hymen

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 twelve, the Müllerian ducts fuse to create a primitive uterovaginal canal called unaleria. At month five, 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 normally becomes perforate before or shortly after birth.{{cite book |last=Healey |first=Andrew |editor-last1=Mann |editor-first1=Gurdeep S. |editor-last2=Blair |editor-first2=Joanne C. |editor-last3=Garden |editor-first3=Anne S. |title=Imaging of Gynecological Disorders in Infants and Children |publisher=Springer |date=2012 |pages=21–30 |chapter=Embryology of the female reproductive tract |isbn=978-3-540-85602-3 |doi=10.1007/978-3-540-85602-3|series=Medical Radiology }}

The hymen has dense innervation. 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.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. {{isbn|978-1-84-110026-5}} Their hymenal opening tends to be annular (circumferential).{{Cite book | last1=Heger | first1=Astrid | author-link = Astrid Heppenstall Heger | last2=Emans | first2=S. Jean | last3=Muram | first3=David |title=Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas |edition=Second |year=2000 |publisher=Oxford University Press |page=116 |isbn=978-0-19-507425-3 }}

Post neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age.{{Cite CiteSeerX |last=Pugno |first=Perry |title=Genital Findings in Prepubertal Girls Evaluated for Sexual Abuse |date=1999|citeseerx=10.1.1.522.1894 }} During puberty, estrogen causes the hymen to become very elastic and fimbriated.{{Cite journal|last1=Lahoti|first1=Sheela L.|last2=McClain|first2=Natalie|last3=Girardet|first3=Rebecca|last4=McNeese|first4=Margaret|last5=Cheung|first5=Kim|date=2001-03-01|title=Evaluating the Child for Sexual Abuse|url=http://www.aafp.org/afp/2001/0301/p883.html|journal=American Family Physician|language=en|volume=63|issue=5|pages=883–92|pmid=11261865|issn=0002-838X}}{{Cite book|url=https://the-eye.eu/public/Books/Medical/texts/Evaluation%20of%20the%20Sexually%20Abused%20Child%202nd%20ed%20-%20A.%20Heger%2C%20et%20al.%2C%20%28Oxford%2C%202000%29%20WW.pdf|title=Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas|date=2000|publisher=Oxford University Press|isbn=978-0-19-507425-3|editor-last=Heger|editor-first=Astrid H.|edition=2nd|location=New York|page=122|language=en|editor-last2=Emans|editor-first2=S. Jean|access-date=July 8, 2018|archive-date=July 8, 2018|archive-url=https://web.archive.org/web/20180708104703/https://the-eye.eu/public/Books/Medical/texts/Evaluation%20of%20the%20Sexually%20Abused%20Child%202nd%20ed%20-%20A.%20Heger,%20et%20al.,%20(Oxford,%202000)%20WW.pdf}}

File:Carunculae myrtiformes.png|Arrows point to carunculae myrtiformes ("remnants") of the hymen in a post-pubertal individual.

The hymen can stretch or tear as a result of various behaviors, by the use of tampons or menstrual cups, pelvic examinations with a speculum, or sexual intercourse. Remnants of the hymen are called carunculae myrtiformes.{{cite book|last=Knight|first=Bernard|title=Simpson's Forensic Medicine|edition=11th|year=1997|publisher=Arnold|location=London|page=114|isbn=978-0-7131-4452-9}}

A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called a Glaister Keen rod, is used for close examination of the hymen or the degree of its rupture. In forensic medicine, it is recommended by health authorities that a physician who must swab near this area of a prepubescent girl avoid the hymen and swab the outer vulval vestibule instead. In cases of suspected rape or child sexual abuse, a detailed examination of the hymen may be performed, but the condition of the hymen alone is often inconclusive.

