How to manage lichen sclerosus and genital itching
Myths about the hymen debunked
The mistaken belief that an intact hymen and bleeding during first intercourse are 'proof' of virginity is a myth that has been perpetuated for centuries. We bust this and other misconceptions, and look at health issues that can affect the hymen.
The hymen is a thin mucous membrane that partially covers the opening to the vagina, until it is either torn or stretched. In normal circumstances, it doesn't cover the opening completely - if it did, menstrual blood couldn't escape. There are exceptions, but more of them later. It is usually a crescent moon-shaped fringe of tissue, but can vary in shape, size, thickness and elasticity. And some women are born without one.
Just like the appendix, the hymen is not thought to have a specific physiological function. Many animals have them too including dogs, horses, bats and frogs.
"It has been suggested that having a rim of tissue around the vaginal opening, particularly during infancy, may offer some protection against bacterial infection, but the truth is we just don't know," says consultant gynaecologist, Tania Adib. Adib runs the vulval disorders clinic at Queen's Hospital in Essex and has experience of hymen disorders.
In some cases, congenital abnormalities of the hymen can cause health issues that require treatment:
- An imperforate hymen has no opening and completely seals off the vagina.
- A microperforate hymen has a very small opening that allows menstrual blood flow, but may cause difficulties when inserting and/or removing tampons.
- A septate hymen means the entrance to the vagina has two small holes with a thin band of tissue running through the middle.
In addition to imperforate, microperforate and septate types, the hymenal tissue may form a ring around the vaginal entrance, fold in on itself, or have several tiny holes rather than one.
"An imperforate hymen is when there's a membrane at the entrance to the vagina that closes it off, so when a girl starts having periods the blood is retained and the whole vaginal area swells up and it looks like a bulging bluish membrane," Adib explains. "It's not that common a condition. Septate and imperforate hymens require surgery, which is a simple procedure."
Sometimes vaginal dilators are used after surgery to make sure the vaginal opening doesn't close back up and psychosexual therapy may be appropriate in some cases.
Worried about your health?
Find a range of women's health pharmacy services, delivered by local providers at a time that suits you
Emily Cole discovered she had a septate hymen when she was 16 and tried unsuccessfully to use tampons for the first time.
"I did what any teenager would do and turned to Google," she says. "As soon as I read that having a septate hymen would require surgery, I decided to put it off as I didn't have a boyfriend and figured I was fine not using tampons. I met my boyfriend (now husband) when I was 20 years old. After about a month of dating, I realised that I was going to have to deal with my hymen. I finally worked up the courage to go to the gynaecologist and she confirmed the diagnosis."
Emily then had surgery to remove the excess hymenal tissue.
"Waking up from the surgery felt like the biggest relief! I thought, now I can be a 'normal' 20-year-old woman. The physical recovery went extremely well. It was the mental recovery that took some time," she explains. "For so long I hadn't been able to use tampons or have sex and now I couldn't mentally wrap my mind around the fact that my septate hymen was gone. After the surgery, there were months of trying unsuccessfully to use tampons and have sex before I decided to go to therapy. After just two sessions my mental block was gone and I was finally able to do both."
Although Emily’s journey was an emotional rollercoaster, she is now fully recovered.
"I would tell [other women with the condition] that they are not alone, and to be courageous as they move through the doctor's appointments and surgery. My husband and I knew the end result of finally being able to have sex would be worth it!"
The hymen is not 'proof' of virginity
Claims that an intact hymen can be used as a way of determining whether a woman is a virgin are nonsense, says Adib.
"Even if you haven't had sex the hymen can still look torn. Tampon use, sports activities and so on can stretch the tissue of the hymen and you'd be unlikely to know this as it wouldn't necessarily bleed, just stretch. There's no way a sexual partner can look at a woman and tell if she's a virgin because there are so many variations in what the hymen can look like - in size and shape. Even if your hymen hasn't stretched, it may not look perfectly formed and you may not bleed the first time you have intercourse."
Although some women may experience blood spotting and pain during first sexual intercourse as a result of the hymen tearing, there are also other reasons why this may occur. Not being fully aroused or lubricated can cause pain and small tears in the vulval or vaginal tissue, particularly if intercourse is too vigorous at the first attempt. Also conditions such as vaginismus, vulvodynia and lichen sclerosus can be a cause of painful sex.
Contrary to urban myth, very minor injuries to the hymen may heal, but the hymen cannot grow back once it has been torn or removed - or as a result of not having sexual intercourse for a lengthy period.
'Virginity tests' and hymen reconstructive surgeries prior to marriage continue to take place in some countries, which can have devastating consequences for the women and girls involved.
"In certain cultures, young women are expected to prove they are virgins in this way," says Adib. "Why should a woman have to be a virgin, but the same rules don't apply to the man? It's a very patriarchal view and it's upsetting that some women in these circumstances feel they have to go through an operation to have their hymens re-sutured tightly so they bleed on the first night of their marriage."
In 2018, the UN Office of the High Commissioner for Human Rights, WHO and UN Women called for a ban on 'virginity testing' and an end to this 'humiliating and traumatic practice'.
How to seek help
If you think you may have an abnormal hymen, or vaginal penetration is painful or impossible, visit your GP or local sexual health clinic, advises Adib.
"It's important to get a diagnosis from a doctor as there are other conditions that can also make tampon use and sex difficult."
This article has not been peer reviewed by a medical professional but has still been fact-checked and is subject to Patient’s rigorous editorial guidelines. If you have any questions or queries please message the team using the contact link below.