultrasound is typically performed to diagnose retained blood (hematocolpos) and to evaluate the internal organs.

What is the cause of an imperforate hymen?

• It is a congenital condition – the hymen simply did not have an opening when you were born. It is not the result of trauma or any other activity.