Normal variations of the hymen range from thin and stretchy to thick and somewhat rigid.{{Cite book|url=https://the-eye.eu/public/Books/Medical/texts/Evaluation%20of%20the%20Sexually%20Abused%20Child%202nd%20ed%20-%20A.%20Heger%2C%20et%20al.%2C%20%28Oxford%2C%202000%29%20WW.pdf|title=Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas|date=2000|publisher=Oxford University Press|isbn=978-0-19-507425-3|editor-last=Heger|editor-first=Astrid H.|edition=2nd|location=New York|pages=61–65|language=en|editor-last2=Emans|editor-first2=S. Jean|access-date=July 8, 2018|archive-date=July 8, 2018|archive-url=https://web.archive.org/web/20180708104703/https://the-eye.eu/public/Books/Medical/texts/Evaluation%20of%20the%20Sexually%20Abused%20Child%202nd%20ed%20-%20A.%20Heger,%20et%20al.,%20(Oxford,%202000)%20WW.pdf}} An imperforate hymen occurs in 1-2 out of 1,000 infants.{{Cite book|url=https://books.google.com/books?id=H7Z-lD9cXBEC&q=vaginal+labial+fusion&pg=PA139|title=Blueprints Obstetrics and Gynecology|last1=Callahan|first1=Tamara L.|last2=Caughey|first2=Aaron B.|date=2009|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-8249-4|language=en}}{{Cite journal|last1=Lardenoije|first1=Céline|last2=Aardenburg|first2=Robert|last3=Mertens|first3=Helen|date=2009-05-26|title=Imperforate hymen: a cause of abdominal pain in female adolescents|journal=BMJ Case Reports|volume=2009|pages=bcr0820080722|doi=10.1136/bcr.08.2008.0722|issn=1757-790X|pmc=3029536|pmid=21686660}} The only variation that may require medical intervention is the imperforate hymen, which either completely prevents the normal passage of menstrual fluid or slows it significantly. In either case, surgical intervention may be needed to allow menstrual fluid to pass or intercourse to take place at all.{{Cite web|title=Imperforate hymen |year=2021 |publisher=United States National Library of Medicine |website=medlineplus.gov |url=https://medlineplus.gov/ency/patientinstructions/000708.htm}}

Prepubescent hymenal openings come 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. In younger children, a torn hymen will typically heal very quickly. In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases.

Variations of the female reproductive tract can result from agenesis or hypoplasia, canalization defects, lateral fusion and failure of resorption, resulting in various complications.{{Cite web|title=Congenital Anomalies of the Hymen |publisher=Brigham and Women's Hospital |website=brighamandwomens.org |url=https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/congenital-anomalies/hymen-anomalies}}

• Imperforate: hymenal opening nonexistent; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape.{{Cite web|title= Imperforate Hymen|publisher=Mount Sinai Hospital (Brooklyn) |website=mountsinai.org |url=https://www.mountsinai.org/health-library/special-topic/imperforate-hymen}}
• Cribriform, or microperforate: sometimes confused for imperforate, the hymenal opening appears to be nonexistent, but has, under close examination, small perforations.{{Cite web|title= Cribriform Hymen|publisher=Texas Children's Hospital |website=texaschildrens.org |url=https://www.texaschildrens.org/health/cribriform-hymen}}
• Septate: the hymenal opening has one or more bands of tissue extending across the opening.{{Cite web|title=Septate Hymen |publisher=Boston Children's Hospital |website=childrenshospital.org |url=https://www.childrenshospital.org/conditions-and-treatments/conditions/s/septate-hymen}}
• Tight hymenal ring: the hymen is rigid and the introitus tight. {{cite book|editor=Jonathan S. Berek|others=Emil Novak|title=Berek & Novak's Gynecology|chapter-url=https://books.google.com/books?id=P3erI0J8tEQC&pg=PA459|volume=2007|issue=935|year=2007|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-6805-4|page=459|chapter=Benign Diseases of the Female Reproductive Tract}}

