The-Clitoris.com: Hymen: The Mysterious Hymen Revealed

Click On Image To See Entire Vulva. The complete photograph
and annotations can be seen by clicking here.

The hymen is a layer of tissue that partially conceals the vaginal orifice of some girls and women. It appears many if not most of us are under the impression the hymen is located within the vagina. It is, as the photographs and illustrations on this page reveal, part of the vulva, external genital organs. The hymen is also referred to as a girl's "cherry" or maidenhead.

During the early stages of fetal development there is no external opening into the vagina. The layer of tissue that conceals the vagina at this time usually divides incompletely prior to birth, forming the hymen. The size and shape of the resulting opening, or openings, varies greatly from one girl to the next. There are girls who do not have a hymen at birth, as the tissue divides completely while they are still in the womb.* The formation of this opening sometimes does not occur, resulting in an imperforate hymen. A doctor should examine an infant girl's vulva soon after birth to ensure this opening exists, as should perhaps her parents, because if menses is not permitted to flow freely from the body, pain and cramping may occur during menarche, a girl's first menstrual period. The tissues of the vulva are generally thin and relatively delicate during childhood, as they haven't been influenced by the increased hormone levels that are present during puberty and the reproductive years; at birth the maternal hormones have had a visible influence on the vulva.

Any activity that places tension on the vulvar tissues may stretch or tear the hymen. Some girls may tear their hymen while inserting a tampon for the first time, as indicated in the medical abstract presented below. It is commonly stated that girls and teens may tear or otherwise dilate their hymen while engaging in physical activities such as sports, horseback riding, and while masturbating, but there is no medical evidence to support this claim at this time, but this doesn't necessarily rule out the possibility, as very little research as been completed on the subject. A survey on this website indicates 49% of girls under the age of 15, and 73% under the age of 18, have inserted one or more fingers into their vagina while exploring their body, which may influence the appearance of their hymen. At the same age, 36% and 62% respectively, have stimulated their vagina with their fingers to produce sexual pleasure, which may also influence the appearance of their hymen.

"The elasticity of the hymen varies from woman to woman. Typically, though, with the introduction of a penis, fingers, or sexual devices, the opening stretches and becomes larger. Contrary to popular belief that the hymen can be ruptured by gymnastics, horseback riding, and other vigorous sports, no relation between sports and hymenal changes was found in a study of three hundred females[6]. There is no medical definition of virginity based on the size of the opening of the hymen. The hymen can, as I said earlier, change in various ways, some occurring naturally during the first years of life[3]." [Page 33]

"In 1994, a large study of three hundred young women showed that the median size of the opening in the hymen was slightly bigger in those who used tampons (1.5 cm or 5/8 inch)*** compared with those who used pads[6]. But once again, it wasn't known what size opening each woman had before she ever used a tampon—so there's no way to know if the tampon enlarged the opening or not. [Page 90]

From: The V Book: A Doctor's Guide to Complete Vulvovaginal Health by Elizabeth G. Stewart, M.D. Copyright 2002.

Note: Conclusions presented in the first reference she cited have subsequently been refuted by other researchers, at least in regard to the potential consequences of tampon use. Reference [1] also presents evidence to support the belief that using tampons may alter the hymen. Injuries to the hymen could potentially be avoided if a young woman is familiar with her vulva, vagina, and proper tampon insertion techniques prior to using tampons.

This close-up photo reveals a hymen that is very pronounced, and there are
visible tears or healed surgical incisions. Considerable hymeneal tissue
remains, which may cause vaginal penetration to be painful.

Virginity is a spiritual attribute, not a physical one, the presence or absence of a hymen in no way indicates a girl's virginal state. No one can determine for certain, based on physical examination alone, whether a woman or teen has engaged in vaginal intercourse. Only around 50% (1 out of 2) experience bleeding the first time they participate in vaginal intercourse, so blood stained bed linen is not a reliable indicator of prior virginity. The hymen of some women is injured and bleeds on more than one occasion; over 20% (1 out of 5) report they experienced bleeding more than once. There are also hymen that are elastic enough to permit a penis to enter without tearing, or tear only partially. A medical abstract presented below indicates 52% of non-virgin adolescents in one study had "nondisrupted, intact hymens."

