The Hymen Examination
In prepubertal girls, a pelvic examination with a speculum is
unnecessary unless there is unexplained, active vaginal bleeding. In most
cases, thorough visual inspection of the external genitalia, vaginal
vestibule, and hymen structures is sufficient. The vaginal vestibule is
the space below the clitoris, above the posterior commissure, and between
the labia minora.
The
supine frog-leg position is comfortable for most girls. Separate the labia
majora by applying gentle traction. Grasp the labia bilaterally between
thumb and forefinger and pull gently outward and downward. Because tension
of other pelvic muscles can obscure the view of vaginal vestibular
structures, allow the girl time to relax while you maintain labial
traction.
The knee-chest position is tolerated well by most
girls. While preserving the patient's modesty with drapes, instruct her or
him to lie prone on the examining table. Then assist the girl to assume a
kneeling position while he or she maintains head and chest contact with
the table surface and lordosis of the back. Once the girl is positioned properly,
lift the labia upward and apart gently. Use this examination position
routinely to verify normal or abnormal findings first noted when the
patient is supine. This technique allows excellent noninvasive
visualization of the posterior hymen, vagina, anus,
and frequently the cervix.
The redundancy of the estrogenized postpubertal
hymen makes close inspection of hymen tissues for traumatic injury
difficult in adolescents.
Figure 2.
Normal prepubertal genitalia visualized while patient is in the supine
frog-leg position (labial traction applied). The vaginal vestibule is the
space below the clitoris, above the posterior commissure, and between the
labia minora. The hymen morphology is annular, ie, circumferential. The
fossa navicularis or posterior fossa is the lower part of the vaginal
vestibule below the vaginal orifice, extending to the posterior
commissure. In nonabused prepubertal girl, the posterior hymen appears uniform
without traumatic defect.
VARIATIONS OF NORMAL
HYMEN
Figure 2 illustrates normal prepubertal vestibular
structures and an annular hymen. An annular hymen extends 360 degrees
circumferentially. Figure 3 demonstrates a crescentic hymen, which is the
most common morphology. A crescentic hymen has attachments at
approximately the 10 o'clock to 11 o'clock and 1 o'clock to 2 o'clock
positions and no hymen tissue at the 12 o'clock position (relating
location in the supine position to the face of a clock). Hymen
appearance may vary over time due to the effects of pubertal or
exogenous
Hymen Figure 3.
A prepubertal girl in the supine frog-leg position with labial traction applied reveals
crescentic hymen morphology. A crescentic hymen has attachments at
approximately the 10 o'clock to 11 o'clock and 1 o'clock to 2 o'clock
positions. No hymen tissue is present at the 12 o'clock position. The
crescentic hymen morphology is the most common variant. The arch-like,
symmetric bands lateral to the urethra and connected to the vestibular
wall are periurethral bands--a normal finding.
Hymen Figure 4. This female, who
is at sexual maturity rating 1, is in the knee-chest examination position.
The hymen appears thin, almost translucent in this colposcopic
photograph.
The
hymen opening size varies, depending on examination technique, degree of
patient relaxation, and the patient's age. There is a wide range of normal
hymen opening sizes among prepubertal girls selected for
non-abuse. A significantly enlarged hymen opening is diagnostic of
penetrating sexual abuse only in the presence of posterior hymen defects
confirmed in two separate examination positions.
Routine
examination of genital-rectal structures during well girl care visits
offers an opportunity to learn the many normal variations. Colposcopy
offers an additional learning opportunity. The widespread use of
colposcopic photography in the medical evaluation of teen girls sexual abuse
has allowed extensive peer review of such photos at educational
conferences and in the medical literature. Significant concurrence on
"normal" versus "abnormal" findings has resulted. Excellent color atlases
of colposcopic photographs are available for review.
PICTURES OF THE HYMEN
Only for adults!
Is it Evidence of
Virginity?
The hymen, or "maidenhead," is a thin, fleshy membrane that in some
girls and young women is found at the opening to the vagina. It has a
central perforation, which can be round or elongated, through which
menstrual blood will flow.
For a long time, it was believed that an intact hymen was evidence of a
girl's virginity, as the hymen posed a barrier to sexual
intercourse.
Some girls who are still virgins have no hymen at all.
Girls who do have a hymen can "break (or pop) their cherry"
in a number of differerent ways, sometimes without even knowing it. Some
of the non-sexual ways in which a hymen will tear are:
1. Through an accident or injury
2. Horseback riding, bicycling, high jumping, or gymnastics
3. Insertion of finger or instrument by doctor during pelvic exam
4. Tampon insertion
5. Overzealous douching
Sex and the Hymen
Sexual methods of "deflowering" a girl (another euphemism for rupturing
the hymen) include:
1. Inserting a finger deeply or roughly into the vagina
2. Masturbation with a phallic-shaped vibrator or other such tool
3. Sexual intercourse
While the presence of a hymen indicates virginity, the absence of
one is no proof a girl is not a virgin.
