Hymen

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For the Greek god, see Hymenaios.

Detail photo of the female vulva, showing a crescentic hymen.

The hymen (or maidenhead; or in slang cherry) is a fold of mucous membrane which surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is present in all females at birth.^[1]^[2] The most common formation of the hymen is crescentic or crescent-shaped, although several other formations are possible.^[3] A woman's hymen is destroyed when she gives birth; she may be left with remnants called carunculae mytriformes or the hymen may be completely absent.^[4]

The hymen has no known anatomical function. In societies which value chastity, the greatest significance of the hymen is a traditional belief that an intact hymen indicates a state of intact virginity. However, it is not possible to confirm that a woman or post-pubescent girl is a virgin by examining the hymen.^[5] A physician routinely checks the appearance of the hymen of baby girls at birth, and again during all future pelvic examinations. In cases of suspected rape or sexual abuse a detailed examination of the hymen may be carried out, however the condition of the hymen alone is often inconclusive or open to misinterpretation, especially if the patient has reached puberty.^[6]

The name hymen is from the Greek for membrane.^[7] Hymen is also a name for the Greek God of marriage and weddings, Hymenaeus, but this name has a different root.^[8]

1 Hymens in animals
2 Types
3 Development
4 What might damage the hymen
5 Historical significance
6 Additional images
7 See also
8 References
9 External links

[edit] Hymens in animals

See the list of animals that have hymens.

[edit] Types

There are several different formations of the hymen, some more common than others. In about 1 in 2000 females, the hymen fails to develop any opening at all^[9]: this is called an imperforate hymen and if it does not spontaneously resolve itself before puberty a physician will need to make a hole in the hymen to allow menstrual fluids to escape.^[10] A hymenotomy may also be required if the hymen is particularly thick or inelastic as it may interfere with sexual intercourse.

The shape of the hymen is easiest to see in girls past infancy but before they reach puberty: at this time their hymen is thin and less likely to be redundant, that is to protrude or fold over on itself.^[11]

When describing the shape of a hymen, a clock face is used. The 12 o'clock position is below the urethra, and 6 o'clock is towards the anus, which is based on the patient lying on her back.^[12]

Most common forms of the hymen:

crescent-shaped, crescentic, or posterior rim: no hymenal tissue at the 12 o'clock position; narrow band of tissue starts at 1 or 2 o'clock going clockwise, is at its widest around 6 o'clock, and tapers off at 10 or 11 o'clock
annular, or circumferential: the hymen forms a ring around the vaginal opening; especially common in newborns^[13]
redundant; sometimes sleeve-like: folds in on itself, which sometimes causes it to protrude; most common in infancy and at/following puberty due to estrogen levels^[14]; can be combined with other type such as "annular and redundant"

Less common forms:

fimbriated, or denticular: an irregular edge to the hymenal orifice; more likely at an age when estrogen is present
septate: the hymen has one or more bands extending across the opening
cribriform, or microperforate: the hymen stretches completely across the vaginal opening, but is perforated with several holes
labial, or vertical: hymen has an opening from the 12 to the 6 o'clock positions and can look similar to a third set of vulvar lips
imperforate: hymen completely covers vaginal orifice; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape

The hymen is torn or stretched by penetrative sex, and destroyed in a woman who gives birth when the baby passes through the vaginal orifice.

parous introitus refers to the vaginal opening which has had a baby pass through it and consequently has nothing left of its hymen but a fleshy irregular outline decorating its perimeter; these tags are called carunculae mytriformes

[edit] Development

During the early stages of fetal development there is no opening into the vagina at all. The thin layer of tissue that covers the vagina at this time usually divides to a certain extent prior to birth, forming the hymen.

