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Background: In conservative cultures, the presence of hymen without rupture in a virgin girl represents an indication of female pride and honor. Accordingly, there are many crimes, committed due to wrong views and conceptions among young people in such societies. The current review aimed to highlight the anatomy of the hymen, in a trial to create a better understanding and to eliminate misconceptions about virginity. Methods: Databases of PubMed, ScienceDirect, SpringerLink, Wiley Interscience and others were searched. The research papers are studied and discussed. Results: The hymen is a thin mucous membrane, partially closing the vaginal orifice. It represents an embryological remnant, originating from the urogenital sinus. It varies greatly in shape. Its elasticity increases after puberty so that it may allow penile penetration without rupture and bleeding. Conclusions: Hymen is not an accurate indication of virginity. Knowledge of the hymen anatomy and its abnormalities is essential to eliminate the misconceptions about it.
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Hymen: facts and conceptions
Correspondence
Abdelmonem A. Hegazy
Department of Anatomy &
Embryology, Faculty of
Medicine, Zagazig University,
Egypt
E-mail:
ahegazy@zu.edu.eg
Keywords:
Hymen, Anatomy, Development,
Abnormalities, Virginity
Funding
None
Competing Interest
None declared.
Received: October 9, 2012
Accepted: December 14, 2012
Abstract
ISSN (print): 2218-3299
ISSN (online): 2219-8083
Review
109 | theHealth | Volume 3 | Issue 4
Hegazy AA1 ,2, Al-Rukban MO3
1Department of Anatomy & Embryology, Faculty of Medicine, Zagazig University, Egypt, 2Department of Anatomy
& Embryology, College of Medicine, Majmaah University, Kingdom of Saudi Arabia, 3Department of Family &
Community Medicine, College of Medicine, King Saud University, Kingdom of Saudi Arabia
Introduction
The hymen is a membrane, partially closing the
external vaginal opening. Until now, many
myths regarding its anatomy exist but are
based primarily on dogma and lack of scien-
tific knowledge.1 In conservative cultures, its
presence without rupture in a premarital girl
represents an indication of her pride and hon-
or. According to Arab customs, woman who is
not found to be virgin on her wedding night
will bring a great shame on her family. She
might be killed by her brothers, uncles or even
her father, thereby "cleansing the shame". Alt-
hough such murders are illegal, the perpetra-
tors escape prosecution because the tribal cus-
toms that underpin these actions are so strong.2
Also, the husband might kill his bride, if he
does not notice a bleeding as a result of deflo-
ration. In such cultures, the traditional proof of
virginity is the occurrence of bleeding from
ruptured hymen on wedding night. Therefore,
the ignorance about structure of the hymen can
lead to violence, such as 'honor killing' as well
as psychological problems including suicidal
feelings. Meanwhile, the physician’s testimony
about the appearance of the genitalia may be
one of the key factors which determine the
outcome of such cases.3 Therefore, the clinician
should be familiar with normal prepubertal
genital anatomy and hymenal configuration.4
The current review aimed to highlight anatomy
of the hymen for medical practitioners and to
eliminate misconceptions of some population
about virginity that might represent a matter of
life and death.
Methods
Databases of PubMed, ScienceDirect, Spring-
erLink, Wiley Interscience and others were
searched. Search included all the available
years. It was conducted between May 2011
and April 2012. The available research pa-
pers were studied and discussed. The contents
included the results, discussion and conclusion.
Results
General Overview
The hymen is named after the God of mar-
riage "Hymenaios" in classical Greek mytholo-
gy.5 The word "hymen" is usually synonymous
with virgin membrane. This concept has origi-
nated in Western cultures, since the medieval
era when chastity among women was ex-
pected.6 In modern times, adolescents who live
in countries with more liberal attitudes about
sexuality may change their views about the
hymen.7 The original concept is still predomi-
nant among people in Islamic culture. Sex be-
fore marriage is frowned upon by Muslims, but
generally approved by non-Muslims. Sex outs-
Background: In conservative cultures, the presence of hymen without rupture in a virgin girl
represents an indication of female pride and honor. Accordingly, there are many crimes,
committed due to wrong views and conceptions among young people in such societies. The current
review aimed to highlight the anatomy of the hymen, in a trial to create a better understanding
and to eliminate misconceptions about virginity.
