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The hymen is a fold of mucous membrane which surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia. Slang terms are maidenhead and "cherry", as in "popping one's cherry" (losing one's virginity). However, it is not possible to confirm that a woman or post-pubescent girl is not a virgin by examining the hymen. 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. In children, although a common appearance of the hymen is crescent-shaped, many variations are possible. After a woman gives birth she may be left with remnants of the hymen called carunculae myrtiformes or the hymen may be completely absent.

Types

There are several different formations of the hymen, some more common than others. In about 1 in 2000 females, the hymen fails to develop any opening at all: this is called an imperforate hymen and if it does not spontaneously resolve itself before puberty a physician will need to make a hole in the hymen to allow menstrual fluids to escape. A hymenotomy may also be required if the hymen is particularly thick or inelastic as it may interfere with sexual intercourse.

The shape of the hymen is easiest to observe in girls past infancy but before they reach puberty: at this time their hymen is thin and less likely to be redundant, that is to protrude or fold over on itself.

When describing the shape of a hymen, a clock face is used. The 12 o'clock position is below the urethra, and 6 o'clock is towards the anus, which is based on the patient lying on her back.

Most common forms of the hymen:

• crescent-shaped, crescentic, or posterior rim: no hymenal tissue at the 12 o'clock position; narrow band of tissue starts at 1 or 2 o'clock going clockwise, is at its widest around 6 o'clock, and tapers off at 10 or 11 o'clock
• annular, or circumferential: the hymen forms a ring around the vaginal opening; especially common in newborns
• redundant; sometimes sleeve-like: folds in on itself, which sometimes causes it to protrude; most common in infancy and at/following puberty due to estrogen levels; can be combined with other type such as "annular and redundant"

Less common forms:

• fimbriated or denticular: an irregular edge to the hymenal orifice; more likely at an age when estrogen is present
• septate: the hymen has one or more bands extending across the opening
• cribriform, or microperforate: the hymen stretches completely across the vaginal opening, but is perforated with several holes
• labial, or vertical: hymen has an opening from the 12 to the 6 o'clock positions and can look similar to a third set of vulvar lips
• imperforate: hymen completely covers vaginal orifice; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape

The hymen is torn or stretched by penetrative sex, and more so when a woman gives birth vaginally.

• parous introitus refers to the vaginal opening which has had a baby pass through it and consequently has nothing left of its hymen but a fleshy irregular outline decorating its perimeter; these tags are called carunculae mytriformes

Development of the hymen

During the early stages of fetal development there is no opening into the vagina at all. The thin layer of tissue that covers the vagina at this time usually divides to a certain extent prior to birth, forming the hymen. That layer was the Müllerian eminence before, and thus, the hymen is a remnant of that structure.

In newborn babies, who are 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 which continue this effect.

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 needed to swab the area would avoid the hymen and swab the outer vulval vestibule instead.

From puberty onwards the appearance of the hymen is affected once more by estrogen. It thickens and becomes pale pink, the opening is often fibriated or erratically shaped, and redundant: the hymen often appears rolled or sleeve-like.

In the normal course of life the vagina's opening progressively becomes enlarged by tampon use, pelvic examinations, regular physical activity or sexual intercourse. Once a girl reaches puberty the hymen tends to become so elastic that it's 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.

Hymens in other animals

Due to similar reproductive system development, many mammals, from chimpanzees and elephants to manatees and whales, retain hymens.

Hymenoplasty

See main article Hymenorrhaphy

In some religious cultures the concept of an intact hymen is highly valued at marriage. In Korea the word for hymen translates literally as “virgin-skin” and a small industry has grown up around its surgical construction through plastic surgery. In 1994 the Korean Medical Research Center was made to pay compensation to a 40-year-old woman for extreme psychological distress after she lost her hymen during a Pap smear test. The court found that, “it is clear that the hymen is still recognized as a symbol of ‘virginity’ and keeping virginity is valued in society". Some Korean prenatal clinics offers STD tests with hymenorrhaphy, in order to "free" women from their history of sexual experiences in the past. These surgeries are not even approved by the Korean medical association because they are based on myths and efforts at re-education are being made.

Debunking myths

• The condition of the hymen is not a reliable indicator of whether a woman past puberty has actually engaged in sexual intercourse.

• "Although some women are born without a hymen, most have one, and the hymen varies in size and shape from woman to woman."

• In the sixteenth and seventeenth centuries, medical researchers have used the presence of the hymen, or lack thereof, as founding evidence of physical diseases such as "womb-fury". If not cured, womb-fury would, according to these early doctors, result in death. The cure, naturally enough, was marriage, since a woman could then go about having sexual intercourse on a "normal" schedule that would stop womb-fury from killing her, hence opening her hymen.

