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do I have 2 hymens??
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An_244147 posted:
Hi there,

I received a hymenectomy almost three months ago. (I had a microperforate hymen, it almost completely covered my vaginal opening.) They estimated a recovery time of 2 weeks, even though I was pretty much entirely pain-free as soon as I got home (and that's WITHOUT pain meds). I thought I was as good as gold.

Anyway, I soon found that I can't insert anything bigger than my finger. I've tried bigger objects, softer objects, bullet vibrators, anything. (LOTS of lube, even sexual arousal.) I've been working at it for weeks and haven't made any progress - I don't even think progress is possible! All I get is an enormous amount of pain. My obgyn couldn't even examine me properly at my 6-week checkup. She couldn't even insert her finger.

There's plenty of room to move around INSIDE my vagina, it's just the ring around the vaginal opening. It's not like a muscle, it's like a round wall. It's so rigid, it won't give even a little slack. It seems to be something like a hymen.... but I just had my hymen removed!!

Do I have 2 hymens, an outer covering and an inner? Did my obgyn just do the surgery wrong? Is it another stupid medical condition?

Better yet, has anybody else experienced this, or know anything about it?
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Jane Harrison Hohner, RN, RNP responded:
Dear An: The incidence of imperforate hymen is between .1 and .05 percent. Multiple literature searches at the National Library of Medicine were done to identify problems after hymenectomy. The best citation I could find was a very thorough study on variations in hymenal anatomy. As you can note there is actually something like a "sleeve hymen":

J Pediatr Adolesc Gynecol. 2002 Feb;15(1):27-35.
Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings.
Heger AH, Ticson L, Guerra L, Lister J, Zaragoza T, McConnell G, Morahan M.

Department of Pediatrics, University of Southern California, Keck School of Medicine, California, Los Angeles 90033, USA. aheger@aol.com

STUDY OBJECTIVE:

To review all existing studies of genital anatomy in girls selected for nonabuse, clarify terminology used to describe hymenal morphology and nonspecific findings, and test consensus terminology in the reevaluation of hymenal morphology and nonspecific findings in 147 premenarchal girls selected for nonabuse.
METHODS:

Over six months, the authors identified and evaluated 147 premenarchal girls without history of sexual abuse who were referred for gynecological examination. Parents and patients were screened for possible abuse or significant past medical or behavioral history, and each girl was interviewed and then received a complete examination including a genital examination documented by colposcopy with both 35 mm camera and video capabilities. Using established terminology(1) each case was then independently reviewed and hymenal morphology and nonspecific findings documented.
RESULTS:

The study population consisted of 147 premenarchal girls; 76.9% were Hispanic, 12.3% African-American, and 10.3% Caucasian. Subjects had a mean age of 63 months ( /minus sign 38). Hymenal configurations included: annular (concentric) 53%, crescentic (posterior rim) 29.2%, sleeve-like (redundant) 14.9%, septate 2%, and other (imperforate, cribriform) < 1%. Nonspecific findings included peri-hymenal bands, 91.8%; longitudinal intravaginal ridges, 93.8%; hymenal tags, 3.4%; hymenal bumps/mounds, 34%; linea vestibularis, 19%; ventral hymenal cleft/notch at 12 o'clock in 79% of annular or redundant hymens; ventral cleft/notch not at 12 o'clock, 19%; failure of midline fusion, 0.6%; hymenal opening size > 4 mm, 30.6%; erythema, 48.9%; change in vascularity, 37.4%; labial adhesions, 15.6%; posterior hymenal notch/cleft (partial), 18.3%; posterior notch/cleft (complete), 0%; posterior hymenal concavity or angularity, 29.5%. In addition, each case was assessed for the presence of a thickened (45.5%) or irregular (51.7%) and narrowed (22.4%) hymenal edge. Each case was also reviewed for exposed intravaginal anatomy (93%).
CONCLUSIONS:

The authors concluded that improved techniques and photo documentation have provided examiners with a better understanding of hymenal morphology and that nonspecific genital findings are commonly found in a population of girls selected for nonabuse. A thorough understanding of normal studies and a consistent application of established terminology can prevent the misinterpretation of nonspecific or congenital findings as posttraumatic changes.

An, it may be that your specific anatomy does involve one of these normal structures which can restrict access through the vaginal opening. As you have noted, an important condition to rule out is vaginismus (involuntary contraction of the muscles around the vaginal opening). I did have a patient who had a hymenectomy and went on to develop vaginismus (this resolved and she was married and gave birth vaginally).

It sounds like you have been doing everything right in terms of trying to dilate the opening. If your GYN has no explanation perhaps you might want to seek a second opinion from a GYN with special expertise in vulvar pain.Such GYNs tend to see all the uncommon types of vulvar conditions.

Yours,
Jane


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