Overview of the surgery:
Hymenoplasty is also known as hymenorrhaphy, hymen reconstruction, hymenal refashioning or revirgination – is the surgical procedure used to repair the hymen.
The hymen is a thin, annular fold of mucosa consisting of epithelium and connective tissue, relatively few blood vessels, and a small number of nerves, some of which are not part of the A symphathetic nervous system. The hymen is usually ruptured or torn and bleeds during a woman’s first sexual intercourse or various types of trauma. A ruptured hymen never heals by itself.
Women who have a hymenal cleft from sexual intercourse, trauma, vigorous sporting activities, and surgical procedures are candidates for hymenoplasty.
Women who have had their hymen repaired multiple time, with history of vaginal or induced delivery, women with medical conditions like venereal disease, vaginal infection and diabetes are not the candidates for this type of surgery.
Preparation before surgery
- Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
- Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
- You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
- Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.
- Do not have sexual intercourse the night before the surgery.
During the procedure:
The patient is placed in the dorsal lithotomy position. The perineal area is prepared with iodophor and draped. Local infiltration is preferred for this operation. The surgeon use local anesthesia. The labium minus margin is sutured to the labium majus lateral border to fully expose and hymen. Both edges of the hymenal cleft are injected with local anesthesia. Hymenal Tear or clefts can be repaired by approximation. The method for approximation involves creating two defects on lateral surface of the cleft edge and on the medial surface of the other edge. The epithelium will be removed approximately 2-3 mm wide. The edges are approximated with 6-0 absorbable interrupted sutures in the mucosa.
When the tissue defect between the edges of the hymenal cleft is wider than 2mm or when the edge of the hymenal left is less than 2mm thick approximation alone may not help and it needs a local transposition flap.
Transposition flap technique, two defects are created one on the internal surface of one cleft edge and one of the lateral area of vaginal vestibular mucosa. After the new flap defect for the medial flap is closed , the flap is rotated to cover the medial defect of one cleft edge. The proximal part of the superior margin of the flap is sutured to the defect margin of the other cleft edge. The lateral flap is rotated to cover the lateral defect on the other cleft edge, and the proximal part of its superior margin is sutured to the defect of the contralateral cleft edge. The middle parts of the superior margin of the two flaps between the two cleft edges are sutured to each other. The new flap defect for the lateral flap is closed directly. Triangular area of mucosa at the tip of the new flap defects is excised to prevent dog-ears.
In cases of multiple clefts, surgeon will usually repair only two or three clefts to prevent high wound tension.
Risks And Complications:
Hymenoplasty complications are minor and can be managed easily. Some patients may develop odynuria but this may resolve after the wound heals. Bleeding, severe postoperative pain, infection, uroschesis, rectal fistula, and retention of the menses did not occur most cases.
No dressing is required. Patients are instructed to softly clean the perineal region, especially the vaginal introitus with iodophor after urination and defecation. Patient can take a baht on the second day postoperatively. Patients need not to perform vigorous exercise, squatting, straddle movements and riding activities. Follow up consultation 7 days after surgery.