Methods: Databases of PubMed, ScienceDirect, SpringerLink, Wiley Interscience and others
were searched. The research papers are studied and discussed.
Results: The hymen is a thin mucous membrane, partially closing the vaginal orifice. It represents
an embryological remnant, originating from the urogenital sinus. It varies greatly in shape. Its
elasticity increases after puberty so that it may allow penile penetration without rupture and
bleeding.
Conclusions: Hymen is not an accurate indication of virginity. Knowledge of the hymen
anatomy and its abnormalities is essential to eliminate the misconceptions about it.
theHealth 2012; 3(4): 109-115
110 | theHealth | Volume 3 | Issue 4
Hymen: facts and conceptions
ide marriage is haram (a sin) in Islam.8
Humans are unique members of the primate group, pos-
sessing sexual characteristics different from other hominoids
(apes).9 According to many sources, human female is the only
primate member to possess a hymen.10,11 However, Balke et
al reported the presence of membranous constriction (hymen)
with an orifice, less than 2 cm in diameter in nulliparous ele-
phants, that is not broken by mating, but only during birth.12
Also, abnormal occurrence of hymen was detected in Murrah
buffalo. It was considered to be a developmental anomaly
of the genital tract in cattle.13
Anatomy of the vulva
Vulva is the term given to the female external genitalia. Its
structure includes mons pubis, labia majora and labia minora
(Fig 1). Anteriorly, the labia minora form the prepuce and
split to enclose the clitoris. The vestibule is the area enclosed
by the labia minora and contains the urethral and vaginal
orifices.14 Bartholin’s glands (mucus-secreting glands) open
into the groove between the hymen and the posterior part of
the labia minora.15 Arterial supply of the vulva is derived
from superficial and deep external pudendal branches of the
femoral artery and the internal pudendal artery on each
side. Venous drainage occurs via external pudendal veins to
the long saphenous vein. Lymphatic drainage reaches super-
ficial inguinal nodes, then femoral nodes and eventually to
pelvic nodes. The sensory innervation is carried by the ili-
oinguinal nerve (L1), perineal nerve (S3) and the perineal
branch of the posterior cutaneous nerve of the thigh (S2).16
Variations of Hymenal Morphology
The hymen is a thin fold of mucous membrane situated just
within the vaginal orifice.16 It is perforated to allow the
egress of the menses. The aperture of the hymen ranges in
diameter from pinpoint to one that admits the tip of one or
even two fingers.17 The configuration of hymen differs dra-
matically from one female to another one.18 At birth, it is
commonly annular in shape, while the crescentic configuration
is most prevalent in children over age 3 years.19 Furthermore,
the redundancy of the hymen decreased in 75% of subjects
during this period.20 The adult hymen varies greatly in shape
and area. When stretched, it is annular and widest posterior-
ly. Sometimes it is semilunar, concave towards the mons pubis.
Occasionally it is cribriform (multiple small openings), septate
hymen (a residual band, usually in the anteroposterior diam-
eter) or fimbriated (or redundant) hymen (Fig 1).16, 21, 22 The
common hymenal configurations in some studies are summa-
rized in table 1.
Hymen size
Early attempts to clarify the normal size of hymen in a pre-
pubertal girl focused on the opening size. The size of the
transverse hymenal opening diameter was one of the most
frequently used indicators of sexual abuse. Despite the upper
normal limit of the normal diameter is not clearly established,
some studies suggested that a diameter greater than 4 mm is
too wide parameter, indicating sexual abuse children of all
ages.28,29 However, other studies showed an upper limit of 8
mm in the absence of sexual abuse.30 Confusions about the
normal values of hymenal opening diameters led other au-
thors to focus on the size of hymenal tissue, as an alternative
criterion of sexual abuse. Narrowing (or attenuation) of the
inferior hymenal rim is correlated with sexual abuse.31 The
amount of tissue present between the hymenal edge and
vestibule inferiorly at 6 o’clock, detected in non-abused girls
is at least 1.0 mm in width.32 However, some studies conclu-
Figure 1: Normal anatomy of vulva and variations in the hymenal appearance.