File:Hymen05.jpg

Historically, it was believed that first sexual intercourse was necessarily traumatic to the hymen and always resulted in the hymen being "broken" or torn, causing bleeding. However, research on women in Western populations has found that bleeding during first intercourse does not invariably occur.{{Cite news|url=https://www.tijdschriftvoorseksuologie.nl/media/k2/attachments/loeberZtvsZ32-3.pdf|title=Over het zwaard en de schede; bloedverlies en pijn bij de eerste coïtus Een onderzoek bij vrouwen uit diverse culturen|last=Loeber|first=Olga|date=2008|work=Tijdschrift voor Seksuologie|access-date=2018-09-07|volume=32|pages=129–137|language=nl-nl|archive-date=November 5, 2019|archive-url=https://web.archive.org/web/20191105174514/https://www.tijdschriftvoorseksuologie.nl/media/k2/attachments/loeberZtvsZ32-3.pdf|url-status=dead}} In one cross-cultural study, slightly more than half of all women self-reported bleeding during first intercourse, with significantly different levels of pain and bleeding reported depending on their region of origin.{{Cite journal|last=Amy|first=Jean-Jacques|date=January 2008|title=Certificates of virginity and reconstruction of the hymen|journal=The European Journal of Contraception & Reproductive Health Care|language=en|volume=13|issue=2|pages=111–113|doi=10.1080/13625180802106045|pmid=18465471|s2cid=37484764|issn=1362-5187}} Not all women experience pain, and one study found a correlation between the experience of strong emotions – such as excitement, nervousness, or fear – with experiencing pain during first intercourse.{{Cite journal |doi = 10.1007/BF01542003|title = The experience of pain during women's first sexual intercourse: Cultural mythology about female sexual initiation|year = 1985|last1 = Weis|first1 = David L.|journal = Archives of Sexual Behavior|volume = 14|issue = 5|pages = 421–438|pmid = 4062539|s2cid = 6427129}}

In several studies of adolescent female rape survivors, where patients were examined at a hospital following sexual assault, half or fewer of survivors who had not had penetration previously had any injury to the hymen.{{Cite journal |vauthors=White C, McLean I |date=2006-05-01|title=Adolescent complainants of sexual assault; injury patterns in virgin and non-virgin groups|journal=Journal of Clinical Forensic Medicine|language=en|volume=13|issue=4|pages=172–180|doi=10.1016/j.jcfm.2006.02.006|pmid=16564196|issn=1353-1131|quote=Hymen injury was noted in 40 (50.6%) participants of the virgin group, but only 11 (12.4%) of the non-virgin group}}{{Cite journal|last1=Adams|first1=Joyce A.|last2=Girardin|first2=Barbara|last3=Faugno|first3=Diana|date=May 2000|title=Signs of genital trauma in adolescent rape victims examined acutely|url=https://www.jpagonline.org/article/S1083-3188(00)00015-2/abstract|journal=Journal of Pediatric and Adolescent Gynecology|language=en|volume=13|issue=2|page=88|doi=10.1016/S1083-3188(00)00015-2|pmid=10869972|issn=1083-3188|url-access=subscription}}{{Cite journal|date=2001-11-01|title=Adolescent Sexual Assault: Documentation of Acute Injuries Using Photo-colposcopy|journal=Journal of Pediatric and Adolescent Gynecology|language=en|volume=14|issue=4|pages=175–180|doi=10.1016/S1083-3188(01)00126-7|issn=1083-3188|quote=The incidence of hymenal tears in self-described virgins was higher than in nonvirgins (19% vs. 3%, P .008);|last1=Adams|first1=Joyce A.|last2=Girardin|first2=Barbara|last3=Faugno|first3=Diana|pmid=11748013}} Tears of the hymen occurred in less than a quarter of cases. However, subjects that previously had not had penetrative intercourse were significantly more likely to have sustained injuries to the hymen than subjects who were found to have had penetrative intercourse.

