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The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina.[1][2] The hymen does not seem to have a specific physiological function and has few, if any, nerve endings.[3]

In children, a common appearance of the hymen is crescent-shaped, although many shapes are possible. During puberty, estrogen causes the hymen to change in appearance[3] and become very elastic.[4][5] Normal variations of the post-pubertal hymen range from thin and stretchy to thick and somewhat rigid; or it may instead be completely absent.[1]

The hymen may rip or tear the first time penetrative intercourse happens, which may cause temporary bleeding or slight discomfort, but sources differ on how common tearing and bleeding after first intercourse is.[6][7][8] The state of the hymen is not a reliable indicator of virginity,[2][9] although it continues to be considered so in certain cultures, and virginity testing may be done. Minor injuries to the hymen may heal[10] without visible signs of previous injury. A torn hymen may be surgically restored in a procedure called hymenorrhaphy.

External genital organs of female. The labia minora have been drawn apart.
Latinhymen vaginae
MeSHD006924 [44]
TAA09.1.04.008 [45]
FMA20005 [46]
Anatomical terminology

Development and histology

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.[11]

The hymen has no nerve 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.[12] Their hymenal opening tends to be annular (circumferential).[13]

Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age.[14] During puberty, estrogen causes the hymen to become very elastic and fimbriated.[4][5]

The hymen can stretch or tear as a result of various behaviors, by tampon or menstrual cup use, pelvic examinations with a speculum, regular physical activity, sexual intercourse,[1] insertion of multiple fingers or items into the vagina, and activities such as gymnastics (doing 'the splits'), or horseback riding.[6] Remnants of the hymen are called carunculae myrtiformes.[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.[12] 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.[2]

Anatomic variations

Various types of hymen (the dark areas represent the vaginal opening)

Various types of hymen (the dark areas represent the vaginal opening)

Normal variations of the hymen range from thin and stretchy to thick and somewhat rigid; or it may also be completely absent.[1][12] An imperforate hymen occurs in 1-2 out of 1,000 infants.[15][16] The only variation that may require medical intervention is the imperforate hymen, which either completely prevents the 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.

Prepubescent girls' 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.[13] 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.[1]

Variations of the female reproductive tract can result from agenesis or hypoplasia, canalization defects, lateral fusion and failure of resorption, resulting in various complications.[14]

  • Imperforate:[17][18] 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 perforations.

  • Septate: the hymenal opening has one or more bands of tissue extending across the opening.


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 consensual intercourse does not always happen or is less common than not bleeding.[7][8][19] 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.[20][19]

In several studies of adolescent female rape victims, where patients were examined at a hospital following sexual assault, half or fewer of virgin victims had any injury to the hymen.[21][22][23] Tears of the hymen occurred in less than a quarter of cases.[23] However, virgins were significantly more likely to have injuries to the hymen than non-virgins.[21][23]

In a study of adolescents who had previously had consensual sex, approximately half showed evidence of trauma to the hymen.[24][25] Trauma to the hymen may also occur in adult non-virgins following consensual sex, although it is rare.[26] Trauma to the hymen may heal without any visible sign of injury.[21][25][1] 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.[27]

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.[6][28][29]

Cultural significance

The hymen is often attributed important cultural significance in certain communities because of its association with a woman's virginity.[6] In those cultures, an intact hymen is highly valued at marriage in the belief that this is a proof of virginity.[6][30][31] Some women undergo hymenorrhaphy to restore their hymen for this reason.[31]

In October 2018, the UN Human Rights, 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.[32]

Womb fury

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.[33][34]

Other animals

Due to similar reproductive system development, many mammals have hymens, including chimpanzees, elephants, manatees, whales, horses and llamas.[35][36]

