Synonyms: Hymenoplasty, hymen reconstruction surgery, hymenorrhaphy, hymen surgery, revirgination operation, hymen repair surgery, hymen rejuvenation etc are different terms used in hymen related operations.

What is hymen: The hymen is the mucous membrane that partially closes the entrance to the vagina, named after the god of marriage in classical Greek mythology, Hymenaios. It is a thin membranous rim of tissue which encircles the vaginal orifice and has an opening in the centre for menstrual discharge.

Myths about intact hymen
Unfortunately, in some cultures, an intact hymen is held as a sign of virginity and has become symbolic of family honour. Blood stained bed-sheets are expected on nuptial nights and they are vibrantly portrayed in society to represent bleeding from ruptured hymen on defloration. Deviation from this religious conviction has harmful repercussion on the woman which ranges from shame to ‘honour killing.’ Young women sometimes go to great lengths to get their hymen repaired.

Medical facts about hymen
According to the available medical literature the hymen serves no known biological function in adults. The available medical literature says that repair of hymen has no direct medical benefits. Various other known facts are:
          Rupture of hymen is of no medical consequence. The absence of hymen and bleeding on first night is not a sign of lost virginity.
          Hymen was intact in as many as 52% of adolescent girls who admitted to have had sexual intercourse.
          The hymen is a relatively bloodless membrane and it is unlikely to bleed significantly even if it is torn. Violent penile penetration results in laceration of the vaginal wall, that appears to be responsible for ‘‘blood-stained bedsheets.’’
          The hymen may not be lacerated even with repeated coitus (wide or elastic hymen).
          In fact, many cases of pregnancy have been reported in women in whom the hymen has not have been ruptured.
          Some women are even born without a hymen

Promoting the concept of intact hymen as a sign of virginity is nothing but perpetuation of myth.

Social and legal aspects of hymen repair:
In many cultures like Muslim and Norwegian ethnic background the chastity of the woman before marriage a key requirement. If not proven to be virgin, she may be ostracized, humiliated and sometimes killed.
The status of hymenoplasty in different parts of the world is controversial and debatable. It is illegal in most Arab countries.  In United States of America, the western society and in India hymenoplasty is legal.
Operative reconstruction of the hymen is a relatively simple procedure. The surgical repair of hymen in most cases solves the problem for these unhappy women and sometimes save lives. It is thus definitely acceptable in certain circumstances, when the woman would otherwise suffer shame, dishonour and humiliation.

Why would somebody seek reconstruction of torn hymen?

Hymen repair surgery is undertaken to tighten and restore the hymen to a more intact, virgin-like state. It is usually demanded for cultural or other personal reasons (for example before marriage). Women who desire to restore an intact, tight hymen ring and experience vaginal bleeding and pain with the "first" sexual intercourse usually go for hymenoplasty. Various reasons for which Hymenoplasty is sought are:
  • Hymen injury: Hymen tear may be caused by sexual intercourse, sports activities, rigorous physical exercise, masturbation, surgical injury, bicycling, gymnastics and horse riding or dancing. Hymen may rupture even by the use of tampon.
  • Cultural or religious reasons: In some cultures, a woman is physically inspected to assure an intact hymen to confirm her virginity.
  • After rape, incest, and sexual abuse: Some women view this as a way to restore their physical and psychological integrity.
  • For Revirginization: Women who want to give their partner a unique gift.

What is Hymenoplasty?
Hymenoplasty is the surgical restoration of the hymen.

The term Hymenoplasty is generally used for:
(1)  Repair of a tear in the hymen.
(2)  Restoration of a hymen ring which has been mutilated due to multiple sexual intercourse.
(3)  Reconstruction of a new hymen membrane using a flap of vaginal mucosa.                                                                                                                 

   Hymen repair is performed under local anaesthesia as an OPD procedure. It may take about 1 – 2 hours. The torn edges of remnant hymen are trimmed and stitched with fine absorbable sutures. A patch of local vaginal tissue may be used to reconstruct the hymen. The hymenoplasty procedure is surgically tailoring the hymenal remnants so that they can be sutured together with absorbable sutures to narrow the vaginal orifice. Hymen repair is done leaving a narrow orifice in the centre, so that menstrual blood may come out. Sometimes a gelatine capsule filled with artificial blood like substance is incorporated in the repaired hymen. During subsequent sexual intercourse the repaired hymen is torn and the gelatine capsule ruptures resulting in typical pain and bleeding as desired for cultural reasons. The procedure can be repeated as many times as desired.

When should Hymenoplasty be done?
The procedure can be done any time after the hymen has ruptured. It is preferable to fix the surgery few days after the menstrual period is over and about a month before marriage.

Preoperative preparation:  A preoperative consultation and examination is required to discuss and evaluate the patient’s needs and expectations.  Local infection if any will require prior treatment. Patients are counselled about various options, the surgical procedure, possible risks and postoperative care. 
                                                                                                                        Postoperative care: The patient can return home after the procedure. Patients are advised to wear a pad, similar to a sanitary pad for 2 – 3 days postoperatively. Irrigation of wound with normal saline is advised 2-3 times daily for 5-7 days.  Patients are prescribed analgesics and antibiotics for about 7-10 days. Swelling may be noticeable after the first day and will slowly subside over a period of 2 weeks. Sexual intercourse and strenuous activities like horse riding and sports should be avoided for at least 4-6 weeks. Patients should also avoid douching and tampons for 4- 6 weeks.

Complications: Hymenoplasty is a relatively safe surgery. Some patients may get postoperative bleeding for a few days. Local infections may require antibiotics for 1-2 weeks. Stricture occurs very rarely due to overcorrection. Patients should come for a follow up if required.  

In conclusion, Hymen repair is ethically and culturally controversial, but is seen as an acceptable surgery in many countries.