What Is a Hymenectomy?

A hymenectomy is a minor surgical procedure where an opening is created in the hymen. It is often done when the hymen is abnormally thick, has excess tissue, or is otherwise obstructing the flow of menstruation (imperforate hymen).

When the hymen only has a small opening (a microperforate hymen), the surgery can be used to alleviate pain and discomfort.

Purpose of the Procedure

The hymen is a membrane near the opening of the vagina. When it forms normally, it is thin and can be easily "broken." To facilitate normal menstruation, an opening needs to be created in the hymen before someone gets their first period.

In most cases, an opening will naturally be made in the hymen through one of several normal activities in a young person's life. Using a tampon, masturbating, and vaginal intercourse are the most frequent ways the hymen is "broken." In other cases, high-intensity physical activities like exercise or athletics may contribute to breaking the hymen.

Any injury or trauma to the area can also affect the membrane and may cause additional health issues, such as those associated with scar tissue.

Some people are born with a hymen that is not easily broken. If a person has an abnormally thicken or tough hymen, the opening needed to allow menstrual effluent to flow freely may not be created.

People may also be born with an imperforate hymen, which completely obstructs the vaginal opening, or a septate hymen, in which a band of tissue prevents the membrane from separating completely to create an adequate opening.

A person can also be born with a microperforated hymen, in which an opening is made, but it is too small.

Often, a congenital condition causing an imperforate hymen is diagnosed at birth. However, this is not always the case and the condition may not become apparent until around the time a person would begin to menstruate.

Other symptoms that a person with a condition affecting their hymen may experience include:

• Amenorrhea (no periods)
• Back pain and/or pelvic pain
• Gastrointestinal symptoms like nausea, bloating, and constipation or diarrhea
• Painful urination or inability to urinate

If a person is found to have a condition affecting the hymen, surgery is usually necessary.

Risks and Contraindications

While hymenectomy is considered a minor surgical procedure, every surgery comes with risks. Your healthcare team will go over these risks with you before you have the procedure. If you have any questions or do not understand the risks, talk to your healthcare provider and share any worries you may have.

You will receive anesthesia, sedation, and other forms of medication. Your healthcare team will likely ask about any medications you take, even vitamins or supplements, to ensure they will not be affected by the medicine you need for surgery.

If you have any other health conditions, especially those that affect how your body clots blood, you may need to take other precautions prior to surgery.

Before the Procedure

In the weeks and days leading up to your surgery, if you are sick or get an infection, let your healthcare provider know. You may not need to postpone your surgery, but it is best to let them know if you have been ill. Your body may need extra time to heal or you may need to take antibiotics before or after the procedure.

Timing

The surgery itself usually takes less than one hour. However, you will likely need to plan to arrive at the hospital an hour or more before you are scheduled for surgery, as well as stay for some time after in recovery.

You will be given sedation and anesthesia, which means you will need someone to drive you.

Location

Your provider may perform the surgery in the operating room at the hospital or in a procedure room at their office or clinic.

What to Wear

You will be given a gown to change into when you arrive at the hospital, but you should still wear or bring something comfortable to wear when you go home.

You will likely feel groggy and a little sore. Wearing clothes that do not have any buttons or zippers and slip-on shoes will make it easier for you to get dressed, go to the bathroom, and move around as you are recovering from the procedure.

The healthcare team will give you specific instructions, but in general, it's best to leave any jewelry, watches, or other wearables of value at home. If there is an item you rarely take off, such as a wedding ring, you can also give these valuables to the person who has driven you for safekeeping.

Food and Drink

If you are receiving anesthesia and sedation, you will be instructed to stop eating or drinking for several hours before your procedure. You may be told to fast completely starting the night before your surgery. If you have medications to take the morning of your surgery, you may be allowed a sip of water.

Cost and Health Insurance

You will want to check with your healthcare provider and insurance company to see if hymenectomy is covered. Your health insurance company may need information from your practitioner's office before making a decision, such as whether the surgery is elective or medically necessary.

If you have questions, it's best to call your insurance company before you have the surgery. You may also be able to find out information on your insurance carrier's website, particularly about which services are covered, how much is covered, and whether the provider you are seeing is considered in-network or out-of-network.

If you receive a bill after you have had surgery and are concerned about how you will pay, you may also be able to talk to the billing department of the healthcare system where the procedure was performed.

In some cases, they may be able to offer payment plans or charity care, depending on your income level, insurance coverage, and other healthcare expenses.

What to Bring

A week or two before your procedure, you will likely receive a packet of information or a phone call from your healthcare provider's office or the hospital where you will be having surgery.

You will be told everything you need to know about when to arrive, what to expect, and what you should bring with you (or leave at home).

In general, it's best to leave your valuables at home or plan to give items such as your cellphone to the person who drives you to and from the hospital.

As for your personal items, such as your wallet, house keys, and something to keep you occupied while you wait (like a book or magazine), you will usually be given a bag to put these items in, as well as your clothes, when you arrive at the hospital.