Cases (n) Age (m) M (annular/
concentric
Cresentric/
Posterior rim
Sleeve like/
small orifice
Fimbriated Septate
Berenson et al.23 468 nb 80 19 1
Al Herbish24 345 nb 60 4.9 22 12.5
Berenson and Grady25 135 36 39 61 2 1
93 60 23 77 2 1
80 84 18 82 3 1
61 108 10 90 3 1
Heger et al.26 147 63 53 29.2 14.9 2
Myhre et al.27 194 69 6.7 78.4 0.5
Table 1: Hyemenal configuration in previous studies
Data is mentioned as %.
theHealth | Volume 3 | Issue 4 | 111
Hymen: facts and conceptions
ed that hymenal measurements demonstrated a high degree
of overlapping between abused and non-abused girls.27,33
Furthermore, these values differ according to the child age,
type of hymen, position of the examination, state of relaxa-
tion and cooperation of the female.34
Histological structure
Hymen is composed mainly of elastic and collagenous con-
nective tissue, covered on its both surfaces by stratified squa-
mous epithelium, without any evidence of cornification. The
epithelium is thicker at the attached edge. Nerve fibers are
scarce, at the free margin of the hymen. No nerve cells and
fibers are present at the free edge of the hymen. There is no
trace of glandular or muscle element.35 Hymen is relatively
an avascular membrane so it is unlikely to bleed significantly
even if it is torn.36
Age related changes
Despite, there is no significant difference in hymenal configu-
ration by race, a wide variations are noted by age.37 In the
newborn the hymen is vascular and the epithelium is thick.35 In
the prepubertal female, the lack of estrogen renders the
hymenal tissue thin and friable.22 Therefore, there is no dis-
tensibility prior to puberty.21 At puberty, it becomes thick and
redundant with a tendency of folding out.38 During adoles-
cence, circumferential hymenal elasticity increases.39 The ad-
olescent who has been sexually active may have a hymen
that does not show obvious trauma, or the hymen may have
old or new lacerations, extending down to the base.40 At
pregnancy, the epithelium of hymen becomes very thick and
very rich in glycogen.4 After childbirth, nothing is left but few
tags termed carunculae myrtiformes.15 At menopause, the
epithelium becomes thin in response to estrogen depriva-
tion.4
Development of Hymen
It is important to have a good grasp of embryology of the
hymen to understand its nature and common anomalies that
may ensue. Although the sex of the developing embryo is
determined at the time of fertilization, external genitalia are
the same till the 7th week of embryological development.41
The genital ducts develop from two pairs of ducts; mullerian
and wollfian ducts (Fig 2). The mullerian duct arises as a lon-
gitudinal invagination of the epithelium on the anterolateral
surface of the urogenital ridge. Cranially, the duct opens into
the abdominal cavity. Caudally, it passes lateral to wollfian
duct, then crosses it ventrally to grow caudomedially in close
contact with the opposite duct. The two adjacent parts of the
ducts fuse together forming the uterine canal. The caudal tip
of this canal forms a bulge into the posterior wall of urogeni-
tal sinus, forming mullerian tubercle.42 The fate of these ducts
depends upon the genetic sex of the embryo. In XX individu-
als, the mullerian ducts develop into a uterus, fallopian tubes
and vagina.43 Vagina develops from two sources; the caudal
part of uterine canal as well as solid vaginal plate, prolifer-
ating from the sinovaginal bulbs at the tip of fused mullerian
ducts.42 Later, central canalization of the vaginal plate oc-
curs, leaving the peripheral cells that form the epithelium of
the vagina. Until late in the female's fetal life, the lumen of
the vagina is separated from the cavity of the urogenital
sinus by the hymen (Fig 3). During the perinatal period, it
ruptures and remains as a thin fold of mucous membrane just
within the vaginal orifice.41
Abnormalities of the Hymen
a. Hymenal polyps and tags
Hymenal polyps and tags are elongated projection of hy-
menal tissue protruding beyond the hymenal rim or extending
from the rim itself.20 They are common after birth. They are
usually very small (less than 5 mm). Most resolve spontane-
ously and they are rarely seen after the age of 3 years.