Modern perspectives

As early as the late sixteenth century, Ambroise Paré and Andreas Laurentius asserted to have never seen the hymen and that it was "a primitive myth, unworthy of a civilized nation like France." In late 2005, Monica Christiansson, former maternity ward nurse and Carola Eriksson, a PhD student at Umeå University announced that according to studies of medical literature and practical experience, the hymen should be considered a social and cultural myth, based on deeply rooted stereotypes of women's roles in sexual relations with men. Christiansson and Eriksson support their claims by pointing out that there are no accurate medical descriptions of what a hymen actually consists of. Statistics presented by the two state that fewer than 30% of women who have gone through puberty and have consensual intercourse bleed the first time. Christiansson has expressed an opinion that the use of the term "hymen" should be discontinued and that it should be considered an integral part of the vaginal opening.

It is argued that since the hymen has been culturally constructed to be the sign of virginity, its existence plays into a political discourse that circulates around the body. By examining women's bodies for the existence of the hymen, researchers have used it to determine whether or not women are "virtuous." Sherry B. Ortner, professor at the University of Chicago, explains how "the hymen itself emerges physiologically with the development of sexual purity codes" as an element of patriarchy. In some cultures it is still customary to examine a woman for her hymen before her marriage to see if she is truly fit to be married. If she is found with a broken hymen, or to have no hymen at all, often the man would not feel obligated to marry her. This has prompted some women who wish to marry within such cultures to seek surgery to restore their hymens to a socially acceptable state.

See also

• Hymenotomy
• Virginity

References

1. 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. 62
2. ^ Perlman, Sally E. (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon. p. 131. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
3. 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. 63-4
4. 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. 63
5. Knight, Bernard (1997). Simpson's Forensic Medicine (11th edition ed.). London: Arnold. p. 114. {{cite book}}: |edition= has extra text (help)
6. Kurman, Robert J., ed. (2002). Blaustein's Pathology of the Female Genital Tract (5th edition ed.). New York: Springer-Verlag. p. 160. {{cite book}}: |edition= has extra text (help)
7. Chang, Lisbeth and Muram, David. (2002) "Pediatric & Adolescent Gynecology" in DeCherney, Alan H. and Nathan, Lauren. Current Obstetric & Gynecological Diagnosis & Treatment, 9th edition, McGraw-Hill, 598-602.
8. 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.
9. 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.
10. Heger, Astrid (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (Second edition ed.). Oxford University Press. p. 116. {{cite book}}: |edition= has extra text (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
11. 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. 110-1.
12. Ergun, E. "Social, Medical, and Legal Control of Female Sexuality Through Construction of Virginity in Turkey" (2006). Unpublished masters thesis, Towson University, MD, USA. Accessed 01.17.2007 at http://www.archive.org/details/ConstructionofVirginityTurkey
13. 1918 Gray's Anatomy
14. 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, 455.
15. 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, 459.
16. Heger, Astrid; Emans, S. Jean and Muram, David (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press, 116.
17. ^ 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. 64-5
18. 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, 460.
19. Blank, Hanne (2007). Virgin: The Untouched History. Bloomsbury Publishing. p. 23.
20. "What is the purpose of the hymen?", The Straight Dope, 02 October, 1992, Cecil Adams
21. 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)
22. Park, J. I., Compensation for hymen lost: Not loss of virginity but a medical accident. Chosun Daily Aug 1994
23. http://www.yunlee.co.kr
24. International Encyclopedia of Sexuality, South Korea by Hyung-Ki Choi, M.D., Ph.D., and Huso Yi, Ph.D.
25. http://health.discovery.com/centers/sex/sexpedia/hymen.html
26. 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
27. Nerikes Allehanda's article on Christiansson's and Eriksson's research Template:Sv icon
28. Ortner, Sherry. "The Virgin and the State" in Feminist Studies, Vol. 4, No. 3. (Oct., 1978), pp. 19-35.
29. "In Europe, Debate Over Islam and Virginity". New York Times. June 11, 2008. Retrieved 2008-06-13. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)

External links

• Hymen at the Encyclopædia Britannica
• The Female Hymen and its Significance
• Hymen gallery - Illustrations of hymen types
• Magical Cups and Bloody Brides the historical context of virginity in a frank and easy-to-understand manner.
• 20 Questions About Virginity - Interview with Hanne Blank, author of "Virgin: The Untouched History". Discusses relationship between hymen and concept of virginity.
• Vaginismus-Awareness-Network Explanation of the hymen, myths on first-time sex, Hymenectomies and Vaginismus (Painful sex or Fear of Penetration)
• Nerikes Allehanda's article on Christiansson's and Eriksson's research Template:Sv icon

• Female reproductive system