There are so many myths attached to the hymen – the thin membrane that surrounds the vaginal opening – that sometimes it's difficult to sort fact from fiction. If you believed them all, you'd think it "pops" the first time you have sex; that if yours isn't visible it means you've already had penetrative sex; that you're no longer a virgin if yours is "broken", to name just a few.
At best, these misnomers are harmless – at worst, they perpetuate sexist notions of female virginity and leave women feeling baffled by- and detached from their own vaginas. Hymens come in different shapes, but most often they're shaped like a half moon, allowing period blood to leave the vagina, as the US-based Center for Young Women's Health's guide explains.
However, some women are born with hymenal abnormalities that can result in problems ranging from period blood getting trapped in the vagina to difficulty having sex, and they may not realise until their teenage years, as an article from BBC Three highlighted recently. Georgia Watts discovered she had a septate hymen at 16 when she visited A&E after a tampon got stuck inside her.
"It was only when I plucked up the courage to have a look in the mirror that I realised why the tampon wasn’t budging," Watts wrote. "My heart sank as I saw a thick, fibrous string of tissue stretching across the bottom of the now expanded tampon." She was booked in for a hymenectomy to remove the extra tissue and now campaigns to raise awareness of the issue.
Hymen abnormalities are most often diagnosed during adolescence when girls start their periods, because once menstrual blood starts becoming trapped inside the vagina each month, it can cause pain that's hard to ignore. Dr Leila CG Frodsham, consultant gynaecologist and specialist in psychosexual medicine, says girls may find out their hymen is atypical "if they have not started their periods but are getting other symptoms: breast development, pubic hair growth, monthly breast tenderness, pelvic cramping pain each month and no bleeding. With an imperforate hymen this can go on for many months." Difficulty inserting tampons or achieving penetration are also telltale signs, she adds.
The different types of hymen abnormalities
Imperforate hymen: An imperforate hymen is where the vaginal opening is completely covered by the hymenal membrane and is therefore the most serious. With nowhere for it to go, period blood is forced back up into the vagina and can develop into a mass or lump and result abdominal and/or back pain, according to the Center for Young Women's Health. Women or girls with an imperforate hymen may experience problems going to the toilet, but corrective surgery can rectify the problem by removing the extra tissue.
Microperforate hymen: This is when the vaginal opening is partially covered by the hymen –in such cases, it's tiny and largely invisible. Period blood can make its way through, but girls/women with a microperforate hymen may have problems inserting and removing tampons, especially when they're saturated with blood.
Septate hymen: Girls/women with a septate hymen have two visible vaginal openings instead of the typical one, due to a thin extra band of tissue (septum) that runs through the middle. Trouble inserting or removing tampons is common, and minor corrective surgery can be carried out to correct it.
How common are hymen abnormalities?
Not very. One statistic suggests an imperforate hymen affects between one in every 1,000 to 10,000 women, which mean between 3,200 and 32,000 women in the UK could be living with the condition. "There are no data to support a prevalence [of hymen abnormalities], and some women may never present [with their issues]", says Dr Frodsham. "Sometimes women can present acutely with cyclical pain as period blood is trapped in the vagina but this is relatively rare. In over 20 years in gynaecology, I've seen this less than five times. Difficulties with consummation are also not common and even in running a specialist service I have seen true difficulties from partially perforate vaginas fewer than ten times."
What causes them?
"There is a common misconception that all hymenal problems are due to sexual abuse or misadventure, such as accidents during childhood and younger life, which is not the case," says Dr Anne Henderson, consultant obstetrician and gynaecologist. "The vast majority of hymenal problems are embryological and occur during growth and development in the womb. Women who present with these problems should therefore not fear any stigma or embarrassment."
What should you do if think you're affected?
As with any gynaecological concerns, visit your doctor, practice nurse or visit a sexual health clinic, advises Dr Frodsham. "If the difficulty is with having periods, a minor surgical procedure to cut the hymen is required. If it is in having sex, massage of the opening of the vagina and insertion of fingers or use of dilators can easily resolve the issue. Inspire dilators are softer and have a curve to match the vagina so can be more comfortable and effective that traditional plastic dilators if there is just a small hole." Surgery will be advised in rare instances.
Why are hymens still shrouded in mystery?
It's taken this long for women's sexual anatomy more broadly to become a topic of public conversation, so it makes sense than hymenal abnormalities – which affect a relatively small portion of women – will remain underground even longer. "I think hymenal issues will become a major topic of conversation, much as labial problems have been in recent years," Dr Anderson says. "Many women first become aware of them when they either have difficulty inserting tampons or experience discomfort or pain with sexual intercourse. Whereas previously generations may have simply ignored this, I think the current generation are much more likely to seek advice and I welcome this."