In newborn girls, who are still under the influence of the mother's hormones, the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones which continue this effect.^[15]

By the time a girl reaches school-age, this hormonal influence has stopped and the hymen becomes thin, smooth, delicate and almost translucent. It is also very sensitive to touch; a physician who needed to swab the area would avoid the hymen and swab the outer vulval vestibule instead.^[16]

From puberty onwards the appearance of the hymen is affected once more by estrogen. It thickens and becomes pale pink, the opening is often fibriated or erratically shaped, and redundant: the hymen often appears rolled or sleeve-like.^[17]

[edit] What might damage the hymen

The hymen is not normally damaged by playing sports, using tampons, pelvic examinations or even straddle injuries.^[18]

Once a girl reaches puberty, the hymen tends to become quite elastic. It is not possible to determine whether a woman uses tampons or not by examining her hymen.^[19] Only 43% of women report bleeding the first time they had sex; which means that in the other 57% of women the hymen likely stretched enough that it didn't tear.^[20]

It is rare to damage the hymen through accidental injury, such as falling on the crossbar of a bicycle. Although such an accident may cause bleeding, this is usually due to damage to surrounding tissues such as the labia.^[21] It is so unlikely that an accident would damage the hymen without injuring any other part of the vulva, that damage to the hymen alone, described as an accident, would be seen as a strong indicator of sexual assault.^[22]

[edit] Historical significance

Illustration of the female sex organs, from Anatomy of the Human Body, 1918

An intact hymen has been historically considered a guarantor of virginity in societies that place a high value on female chastity before marriage. This was assessed in a variety of ways, ranging from observation by the husband at first sexual contact to examination of bedlinens for bloodspots after her first night with her new husband.

However, the condition of the hymen is not a reliable indicator of whether a woman past puberty has actually engaged in sexual intercourse.

A tear to the hymen, medically referred to as a "transection," can be seen in some women or girls after first penetration. Bleeding does not always occur following transection. The blood that is sometimes observed after first penetration can be due to tearing of the hymen, but it can also be from injury to nearby tissues. Post-injury, injuries to the hymen and surrounding tissues often quickly heal, leaving the hymenal tissue looking as if there had been no injury at all.

[edit] Additional images

Vulva anatomy

[edit] See also

[edit] References

^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 62
^ Perlman, Sally E., Nakajima, Steven T. and Hertweck, S. Paige (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon, 131.
^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 63
^ Knight, Bernard (1997). Simpson's Forensic Medicine, 11th edition, London: Arnold, 114.
^ Perlman, Sally E., Nakajima, Steven T. and Hertweck, S. Paige (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon, 131.
^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 63-4
^ Oxford English Dictionary, Second edition.
^ Oxford English Dictionary, Second edition.
^ (2002) Kurman, Robert J. Blaustein's Pathology of the Female Genital Tract, 5th edition, New York: Springer-Verlag, 160.
^ Chang, Lisbeth and Muram, David. (2002) "Pediatric & Adolescent Gynecology" in DeCherney, Alan H. and Nathan, Lauren. Current Obstetric & Gynecological Diagnosis & Treatment, 9th edition, McGraw-Hill, 598-602.
^ Muram, David. "Anatomical and Physiologic Changes" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 105-7.
^ Pokorny, Susan. "Anatomical Terms of Female External Genitalia" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 110.
^ Heger, Astrid, Emans, S. Jean and Muram, David (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press, 116.
^ Pokorny, Susan. "Anatomical Terms of Female External Genitalia" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 110-1.
^ McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, 455.
^ McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, 459.
^ Heger, Astrid; Emans, S. Jean and Muram, David (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press, 116.
^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 64-5
^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 64-5
^ McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, 460.
^ McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, 465.
^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 65

[edit] External links

Hymen gallery - Illustrations of hymen types (no explicit photos)
Pink Parts - "Walk through" of female sexual anatomy by noted sex activist and educator Heather Corinna (explicit photos)
Magical Cups and Bloody Brides the historical context of virginity in a frank and easy-to-understand manner.
20 Questions About Virginity - Interview with Hanne Blank, author of an upcoming book on virginity. Discusses relationship between hymen and concept of virginity.
Nerikes Allehanda's article on Christiansson's and Eriksson's research (Swedish)