Hymen: Difference between revisions
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== Hymenal resorption == |
== Hymenal resorption == |
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Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) has been proposed to be approximately 1 mm for each year of age.<ref name="WebMD" /> In children, to make this measurement, a doctor may place a [[Foley catheter]] into the vagina and inflate the balloon behind the hymen to stretch the hymenal margin and allow for a better examination. In the normal course of life, the hymenal opening can also be enlarged by [[tampon]] use, pelvic examinations with a [[speculum]], regular physical activity |
Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) has been proposed to be approximately 1 mm for each year of age.<ref name="WebMD" /> In children, to make this measurement, a doctor may place a [[Foley catheter]] into the vagina and inflate the balloon behind the hymen to stretch the hymenal margin and allow for a better examination. In the normal course of life, the hymenal opening can also be enlarged by [[tampon]] use, pelvic examinations with a [[speculum]], regular physical activity or sexual intercourse.<ref name=emans/> Once a girl reaches puberty, the hymen tends to become so elastic that it is not possible to determine whether a woman uses tampons or not by examining a hymen. In one survey, only 43% of women reported bleeding the first time they had sex, indicating that the vagina of a majority of women is sufficiently opened.<ref name=emans/><ref name="McCann" /> |
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The hymen is most apparent in young girls: At this time, their hymen is thin and less likely to be ''redundant'', that is to protrude or fold over on itself.<ref>Muram, David. "Anatomical and Physiologic Changes" (2000) in ''Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas'', Second edition, [[Oxford University]] Press. 105–7.</ref> In instances of suspected child abuse, doctors use the [[clock face]] system to describe the hymenal opening. The 12 o'clock position is below the [[urethra]], and 6 o'clock is towards the [[anus]], with the patient lying on her back.<ref name=pok>Pokorny, Susan. "Anatomical Terms of Female External Genitalia" (2000) in ''Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas'', Second edition, Oxford University Press. 110.</ref> |
The hymen is most apparent in young girls: At this time, their hymen is thin and less likely to be ''redundant'', that is to protrude or fold over on itself.<ref>Muram, David. "Anatomical and Physiologic Changes" (2000) in ''Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas'', Second edition, [[Oxford University]] Press. 105–7.</ref> In instances of suspected child abuse, doctors use the [[clock face]] system to describe the hymenal opening. The 12 o'clock position is below the [[urethra]], and 6 o'clock is towards the [[anus]], with the patient lying on her back.<ref name=pok>Pokorny, Susan. "Anatomical Terms of Female External Genitalia" (2000) in ''Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas'', Second edition, Oxford University Press. 110.</ref> |
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Revision as of 03:24, 23 June 2010
| Hymen | |
|---|---|
 External genital organs of female. The labia minora have been drawn apart. | |
| Details | |
| Identifiers | |
| Latin | hymen vaginae |
| MeSH | D006924 |
| TA98 | A09.1.04.008 |
| TA2 | 3530 |
| FMA | 20005 |
| Anatomical terminology | |
The hymen or the vaginal corona, is a fold of mucous membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia.[1][2][3] Despite this, it is not possible to confirm that a woman is a virgin by examining her hymen.[2][3] In cases of suspected rape or sexual abuse, a detailed examination of the hymen may be carried out; but the condition of the hymen alone is often inconclusive or open to misinterpretation, especially if the patient has reached puberty.[1] In children, although a common appearance of the hymen is crescent-shaped, many variations are possible.[1] After a woman gives birth, she may be left with remnants of the hymen, called carunculae myrtiformes, or the hymen may be completely absent.[4]
Hymenal development
The genital tract develops during embryogenesis, from the third week of gestation to the second trimester, and the hymen is formed following the vagina.
At week seven, the urorectal septum forms and separates the rectum from the urogenital sinus.
At week nine, the müllerian ducts move downwards to reach the urogenital sinus, forming the uterovaginal canal and inserting into the urogenital sinus.
At week 12, the müllerian ducts fuse to create a primitive uterovaginal canal.
At month 5, the vaginal canalization is complete and the fetal hymen is formed from the proliferation of the sinovaginal bulbs (where müllerian ducts meet the urogenital sinus), and becomes perforate before or shortly after birth.
In newborn babies, still under the influence of the mother's hormones, the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones that continue this effect.[5] Their hymenal opening tends to be annular (circumferential).[6]
Hymenal resorption
Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) has been proposed to be approximately 1 mm for each year of age.[7] In children, to make this measurement, a doctor may place a Foley catheter into the vagina and inflate the balloon behind the hymen to stretch the hymenal margin and allow for a better examination. In the normal course of life, the hymenal opening can also be enlarged by tampon use, pelvic examinations with a speculum, regular physical activity or sexual intercourse.[1] Once a girl reaches puberty, the hymen tends to become so elastic that it is not possible to determine whether a woman uses tampons or not by examining a hymen. In one survey, only 43% of women reported bleeding the first time they had sex, indicating that the vagina of a majority of women is sufficiently opened.[1][5]
The hymen is most apparent in young girls: At this time, their hymen is thin and less likely to be redundant, that is to protrude or fold over on itself.[8] In instances of suspected child abuse, doctors use the clock face system to describe the hymenal opening. The 12 o'clock position is below the urethra, and 6 o'clock is towards the anus, with the patient lying on her back.[9]
Infants' hymenal openings tend to be redundant (sleeve-like, folding in on itself), and may be ring-shaped.[9]
By the time a girl reaches school-age, this hormonal influence has stopped and the hymen becomes thin, smooth, delicate, and almost translucent. It is also very sensitive to touch; a physician who must swab the area would avoid the hymen and swab the outer vulval vestibule instead.[5]
Prepubescent girls' hymenal opening comes in many shapes, depending on hormonal and activity level, the most common being crescentic (posterior rim): no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1–2 to 10–11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on estrogen and activity levels, the hymenal tissue may be thicker, and the opening is often fimbriated or erratically shaped.[6]
After giving birth, the vaginal opening usually has nothing left but hymenal tags (carunculae mytriformes) and is called "parous introitus".