See also

  • Artificial hymen


Citation Linkthe-eye.euHeger, Astrid H.; Emans, S. Jean, eds. (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (PDF) (2nd ed.). New York: Oxford University Press. pp. 61–65. ISBN 9780195074253.
Oct 1, 2019, 4:17 AM
Citation Linkopenlibrary.orgPerlman, Sally E.; Nakajyma, Steven T.; Hertweck, S. Paige (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon. p. 131. ISBN 978-1-84214-199-1.
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Citation Linkbooks.google.com.phBlank, Hanne (2008). Virgin: The Untouched History. Bloomsbury USA. p. 35. ISBN 978-1-59691-011-9.
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Citation Linkportal.issn.orgLahoti, Sheela L.; McClain, Natalie; Girardet, Rebecca; McNeese, Margaret; Cheung, Kim (March 1, 2001). "Evaluating the Child for Sexual Abuse". American Family Physician. 63 (5). ISSN 0002-838X.
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Citation Linkthe-eye.euHeger, Astrid H.; Emans, S. Jean, eds. (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (PDF) (2nd ed.). New York: Oxford University Press. p. 122. ISBN 9780195074253.
Oct 1, 2019, 4:17 AM
Citation Linkwww.soc.ucsb.edu"The Hymen". University of California, Santa Barbara. Retrieved February 9, 2009. The hymen oftentimes, though not always, rips or tears the first time a female engages in penetrative intercourse, which may cause some temporary bleeding and slight discomfort.
Oct 1, 2019, 4:17 AM
Citation Linkportal.issn.orgRogers, Deborah J; Stark, Margaret (August 8, 1998). "The hymen is not necessarily torn after sexual intercourse". BMJ : British Medical Journal. 317 (7155): 414. doi:10.1136/bmj.317.7155.414. ISSN 0959-8138. PMC 1113684. PMID 9694770.
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Citation Link//www.ncbi.nlm.nih.gov/pubmed/10037658Emma Curtis, Camille San Lazaro (February 27, 1999). "Appearance of the hymen in adolescents is not well documented". BMJ : British Medical Journal. 318 (7183): 605. doi:10.1136/bmj.318.7183.605. PMC 1115047. PMID 10037658. We agree with Rogers and Stark that so called rupture and bleeding of the hymen is not to be routinely expected after first sexual intercourse.
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Citation Linkopenlibrary.orgKnight, Bernard (1997). Simpson's Forensic Medicine (11th ed.). London: Arnold. p. 114. ISBN 978-0-7131-4452-9.
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Citation Linkportal.issn.orgHegazy, Abdelmonem; Al-Rukban, Mohammed (January 1, 2012). "Hymen: Facts and conceptions". TheHealth. 3 (4). ISSN 2219-8083. Possible explanations for the lack of genital trauma include... acute injuries occur but heal completely.
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Citation Link//doi.org/10.1007%2F978-3-540-85602-3Healey, Andrew (2012). "Embryology of the female reproductive tract". In Mann, Gurdeep S.; Blair, Joanne C.; Garden, Anne S. (eds.). Imaging of Gynecological Disorders in Infants and Children. Medical Radiology. Springer. pp. 21–30. doi:10.1007/978-3-540-85602-3. ISBN 978-3-540-85602-3.
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Citation Linkopenlibrary.orgMcCann, 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.
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Citation Linkopenlibrary.orgHeger, Astrid; Emans, S. Jean; Muram, David (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (Second ed.). Oxford University Press. p. 116. ISBN 978-0-19-507425-3.
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Citation Linkemedicine.medscape.com"Imperforate Hymen". WebMD. Retrieved February 2, 2009. 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.
Oct 1, 2019, 4:17 AM
Citation Linkbooks.google.comCallahan, Tamara L.; Caughey, Aaron B. (2009). Blueprints Obstetrics and Gynecology. Lippincott Williams & Wilkins. ISBN 9780781782494.
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Citation Linkportal.issn.orgLardenoije, Céline; Aardenburg, Robert; Mertens, Helen (May 26, 2009). "Imperforate hymen: a cause of abdominal pain in female adolescents". BMJ Case Reports. 2009: bcr0820080722. doi:10.1136/bcr.08.2008.0722. ISSN 1757-790X. PMC 3029536. PMID 21686660.
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Citation Linkbooks.google.comSteinberg, Avraham; Rosner, Fred (2003). Encyclopedia of Jewish Medical Ethics. ISBN 978-1-58330-592-8. 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 ...
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Citation Linkbooks.google.comDeCherney, Alan H.; Pernoll, Martin L.; Nathan, Lauren (2002). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 602. ISBN 978-0-8385-1401-6. Imperforate hymen represents a persistent portion of the urogenital membrane ... It is one of the most common obstructive lesions of the female genital tract. ...
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Citation Linkwww.tijdschriftvoorseksuologie.nlLoeber, Olga (2008). "Over het zwaard en de schede; bloedverlies en pijn bij de eerste coïtus Een onderzoek bij vrouwen uit diverse culturen" (PDF). Tijdschrift voor Seksuologie (in Dutch). 32. pp. 129–137. Retrieved September 7, 2018.
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Citation Linkportal.issn.orgAmy, Jean-Jacques (January 2008). "Certificates of virginity and reconstruction of the hymen". The European Journal of Contraception & Reproductive Health Care. 13 (2): 111–113. doi:10.1080/13625180802106045. ISSN 1362-5187. PMID 18465471.
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