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Vaginismus and hymen

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Can a hymen cause vaginismus?

Typically, NO, the presence of a hymen will not cause vaginismus or this condition would have been most common, which is not the case. Furthermore, the majority of vaginismus patients do not have an intact hymen in the first place despite not having had any vaginal penetration.

Let’s take this opportunity to also correct a common fallacy: a hymen does not grow back!

The hymen is a thin, vascularized membrane, an embryonic remnant of the vaginal separation from the urogenital sinus = the tissue that forms the genitals. The hymen will usually perforate during embryonic development and will vary in thickness, size, and shape from one female to another. The hymen does not regenerate (grow back)!

There are 3 typical variations of hymeneal presence (excluding anomalies):

  1. An imperforate hymen, which means it did not perforate (did not develop an opening within it). An imperforate hymen is uncommon, and is typically diagnosed during onset of menstruation when the blood that cannot ‘come out’ of the body keeps accumulating on the inside. This is a painful and a potentially life-threatening situation that needs immediate medical attention.
  2. An intact hymen, which means that there is leftover hymeneal tissue present, typically between the 4 o’clock and the 8 o’clock, if we use that description. The opening within the hymen can be large enough to accommodate a tampon or a finger, or so small that even the pinky (smallest finger) will not pass through. A partially-intact hymen can be elastic and responsive to stretch (common), or fibrous and rigid (less common).
  3. Minimal or no hymen, even in the absence of vaginal penetration! Despite it being quite common, there is no explanation for it; bike riding or gymnastics are not the cause…

Imperforate and rigid hymens require a hymenectomy, a simple procedure during which the hymen is removed. When it comes to an intact hymen, of our thousands of patients treated, we encountered only 4 women that needed surgical intervention due to hymenal abnormality that restricted vaginal penetration.

An intact elastic hymen will respond to vaginal penetration, may it be a finger, tampon, gyno exam, or intercourse. There may be initial discomfort and/or bleeding, but not necessarily as not all hymens react the same. So, when it comes to intercourse, do not assume that the first-time will be painful or bloody!

Note: the presence of a hymen cannot be established just by looking at the vaginal opening. Clinicians who attempt a gynecologic exam inationon a woman with vaginismus will often interpret her tight (and anxious!) vaginal opening as an intact hymen and offer a hymenectomy as a solution… Remember: a digital (finger) exam is necessary to arrive at a definitive conclusion!

The presence of a hymen does not cause vaginismus. It may restrict or limit vaginal access, but the woman will typically be cool about her vagina and able to face vaginal management without distress.

So when may the presence of a hymen be associated with vaginismus? When there is an underlying stress/anxiety condition, either conscious or subconscious:

  • Anticipating pain upon first-time penetration (but maybe it won’t really hurt?)
  • Is anxious about ‘breaking’ the hymen (maybe there is no hymen?)
  • Cannot handle physical discomfort (maybe there will be none?)
  • Cannot handle the site of blood (maybe it won’t bleed?)
  • Stressed about an unknown; what will it be like to have something inside my vagina?
  • Forced into having intercourse/losing her virginity

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On a humorous note, check the following quote from a book by the name of Sex Revelations and The New Eugenics, published in 1936 by two physicians, Whitehead and Hertel:  “Regarding the hymen… It sometimes grows again in widows, or in women who have been a long time separated from their husbands…”

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