Anatomic anomalies
Anomalies of the female reproductive tract can result from agenesis or hypoplasia, canalization defects, lateral fusion and failure of resorption, resulting in various complications.[7]
- Imperforate:[10][11] hymenal opening nonexistent; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape.
- Cribriform, or microperforate: sometimes confused for imperforate, the hymenal opening appears to be nonexistent, but has, under close examination, small openings.
- Septate: the hymenal opening has one or more bands extending across the opening.
Hymens in other animals
Due to similar reproductive system development, many mammals, including chimpanzees, elephants, manatees, whales, and horses, retain hymens.[12][13]
Hymenorrhaphy
In some cultures, the concept of an intact hymen is highly valued at marriage.[14][15][16] Some women undergo hymenoplasty, a restoration of their hymen.[16][17]
Womb fury
In the sixteenth and seventeenth centuries, medical researchers used the presence of the hymen, or lack thereof, as founding evidence of physical diseases such as "womb-fury" (Hysteria). If not cured, womb-fury would, according to these early doctors, result in death.[18][19]
See also
References
- ^ a b c d e Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 61-65
- ^ a b Perlman, Sally E. (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon. p. 131. ISBN 1842141996.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b "Hymen". Discovery.com. Retrieved 2009-02-02.
Knowing the facts about the hymen can help women dispel the myth that it proves virginity, freeing them from the negative effects of popular mythology. Having accurate information about the hymen can assist in normalizing a woman's fears about her body and help promote greater self-acceptance.
- ^ Knight, Bernard (1997). Simpson's Forensic Medicine (11th ed.). London: Arnold. p. 114. ISBN 0713144521.
- ^ a b c McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, a)p.453, b)p.455 c)p.460.
- ^ a b Heger, Astrid (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (Second ed.). Oxford University Press. p. 116. ISBN 0195074254.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b "Imperforate Hymen". Web MD. Retrieved 2009-02-02.
Different normal variants in hymenal configuration are described, varying from the common annular, to crescentic, to navicular ("boatlike" with an anteriorly displaced hymenal orifice). Hymenal variations are rarely clinically significant before menarche. In the case of a navicular configuration, urinary complaints (e.g., dribbling, retention, urinary tract infections) may result. Sometimes, a cribriform (fenestrated), septate, or navicular configuration to the hymen can be associated with retention of vaginal secretions and prolongation of the common condition of a mixed bacterial vulvovaginitis.
- ^ Muram, David. "Anatomical and Physiologic Changes" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 105–7.
- ^ a b Pokorny, Susan. "Anatomical Terms of Female External Genitalia" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 110.
- ^ Encyclopedia of Jewish Medical Ethics. 2003. ISBN 1583305920.
Occasionally, the hymen is harder than normal or it is complete and sealed without there being ... This condition is called imperforate hymen and, at times ...
{{cite book}}: Cite has empty unknown parameter:|coauthors=(help) - ^ DeCherney, Alan H. (2002). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 602. ISBN 0838514014.
Imperforate hymen represents a persistent portion of the urogenital membrane ... It is one of the most common obstructive lesions of the female genital tract. ...
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Blank, Hanne (2007). Virgin: The Untouched History. Bloomsbury Publishing. p. 23. ISBN 1596910100.
- ^ Blackledge, Catherine (2004). The Story of V. Rutgers University Press. ISBN 0813534550.
Hymens, or vaginal closure membranes or vaginal constrictions, as they are often referred to, are found in a number of mammals, including llamas, ...
{{cite book}}: Cite has empty unknown parameter:|coauthors=(help) - ^ "Muslim women in France regain virginity in clinics". Reuters.
'Many of my patients are caught between two worlds,' said Abecassis. They have had sex already but are expected to be virgins at marriage according to a custom that he called 'cultural and traditional, with enormous family pressure'.
- ^ "The Hymen". University of California at Santa Barbara. Retrieved 2009-02-09.
The hymen can have very important cultural significance in certain cultures because of its association with a woman's virginity.
- ^ a b Sciolino, Elaine; Mekhennet, Souad (June 11, 2008). "In Europe, Debate Over Islam and Virginity". The New York Times. Retrieved 2008-06-13.
'In my culture, not to be a virgin is to be dirt,' said the student, perched on a hospital bed as she awaited surgery on Thursday. 'Right now, virginity is more important to me than life.'
{{cite news}}: Cite has empty unknown parameter:|coauthors=(help) - ^ Hymenoplasty is depicted in a fictional context in "Everett Poe", an episode of the television series Nip/Tuck that was broadcast in 2007.
- ^ Berrios GE, Rivière L. (2006) 'Madness from the womb'. History of Psychiatry. 17:223-35.
- ^ The linkage between the hymen and social elements of control has been taken up in Marie Loughlin's book Hymeneutics: Interpreting Virginity on the Early Modern Stage published in 1997
External links
- Hymen gallery—Illustrations of hymen types
- Magical Cups and Bloody Brides—the historical context of virginity
- 20 Questions About Virginity—Interview with Hanne Blank, author of Virgin: The Untouched History. Discusses relationship between hymen and concept of virginity.
- All about The Hymen: To prevent Vaginismus and painful first-time sex at the Vaginismus Awareness Network
- MedPix Teaching Case Radiology (US - ultrasound) of Hydrocolpos