Very rarely they can persist and become more polypoid.43
Although the etiology of this congenital feature is unknown, its
frequent occurrence in the midline at birth has led to sugges-
tion that these projections originate from septate hymens that
cleave in utero or shortly after birth.44
b. Hymenal ridges and bands
This congenital feature might be observed on the external or
internal surface of the hymen. External ridges may be found,
inferiorly at 6 o’clock or superiorly at 12 o’clock, immediate-
ly under the urethra. They occur in up to 86% of newborn
females.23 As the hymen becomes less redundant with aging,
external ridges tend to resolve and can be observed by 3
years of age in only 7% of children who had this finding at
birth.19 Internal ridges extend longitudinally from the hymen
into the vagina. They may observed on the all four quadrants
of hymen.23
c. Hymenal notches
An angular or V-shaped indentation on the edge of the hy-
menal membrane is defined as a notch. Superior and lateral
notches have been observed in 35% of newborn girls.23 Their
frequency decreases with age as superior notches widen to
form crescentic hymens, or as superficial notches disappear
Figure 2: Development of female genital ducts (coronal sections). Figure 3: Development of vagina and uterus (sagittal sections).
112 | theHealth | Volume 3 | Issue 4
Hymen: facts and conceptions
as the hymen becomes less redundant.44, 45 A notch extending
to the junction of the hymen and vestibule in any location has
been shown only in victims of abuse or trauma and should not
be considered as a congenital finding.20
d. Imperforate Hymen
It has been reported to occur in up to 0.1% of female new-
borns.46, 47 Imperforate hymen occurs mostly in a sporadic
manner, although rare familial cases do occur.47 It may be
detected in the neonatal period, less commonly in childhood
or, more typically, at adolescence when the girl presents with
cryptomenorrhoea and haematocolpos.48 Treatment is gener-
ally aimed to form a patent outflow tract. The traditional
treatment is surgical hymenectomy with T, X, plus, or cruciform
incisions and removal of excess hymenal tissue.49 It is a simple
procedure and yields good results. However, it may result in
social problems for some girls, due to destruction of the hy-
men that represents a symbol of virginity in some cultures.
There is another technique using the Foley catheter that rep-
resents an adequate alternative when preservation of the
hymen is required.50, 51 Basaran et al stated that the imperfo-
rate hymen is somewhat thicker than the borders of the nor-
mal hymen.52 Therefore simple incision and sutures will even-
tually forms a thick posterior rim of hymenal tissue suitable
for defloration during sexual intercourse. Although, conserva-
tive surgery with simple incision and sutures might be an al-
ternative option to standard treatment, the follow-up is nec-
essary to exclude occurrence of re-closure of the hymen.53
e. Microperforate Hymen
Microperforate hymen is a rare congenital condition consist-
ing of a tiny hymeneal orifice with normal female genitals.54,
55 The microperforation is quite difficult to visualize.54 Donato
et al reported a case of microperforate hymen in which di-
agnosis and treatment was performed after decades of ure-
thral coitus.55
Function of the Hymen
The hymen has no known biological function and its rupture is
of no medical consequences.5 However, its psychological and
cultural significance as a sign of virginity has been enormous.
