Most females are born with a hymen. A hymen is a thin membrane that stretches across the vagina. It generally has a ring-like appearance with a small opening.

There’s no real medical purpose for the hymen, although some think it may have evolved over time to help protect the vagina from infection.

Most girls have a small crescent- or donut-shaped opening in their hymen. This opening allows for access to the vagina. Approximately 1 in 1,000 girls are born with what’s called an imperforate hymen. This is a hymen in which no opening to the vagina is present.

Many girls won’t even be aware that they have an imperforate hymen until they begin their menstrual period and experience complications due to blood pooling in the vagina. Experts aren’t exactly sure why some girls are born with the condition, but it can sometimes run in families.

Did you know?

In some cultures, the hymen is known as the “virginal tissue.” It was once believed that a broken or torn hymen indicated a girl had already had sexual intercourse prior to marriage, and therefore wasn’t a virgin.

However, it’s now widely recognized that even nonsexual activity, like exercising or inserting a tampon, can tear a hymen.

An imperforate hymen is present from birth, but many girls won’t know they have it until puberty.

Symptoms often appear when a girl reaches puberty, and may include abdominal pain and swelling that can last days. Physical symptoms generally occur because of a buildup of menstrual blood trapped in the vagina. That blood can also spill into the uterus and fallopian tubes.

Other symptoms of an imperforate hymen include:

  • Lack of a menstrual cycle despite having other signs of sexual maturity, such as developing breasts and pubic hair.
  • Abdominal or pelvic pain, often come and going each month.
  • Back pain.
  • Painful urination or no urination at all. This can occur when pooled blood presses against the urethra. The urethra is a tube that carries urine from the bladder to outside the body.
  • Bowel problems, such as constipation.

Some women may also have a painful abdominal mass.

Imperforate hymens diagnosed in girls younger than 10 years are often found by chance. In some cases, a doctor may suspect an imperforate hymen following a routine newborn checkup.

That’s because sometimes the condition can cause the hymen to bulge thanks to a buildup of milky mucus, produced by the mother’s hormones during the pregnancy, that can’t drain into the vagina.

In this case, surgery to produce an opening to the hymen may be recommended, but some parents prefer to wait until their daughters are older.

In older girls, painful symptoms often bring them to the doctor. A doctor may also spot visual cues of an imperforate hymen when doing a pelvic exam. For example, a doctor may notice a bulging hymen while performing a gynecological exam. The hymen may be bluish in color due to the menstrual blood collecting in the vagina.

If a health care professional suspects an imperforate hymen, they may order a vaginal or pelvic ultrasound. An imperforate hymen can be mistaken for other pelvic conditions, such as a transverse vaginal septum. This is a thick mass blocking the vagina. An ultrasound can help confirm the diagnosis.

The standard treatment is to surgically cut away part of the hymen using a scalpel or laser. This procedure is called an hymenotomy.

Usually an X-shaped cut versus a small, pinpoint one is made in the hymen. This type of cut allows for proper drainage of backed-up menstrual blood and the subsequent relief of symptoms. Some doctors will stitch the ends of the incision to the vaginal wall to help prevent the hole from closing.

The procedure is often performed under general anesthesia. It may be done in the hospital or a surgical center with twilight sleep (light anesthesia).

You may experience postsurgerical pain and cramping. It can be managed with nonsteroidal anti-inflammatories, and sometimes a pain-relieving cream prescribed by a physician.

Antibiotics may be ordered to reduce the risk of an infection. Some doctors advise the use of a tampon-like device, called a dilator. A dilator is inserted into the vagina at various intervals to keep the hole open as it heals.

After treatment, most females have no long-term complications. You should be able to enjoy sex, get pregnant, and deliver babies just as any other woman can.

If not detected early and treated, an imperforate hymen can lead to vaginal infection, kidney issues, and fertility-reducing endometriosis. Endometriosis is a condition in which uterine tissue grows outside the uterus.

An imperforate hymen, although a rare condition, is one of the most common malformations of a woman’s genital tract. Symptoms can be painful, but creating an opening for the hymen generally provides full relief with few, if any, complications. The vast majority of women will have a normal sex life and no related fertility problems.