If you prefer, you can also bring a tote bag or knapsack large enough for these items, which can be left with the person who accompanies you. As you would when traveling, put a tag with your name and contact information on it in case it is misplaced or accidentally picked up by someone else.

Before surgery, you will likely not be allowed to have anything to eat or drink. However, after your procedure is finished, you will be able to have something to drink and a small snack. You can bring a reusable water bottle with you and something light to eat, such as a granola bar.

Usually, the nurses in recovery will be able to provide you with juice, ginger ale, or Saltines, which can help settle your stomach if the anesthesia leaves you feeling a little queasy.

During the Procedure

When you arrive at the hospital you will be asked to change out of your regular clothes and into a hospital gown. Depending on whether you are in a clinic or hospital, you may be put into a room to wait or sent to the pre-op area, which usually has stretchers divided by privacy curtains.

Pre-Surgery

A nurse will start an IV line in your arm so you can be given fluids and medication during the procedure. Your healthcare provider, the surgeon performing the procedure, and the anesthesiologist will come to speak to you before the procedure. They may do an exam, ask you questions, or perform other pre-operative tasks.

If you have any questions or concerns, this is a good time to speak to them.

You may need to wait a while. If someone is with you, they can help distract you or comfort you if you feel nervous. You may also find it helpful to read, do a crossword puzzle or word search, listen to music, or just rest quietly.

During the Surgery

You will receive sedation and anesthesia before the procedure begins, so you won't be awake or remember what happens during the surgery.

The surgeon and nurses will get you into a position that will help them perform the surgery. They will clean the area with disinfectant and cover most of your body with sterile drapes. This helps keep the area clean and free from infection and also helps the surgeon focus on the area where they are performing the procedure.

If you have not received it already, at this time a local anesthetic will be injected near your vagina to help prevent pain.

After the opening has been made, the surgeon will use small stitches (sutures) to secure these incisions. These sutures will not need to be removed—instead, they will be absorbed naturally as your body heals.

Post-Surgery

After your surgery, you will be taken to the recovery area. A nurse will monitor your vital signs, such as your blood pressure, as you wake up from anesthesia.

You may feel teary, nauseated, or a little disoriented when you first wake up. You will be allowed to have something to drink and a little something to eat.

You will also need to use the bathroom before you can be discharged. You will likely still be "numb" due to the local anesthesia you were given before your surgeon began, but urinating may still be uncomfortable. In the first few days of healing, it may be quite painful.

Your healthcare provider or surgeon may come to see how you are doing after the surgery and answer any questions you have. They may give you an idea of when you can resume your normal activities or return to work, or they may want to wait until they see you at your post-op appointment in a week or two.

Before you are discharged, a nurse will go over instructions with you about resting and healing, as well as everything you'll need to know about keeping the healing area clean. If you have any questions or don't understand the instructions, be sure to ask for clarification.

You can also ask the person who is driving you home to help take notes. If you are too tired and overwhelmed, ask the nurse to write down the number you should call if you have questions or concerns when you get home.

Recovery

Your healthcare provider will let you know when you can go back to work and resume all your normal activities. You will usually be feeling well enough after a week or so. In some cases, you may have lingering discomfort for a couple of months.

In the first few days after surgery, you may have some pain, though it usually responds to over-the-counter pain relievers like ibuprofen. Your practioner may also recommend you try a warm sitz bath to ease any post-operative discomfort.

If you experience any of the following symptoms, it may be a sign of an infection. Call your healthcare provider or seek medical attention right away if you:

• Are running a high fever
• Develop a rash
• Experience vaginal bleeding or abnormal discharge
• Have blood in your urine, are unable to urinate, or experience severe pain when passing urine
• Feel ill, suddenly weak and dizzy, or faint

If you are sexually active, your healthcare provider will give you very important instructions about having intercourse after your surgery. You will usually need to wait at least a month, sometimes longer, after your surgery to resume sexual activity involving penetration.

You may also be advised to avoid inserting anything into your vagina such as a tampon, menstrual cup, or diaphragm until you are healed.

Results

It's likely that you won't notice a real difference until you have completely healed and are able to resume the activities that caused you pain, such as intercourse, or are able to have a normal period if menstruation had not been possible in the past.

Follow-Up

A week or two after surgery, your healthcare provider will want you to come back to the office for a follow-up appointment. They will ask you how you are feeling and will check the incisions to see that they are healing well.

If you have any questions or concerns about your recovery, your post-operative appointment is the time to ask.

It may be too soon to tell if the symptoms that prompted you to undergo a hymenectomy have resolved, but your healthcare provider will likely be able to give you a sense of when you should be feeling better.

Long-Term Outcome

While every surgery has risks and the potential for complications, most people who have hymenectomies do well after surgery and recover without any longterm problems.

In some cases, people who become pregnant and give birth after having a hymenectomy may have complications, so it's important to let your healthcare provider know if you plan to become pregnant.

Rarely, more severe cases (such as those complicated by conditions of the urinary tract or that result from trauma) may require additional surgery.

Most people who were unable to have sex, use a tampon, or menstruate before having a hymenectomy are relieved when these activities become a regular, painless part of their lives.