In a study of adolescents who had previously had consensual sex, approximately half showed evidence of trauma to the hymen.{{Cite journal|last1=Adams|first1=Joyce A.|last2=Botash|first2=Ann S.|last3=Kellogg|first3=Nancy|date=March 2004|title=Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse|journal=Archives of Pediatrics & Adolescent Medicine|volume=158|issue=3|pages=280–285|doi=10.1001/archpedi.158.3.280|issn=1072-4710|pmid=14993089|quote=Subjects who admitted having past intercourse still had non disrupted, intact hymens in 52% of cases.|doi-access=free}}{{Cite web|url=https://www.psychologytoday.com/gb/blog/you-it/200806/new-york-times-is-wrong-about-hymens-they-are-not-alone|title=New York Times Is Wrong about Hymens--But They Are Not Alone|website=Psychology Today|language=en-GB|access-date=2018-09-08}} Trauma to the hymen may also occur in adult non-virgins following consensual sex, although it is rare.{{Cite journal|last1=Slaughter|first1=Laura|last2=Brown|first2=Carl R.V.|last3=Crowley|first3=Sharon|last4=Peck|first4=Roxy|date=March 1997|title=Patterns of genital injury in female sexual assault victims|journal=American Journal of Obstetrics and Gynecology|volume=176|issue=3|pages=609–616|doi=10.1016/s0002-9378(97)70556-8|pmid=9077615|issn=0002-9378}} Trauma to the hymen may heal without any visible sign of injury. An observational study of adolescent sexual assault victims found that majority of wounds to the hymen healed without any visible sign of injury having occurred.{{Cite journal|last=Reading|first=Richard|date=2007-12-12|title=Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study|journal=Child: Care, Health and Development|language=en|volume=34|issue=1|pages=137–138|doi=10.1111/j.1365-2214.2007.00818_7.x|issn=0305-1862|quote=Of the girls who sustained 'superficial', 'intermediate,' or 'deep' lacerations, 15 of 18 prepubertal girls had smooth and continuous appearing hymenal rims, whereas 24 of 41 adolescents' hymens had a normal, 'scalloped' appearance and 30 of 34 had no disruption of continuity on healing. The final 'width' of a hymenal rim was dependent on the initial depth of the laceration. No scar tissue formation was observed in either group of girls.}}

Trauma to the hymen is hypothesized to occur as a result of various other behaviors, such as tampon or menstrual cup use, pelvic examinations with a speculum, masturbation, gymnastics, or horseback riding, although the true prevalence of trauma as a result of these activities is unclear.{{Cite journal|date=1998-06-08|title=Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature|journal=Forensic Science International|language=en|volume=94|issue=1–2|pages=147–153|doi=10.1016/S0379-0738(98)00053-X|issn=0379-0738|last1=Goodyear-Smith|first1=Felicity A.|last2=Laidlaw|first2=Tannis M.|pmid=9670493}}{{Cite journal|date=1994-07-01|title=Hymenal findings in adolescent women: Impact of tampon use and consensual sexual activity|journal=The Journal of Pediatrics|language=en|volume=125|issue=1|pages=153–160|doi=10.1016/S0022-3476(94)70144-X|issn=0022-3476|quote=Contrary to the popular belief that transections of the hymen are associated with gymnastics, horseback riding, and other vigorous sports, we found no relation between sports or gymnastics and hymenal changes. There was also no relation to prior gynecologic examination.|last1=Emans|first1=S.Jean|last2=Woods|first2=Elizabeth R.|last3=Allred|first3=Elizabeth N.|last4=Grace|first4=Estherann|pmid=8021768}}

{{further|Virginity test}}

The hymen is often attributed important cultural significance in certain communities because of its association with a woman's virginity. In those cultures, an intact hymen is highly valued at marriage in the belief that this is a proof of virginity.{{cite news|url=https://www.reuters.com/article/us-muslimwomen-europe-virginity-idUSL2532025120070430?pageNumber=2&sp=true |title=Muslim women in France regain virginity in clinics |work=Reuters |quote='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'. | date=April 30, 2007}} Some women undergo hymenorrhaphy to restore their hymen for this reason.{{Cite news|last1=Sciolino|first1=Elaine|last2=Mekhennet|first2=Souad|date=June 11, 2008|title=In Europe, Debate Over Islam and Virginity|work=The New York Times|url=https://www.nytimes.com/2008/06/11/world/europe/11virgin.html?_r=1&scp=1&sq=hymen&st=nyt&oref=slogin|access-date=2008-06-13|quote='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.'}} In October 2018, the UN Human Rights Council, UN Women and the World Health Organization (WHO) stated that virginity testing must end as "it is a painful, humiliating and traumatic practice, constituting violence against women".{{Cite web|url=https://www.who.int/news-room/detail/17-10-2018-united-nations-agencies-call-for-ban-on-virginity-testing|title=United Nations agencies call for ban on virginity testing|date=17 October 2018|publisher=World Health Organization|access-date=22 October 2018}}

