hymenotomy

Hymenotomy is a minor gynecologic surgical procedure in which an incision is made in the hymenal tissue to create a patent opening. It is performed to relieve outflow obstruction in conditions such as imperforate hymen or hymenal stenosis and to permit normal menstrual flow, pelvic examinations, or future vaginal intercourse when the hymenal rim is obstructive. It is most commonly indicated in adolescents presenting with cyclic abdominal or pelvic pain and primary amenorrhea due to trapped menstrual blood (hematocolpos or hematometra).

The procedure is typically performed under local, regional, or general anesthesia, depending on patient age and setting. Common techniques include a cruciate hymenotomy, where four small incisions are made at the 12, 3, 6, and 9 o’clock positions to form a central opening, or alternative patterns such as vertical or horizontal incisions. The goal is to create a stoma that remains patent while preserving as much hymenal tissue as possible. Hemostasis is achieved during the procedure, and additional measures such as suturing or gentle dilation may be used to maintain patency in the immediate postoperative period.

Postoperative care focuses on wound hygiene, avoidance of strenuous activity or intercourse until healing is complete, and monitoring for complications. Most patients experience relief of obstruction and normal menstruation after healing. Potential risks include restenosis or reclosure of the opening, infection, and bleeding. Hymenotomy is distinct from hymenectomy, in which the entire hymenal tissue is removed; the former aims to preserve hymenal tissue while providing drainage and function.