The hymen does not magically disappear when something is inserted into the vagina, it will only stretch or tear sufficiently to permit entry of whatever is being inserted. If for example, a teen inserts two fingers into her vagina while masturbating, her hymen may still tear when she has vaginal intercourse for the first time, as the average penis is likely larger than her two fingers, and perhaps much less gentle. A woman who has experienced vaginal intercourse may still have hymeneal tissue present, and this remaining tissue can be the cause of pain during intercourse. If a woman's current partner has a larger penis than her prior partners, or a couple tries a new technique or position during intercourse, her hymen may tear again, or for the first time. When doctors examine preadolescent and adolescent girls for evidence of sexual abuse, they look for injuries to the hymen; the hymen may still be intact except for a single tear. Remnants of the hymen are often present until a woman delivers a baby vaginally.

A prominent collar/cuff-like hymen **

More photographs of the hymen can be seen in the medical article addressing childhood sex abuse linked to below:

http://www.aafp.org/afp/20010301/883.html

Medical Abstracts

Medical Abstract:

Originally Published: March 2004

Objective: To compare the morphology of the hymen in adolescent girls who have and have not had sexual intercourse involving penile-vaginal penetration.

Subjects: Female patients aged 13 to 19 years, recruited from an urban adolescent medicine practice.

Methods: Subjects were interviewed in private after completing detailed questionnaires and then underwent a physical examination. External genital inspections were performed using a colposcope with an attached 35-mm camera to document the appearance of the hymen. The presence of notches or clefts was recorded during the examination, and photographs taken at x10 magnification were used to take measurements of the width of the posterior hymenal rim.

Results: Posterior hymenal notches and clefts were more common among girls admitting past intercourse (13/27 [48%]) than in girls who denied intercourse (2/58 [3%]; P = .001), but the mean width of the posterior hymenal rim was not significantly different between the 2 groups (2.5 mm vs 3.0 mm; P = .11). Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion.

Conclusions: Deep notches or complete clefts in the posterior rim of the hymen were rare in girls who denied intercourse. Subjects who admitted past intercourse still had nondisrupted, intact hymens in 52% of cases. [1]

PDF file available online includes additional images of hymen.

Medical Abstract:

Originally Published: January 2004

Many clinicians expect that a history of penile-vaginal penetration will be associated with examination findings of penetrating trauma. A retrospective case review of 36 pregnant adolescent girls who presented for sexual abuse evaluations was performed to determine the presence or absence of genital findings that indicate penetrating trauma. Historical information and photograph documentation were reviewed. Only 2 of the 36 subjects had definitive findings of penetration. This study may be helpful in assisting clinicians and juries to understand that vaginal penetration generally does not result in observable evidence of healed injury to perihymenal tissues. [5]

Medical Abstract:

Originally Published: February 2002

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 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 (+/- 38) [5 1/4 years]. 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. [2]

Medical Abstract:

Originally Published: June 1998

Since tampon availability has become ubiquitous, several authors have opined about their effect on the virginal hymen, but only one paper has scientifically addressed the subject of tampon use and clefts in the hymens of never-sexually-active adolescent girls. It naturally has become an authority used by the courts. The Emans et al. (1994) study asserts that 'for physicians testifying in court about sexual assault cases, complete clefts in adolescents cannot be attributed to prior tampon use'. On closer inspection, however, it appears that the authors have interpreted their statistical finding using a strict scientific convention (chi 2, P = 0.06 as not having statistical significance) that may mislead in a clinical or legal situation. Indeed, there is a definite possibility that tampon use compared to not having used tampons in their never-sexually-active sample was associated with an increased percentage of complete hymenal clefts (14% vs. 6%; P = 0.06). Nevertheless, clefts were found in both the sexually active and the never-active groups: 20 of their 200 never-sexually-active subjects possessed complete hymenal clefts, as did only 84 of their 100 sexually active subjects. Caution should be used by all physicians asked to testify in courts regarding possible causes of a hymenal cleft. [4]