Some traditional Christian theological interpretations state that it is intended by God for the husband to be the one to break his wife's hymen, and that the bleeding the hymen, believed occur during first intercourse (but see above), is a blood covenant that seals the bond of holy matrimony between husband and wife (cf. consummation).{{cite book |last1=Gentry |first1=Harold |title=Intimacy |date=21 January 2021 |publisher=WestBow Press |isbn=978-1-6642-1232-9 |language=en}}

In the 16th and 17th centuries, medical researchers mistakenly saw the presence or absence of the hymen as founding evidence of physical diseases such as "womb-fury", i.e., (female) hysteria. If not cured, womb-fury would, according to doctors practicing at the time, result in death.{{cite journal | last1 = Berrios | first1 = GE | last2 = Rivière | first2 = L | year = 2006 | title = Madness from the womb | journal = History of Psychiatry | volume = 17 | issue = 66 Pt 2 | pages = 223–35 | doi=10.1177/0957154x06065699| pmid = 17146991 | s2cid = 148179899 | url = https://hal.science/hal-00570861 | hdl = 2262/51593 | hdl-access = free }}The linkage between the hymen and social elements of control has been taken up in Marie Loughlin's book [https://archive.org/details/hymeneuticsinter00loug/page/43 Hymeneutics: Interpreting Virginity on the Early Modern Stage] published in 1997

Due to similar reproductive system development, many mammals have hymens, including chimpanzees, elephants, manatees, whales, horses and llamas.{{Cite book|last=Blank |first=Hanne|author-link=Hanne Blank|url=https://books.google.com/books?id=shq1AAAAIAAJ&q=toothed+whales | title=Virgin: The Untouched History |year=2007|publisher=Bloomsbury Publishing |page=23 |isbn=978-1-59691-010-2 |access-date=2013-11-09}}{{Cite book|last=Blackledge |first=Catherine |title=The Story of V |year=2004 |publisher=Rutgers University Press |quote=Hymens, or vaginal closure membranes or vaginal constrictions, as they are often referred to, are found in a number of mammals, including llamas, ... | url=https://archive.org/details/storyofv00cath |url-access=registration |isbn=978-0-8135-3455-8 }}

• Artificial hymen

{{Reflist|2}}

{{commons category|Hymen}}

{{wikiquote}}

{{Prone to spam|date=September 2011}}

• [http://www.scarleteen.com/article/politics/magical_cups_bloody_brides_virginity_in_context Magical Cups and Bloody Brides]—the historical context of virginity
• [http://www.scarleteen.com/article/politics/20_questions_about_virginity_scarleteen_interviews_hanne_blank 20 Questions About Virginity]—Interview with Hanne Blank, author of Virgin: The Untouched History. Discusses relationship between hymen and concept of virginity.
• [https://web.archive.org/web/20170923145159/http://www.htdiary.com/how-to-put-a-tampon-in-painlessly/ Putting tampon in painlessly] Radiology (US – ultrasound) of Hydrocolpos
• [http://www.aafp.org/afp/2001/0301/p883.html Evaluating the Child for Sexual Abuse] at the American Family Physician
• [http://www.scarleteen.com/article/body/my_corona_the_anatomy_formerly_known_as_the_hymen_the_myths_that_surround_it My Corona: The Anatomy Formerly Known as the Hymen & the Myths That Surround It] {{Webarchive|url=https://web.archive.org/web/20130117005752/http://www.scarleteen.com/article/body/my_corona_the_anatomy_formerly_known_as_the_hymen_the_myths_that_surround_it |date=January 17, 2013 }}, Scarleteen, Sex education for the real world
• [http://www.psychologytoday.com/blog/you-it/200806/new-york-times-is-wrong-about-the-hymen-they-are-not-alone The Hymen Myth]
• [http://www.rfsu.se/en/Engelska/About-rfsu/Resources/Publications/Vagnial-Corona/ Vaginal Corona]. {{Webarchive|url=https://web.archive.org/web/20170110225148/http://www.rfsu.se/en/Engelska/About-rfsu/Resources/Publications/Vagnial-Corona/ |date=January 10, 2017 }}.
• [https://www.bedsider.org/features/962-5-myths-about-virginity-busted 5 Myths about Virginity, Busted]

{{Female reproductive system}}

{{Authority control}}

Category:Sexual abstinence

Category:Vagina

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