Hymenectomy

A Hymenectomy (hymenotomy) is a minor medical procedure involving the surgical removal or opening of the hymen. It is done to treat imperforate hymen or other situations where the hymen is unusually thick or rigid in order to allow normal menstruation or sexual intercourse. Imperforate hymen can lead to hematometra or hematocolpos.

Preoperative

The surgical procedure of hymenectomy and evacuation of hematocolpos is performed on an outpatient basis. Preoperative pelvic and abdominal ultrasound to view the kidneys and urinary tract as many patients with hematocolpos have pelvic adhesions which could lead to ureteric obstruction and hence subsequent renal failure.

Procedure

The gynecologist will first infiltrate the membrane prior to the incision with a local anesthetic in order to provide analgesia. If a large hematocolpos is present, the surgeon may need to evacuate the hematocolpos and hematometra using suction. The hymenal orifice is enlarged using a circular incision following the lines of the normal annular hymenal configuration. Alternatively, a cruciate incision along the diagonal diameters of the hymen, rather than anterior to posterior, avoids injury to the urethra directly anteriorly and can be enlarged by removal of excess hymenal tissue.

In either approach, the vaginal epithelium then is sutured to the hymenal ring using interrupted stitches with fine absorbable suture. The application of local anesthetic jelly to the suture line to provide postoperative analgesia.

Postoperative

Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for the cramping. Topical lidocaine jelly is recommended for the vaginal orifice.

Follow-up care

Schedule a postoperative office visit 1-4 weeks after the surgical procedure. At that visit, inspect the area for signs of inflammation or infection. Topical lidocaine jelly facilitates the examination and helps to relieve the patient's anxiety. A 3- to 6-month course (or longer) of menstrual suppression with oral contraceptives may be indicated and should be discussed at the postoperative visit.

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