In many societies, virginity of wives with intact hymen is high-
ly desired and even demanded. A second hypothesis, sug-
gests that the hymen is functioning in protection of the vaginal
area from contamination by fecal and other materials, espe-
cially at the early stage of life.9
Rupture of the Hymen
The hymen may be ruptured by sexual intercourse. The rup-
ture appears as irregular hymenal edges and narrow rims at
the point of the injury. Later on, the jagged angular margins
appear to be smoothed off.56 However, deeper penetrating
injuries of the hymen may lead to defects in the integrity of
the hymen, situated posteriorly or posterolaterally.15 Despite
definitive evidence of sexual contact (pregnancy), Kellogg et
al noticed only 2 of 36 examined adolescents having genital
changes that were diagnostic of penetrating trauma.57 Possi-
ble explanations for the lack of genital trauma include: pene-
tration does not result in visible tissue damage, or acute inju-
ries occur but heal completely.58 Similarly, Onan et al report-
ed a case of spontaneous formation of imperforate hymen
during pregnancy in the absence of previous surgical proce-
dures.59 This might be attributed to glycogenated epithelium,
occurring in response to estrogen exposure at pregnancy.35,
59 In the prepubertal girl, because of the relative size of the
structures, penetration occurs through the hymenal tissue and
causes tearing. However, in the adolescent girl and adult
woman consensual penetration occurs into the orifice which
thus stretches, resulting in spreading and indeterminate dis-
ruption.60, 61 Many authors agreed that the so called rupture
and bleeding of the hymen is not to be routinely expected
after first coitus.60, 62-64 Other causes of hymenal rupture,
other than sexual intercourse include vaginal insertion of ob-
jects such as tampons and digits, vigorous sporting activities,
surgical procedures and falling on sharp objects.5, 65
Hymen reconstruction
Hymen reconstruction, also described as hymenoplasty or
hymenorrhaphy, has emerged as a procedure restoring the
ability of the hymen to bleed at sexual intercourse on the
wedding night. It is indicated in some communities to protect
women from violent reprisals.66 It is sometimes needed as
part of rape rehabilitation.5 Hymen reconstruction is a minor
operation, performed on the eve of the wedding.67 It is done
by approximating the free borders of the remnants, using
fine, absorbable sutures to achieve partial occlusion of the
introitus. If hymenal remnants are inadequate, a small flap of
vaginal mucosa is reflected from the posterior vaginal wall
and approximated to the anterior wall as a band across the
hymenal ring.68
Virginity and chastity
Virginity revolves around whether a female has ever had
sex. It has been noticed that the description “virgin” itself
shows women's subordination to men, since the French term
“virgine” is derived from Latin by combination of the words
“vir,” meaning “man,” and “genere,” meaning generated or
“created for”.69 The Jewish, Christian, Muslims faiths all at-
tach considerable importance to the premarital virginity.70 In
fact, virginity is a physiological state, indicated though not
conclusively by an intact hymen (since some may be suffi-
ciently elastic to allow sexual penetration), whereas chastity
is a status of moral virtue.5 The postpubertal hy-
men is elastic so that some prostitutes have been found to
have intact hymens.71 Therefore, the absence of any injury to
the hymen should not be used as a reason to negate the pos-
sibility that the adolescent has experienced vaginal penetra-
tion.61 Strengthening the norm of virginity or delaying sex
might be helpful to prevent HIV and other sexually transmit-
ted infections among young people in some rural settings
where access to information and condoms is limited.72
Virginity Testing
Extraordinary as it may seem in the 21st century, examinati-
theHealth | Volume 3 | Issue 4 | 113
Hymen: facts and conceptions
tion of young women to ascertain evidence of consenting sex-
ual activity remains a flourishing activity.73 If there is any
suspicion about virginity, young girls are forced to undergo
hymen examination against their will. This forced virginity
testing appears to be a factor in a significant number of sui-
cides of young Turkish women. Nurses and midwives are al-
ways being involved in this procedure.74 Virginity testing is
likely to be harmful for many girls, regardless of whether
they pass the test. This examination strips the girl of her dig-
nity. Some parents under societal pressure may coerce or
persuade their daughters to undergo the practice. To pre-
serve their virginity, girls sometimes will have anal sexual
intercourse. This carries more risk of HIV infection than vagi-
nal intercourse if the sexual partner is HIV-infected.75
Discussion
Misconceptions in regard to virginity may lead to many
avoidable social disasters in conservative cultures. The im-
portance of virginity in such cultures is not only a matter of
individual wishes or values, but it is rooted in traditions re-
garding the honor of the extended families of the bride and
groom. Virgin in Islamic cultures is defined as the girl who has
not married and never experienced penile penetration of the
vagina. Conceptions about the hymen and virginity carry
many wrong ideas. Despite knowing female menses, many
male youths especially in rural areas do not know that the
hymen is normally perforated for egress of that menses.