Since an intact hymen can be stretched and split by an erect penis during
sexual intercourse, a woman may feel momentary discomfort and/or bleed.
Should either persist, a consultation with a doctor is in order. On the
other hand, there may be no blood or pain involved at all when the hymen
is torn.
In many cultures, a girl’s virginity until marriage is considered a
critical virtue. Consequently certain fanfare may accompany the display of
"proof." In some Mediterranean and African countries, the blood-stained
sheet is still hung proudly outdoors following the wedding night.
Restoring the Hymen:
In some backward countries, the absence of blood after first intercourse
still casts questions on a bride's virginity. To protect themselves from
violence and even death, some engaged women in these places arrange for
hymenorraphy, which is surgery to repair the hymen. Typical hymen
repair surgery involves stitching what remains of a torn hymen
together and inserting a gelatin capsule that contains a blood-like
substance.
Who was Hymen?
According to sources, the hymen is named after the Greek god Hymenaeus.
Son of Bacchus and Venus, Hymenaeus earned his reputation as the
god of marriage and weddings.
PICTURES OF THE HYMEN -CLICK HERE
Updated: March 02, 2005
THE FEMALE HYMEN:
I am asked about hymens almost as much as
about masturbation and penis size. I thought it was time to try to address
this subject and hopefully end the confusion. I have written about the
hymen in the Sexuality FAQ pages also.
I want this site to provide accurate information for teens and young
adults about their bodies. I often do so at the risk of losing potential
sponsors - they often don’t appreciate honest information, but the hymen
shouldn't be such a mystery.
When I was a teen in the 1970s, there were the same myths and
misinformation that I am hearing today from readers. Maybe some things
don’t really change so much.
~ Amy, RN, BSN, Founder/Publisher, Cool Nurse ~
Many people are under the impression that the hymen is located within the
vagina. It is not. It’s part of the vulva, the external genital organs.
It’s located outside the vagina. The hymen is a layer of tissue, just like
the tissue around the opening of your vagina that partially conceals the
vaginal orifice. You may or may not have one, most females do. The hymen
is named after the Greek God Hymenaeus -- the God of marriage and
weddings, FYI.
During the early stages of fetal development there is no opening into the
vagina at all. The thin layer of tissue that conceals the vagina at this
time usually divides incompletely prior to birth, forming the hymen. The
size and shape of this opening (or openings) varies greatly from person to
person.
Sometimes this formation of an opening does not occur, resulting in an
imperforated hymen (it lacks the more common opening). Some females have
no hymen at birth at all, since the tissue divided completely while they
were still in the womb.
Many girls and teens tear or otherwise dilate their hymen while
participating in sports like bicycling, horseback riding, gymnastics or
inserting tampons, or while masturbating. A girl may not even know this
has occurred, since there may be little or no blood or pain involved when
this happens. The tissues of the vulva are generally very thin and
delicate prior to puberty. The presence or absence of a hymen in no way
indicates whether or not a female is a virgin. * You are a virgin until
you have sexual intercourse.*
Some hymens are elastic enough to permit a penis to enter without tearing,
or they tear only partially, and there is NO bleeding at all. When
adequately lubricated the vagina is fairly 'flexible' and will stretch
without discomfort for most women. Sometimes, a woman has sex for years
with no real 'tearing' at all, only stretching of the hymen and then at
another time the same woman might tear from 'rough sex' or sex with a
different partner with a larger penis. Remnants of the hymen are usually
still present until a woman delivers a baby vaginally. See Pregnancy
Articles for more on childbirth.
Sure, see what your vagina looks like with a mirror, it's your body, you
should not be afraid of it . Some young women seem to obsess over what is
'normal'. So, put away the mirror after you know what is normal for you.
While it is important to know what your body looks like, so you can tell
when there is a change or something to see your health care provider
about, don’t obsess over what is is 'supposed to' look like. All of our
faces look different and none of our vaginas look exactly the same either.
That’s all I have to say about hymens.
I have some diagrams of different hymens, but some sponsor think they are
not appropriate for me to show, even for educational purposes. However,
there is a page that does have a photograph of the anatomy of the female
vagina. It’s not that hard to find if you do a search. AND, speaking of
sponsors, if you would kindly click on the banner ads on the top of the
page or on the left here that helps keep this site on the web. That’s who
helps me continue to bring you information, kind of like commercials on
TV, they are annoying, but they are a reality of our world. Thank you in
advance!
For more on your GYN health go to that section and visit the Gynecologic
video & transcript library. Your body shouldn’t be a mystery to you. For
more information about hymen as :
hymen pictures
please click here.
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