Medical Abstract:

Originally Published: July 1994

We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women. [6]

Medical Abstract:

Originally Published: March 1992

The recent increase in requests for genital examinations in girls who may have been sexually abused has necessitated detailed information not previously available on normal anatomy of the prepubertal girl. This study was undertaken to document the genital anatomy of 211 girls between the ages of 1 month and 7 years who presented for well child care or nongynecologic complaints and who had no history of sexual abuse. Each child's genitalia was examined and photographed, with findings reported reflecting those observed photographically. The study population consisted of 36% blacks, 33.6% white non-Hispanics, 29.9% Hispanics, and 0.5% Asians. Subjects had a mean age of 21 ± 20.6 (SD) months. Extensive labial agglutination [fusion] sufficient to obscure the hymen was noted in 5% (10/211) and partial agglutination in an additional 17% (35/211). A significant difference was noted in hymenal configuration by age, with a fimbriated [fringed] hymen the most common type (46%) in infants aged 12 months or younger and a crescentic hymen the most common (51%) in girls older than 24 months (P le .001). No significant difference was noted in hymen configuration by race. Hymenal bumps (mounds) were observed in 7%, hymenal tags in 3%, vestibular bands in 98%, longitudinal intravaginal ridges in 25%, and external ridges in 15% of subjects in whom the anatomy under study could be visualized. Hymenal notches (clefts) occurred superiorly [above] and laterally [side] on the hymenal rim but none were found inferiorly [below] on the lower half of the hymen. A narrow rounded hymenal ring with a transection was observed in only 1 (0.5%) of 201 subjects and was not considered a normal finding. Transverse hymenal openings measured only in annular and crescentic hymens had a mean which ranged from 2.5 ± 0.8 to 3.6 ± 1.2 mm and varied significantly with age (P = .003). Normal hymenal findings must be recognized by medical professionals so that posttraumatic findings can be diagnosed appropriately. [3]

Additional Images

Click On Images Shown Below To See Them Full Size

From the book "Masters and Johnson on Sex and Human Loving" Page 34.
Copyright 1982,1985, 1986, By William H. Masters, M.D.,
Virginia E. Johnson, and Robert C. Kolodny

From the book "Pediatric and Adolescent Gynecology" Page 17
Copyright 1994 W. B. Saunders Company

Notes:

* I haven't located a medical reference that substantiates this claim.
** Submitted to the website by a woman who was greatly concerned about the appearance of her hymen prior to being reassured by her doctor.
*** For the study participants who had not engaged in vaginal intercourse, pad users had a median hymenal opening of 1.2 cm and the tampon users had a 1.5 cm opening [6]. The difference between the two median measurements is 0.3 cm or 0.12 inches. To provide a frame of reference, the graphite material in a standard wooden pencil is equal to about half that difference, or 0.06 inches (1.6 mm).

References:

1 Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med. 2004;158:280-285. [PDF File]

2 Appearance of the Genitalia in Girls Selected for Nonabuse: Review of Hymenal Morphology and Nonspecific Findings. Journal of Pediatric and Adolescent Gynecology Volume 15, Issue 1, February 2002, Pages 27-35.

3 Appearance of the Hymen in Prepubertal Girls. PEDIATRICS Vol. 89 No. 3 March 1992, pp. 387-394

4 Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature. Forensic Sci Int. 1998 Jun 8;94(1-2):147-53.

5 Genital Anatomy in Pregnant Adolescents: "Normal" Does Not Mean "Nothing Happened" PEDIATRICS Vol. 113 No. 1 January 2004, pp. e67-e69. [PDF File]

6 Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr. 1994 Jul;125(1):153-60.