Moreover, the traditional proof of virginity is the occurrence
of bleeding as a result of defloration. On contrary to these
misconceptions, the post pubertal hymen is elastic so that it
may stretch to allow sexual penetration without tears and
bleeding.71
On the other hand, the postpubertal hymen is relatively a
bloodless membrane, so if it is torn, it mostly result in a slight
bleeding.36 This bleeding might be unnoticed by the husband
especially after ejaculation, where the color of blood be-
comes faint after its mixing with the seminal fluid. Factors that
may increase the likelihood of bleeding at that time are
forced sexual relations, lack of arousal or lubrication, vaginal
infection, genital malformation (e.g. imperforate hymen),
generalized bleeding disorder, or if the girl is at pre-
puberty.76 Contrary to the common popular belief, the hymen
is not a solid septum separating the vagina from the external
world, but rather an embryological thin mucous membrane
remnant. This misconception might lead to fixation of the
groom upon defloration that in conjunction with ignorance
about the anatomy of the hymen and female genitalia can
result in a traumatic wedding night, instead of the required
pleasure. Violent penile penetration leading to minor lacera-
tions of vaginal wall rather than that of hymen appears to be
responsible for “blood stained bed-sheets”.36 On the other
hand, tears are more likely to occur in cases prepubertal
assault than after puberty due to coverage of estrogen. Oth-
er factors might play a role in the occurrence of severe
bleeding in cases of children. These factors include the in-
creased vascularity and decreased elasticity of the prepu-
bertal hymen, as well as incongruous of genitalia size of the
adult male and prepubertal female. Moreover, the hymenal
tissue of prepubertal females is thin and friable, rendering it
to be easily torn.22 Therefore, marriage before puberty that
usually happened in some rural areas should be prohibited.
Some girls who denied past intercourse had complete clefts in
the posterior rim of the hymen.61, 62 This might be explained
by factors other than sexual intercourse that might lead to
hymenal tears. These factors include violent sports, falling on
sharp objects, use of tampons and surgical procedures.5, 65
Premarital girls in such societies must avoid such factors. They
can use pads for menses, instead of using tampons, until they
become sexually active after marriage. Also, it is imperative
that the examiner digitally explore the vaginal orifice before
any attempt to insert a speculum is made. In case of female
with intact hymen, the anterior wall of the rectum might be
the method of examining the pelvic organs instead of vaginal
examination.
In some societies, women who have had sexual relationships
before marriage, might request the hymen repair due to fear
of being divorced or even killed. According to Amy, there
are increasing demands from young women, mostly but not
exclusively of Muslim faith, to seek certificates of virginity for
them or to reconstruct their hymen before they marry in Eu-
rope.70 Through the creation of artificial virginity, she be-
comes pure again and her honor is regained.2 Although, it is
a simple procedure, many Muslim doctors refuse to perform
it. They consider such procedure as a fraud for her groom.
This is because the adultery or sexual relationship outside
marriage is strictly prohibited in Islam.
The hymen is perforated during embryonic life. Failure of this
process could result in imperforate hymen. These cases need
surgical hymenectomy to relieve the blockage, for egress of
menses. Follow-up after this surgery is necessary to exclude
occurrence of re-closure of the hymen. Also, it should be done
under great care and asepsis as the closed vagina lacks its
protecting Doederlein’s bacilli and the pH is alkaline or
weakly acidic, so there is poor natural resistance to bacteria
entering from below and the blood and debris provide a
good culture medium.77 Imperforate hymen is considered
another cause for loss of the hymen, without experience of
sexual intercourse.
The integrity of the hymen is not easily assessed. This is at-
tributed to the wide varieties of its shape. Also, there are
many congenital features that might mislead with the sexual
assault. Hymenal notches or bumps are often present in the
normal child and should not prompt evaluation of sexual
abuse without associated history or parental concern. The
exception to this is the finding of notches in the inferior por-
tion of the hymen from 5 to 7 o'clock, which should prompt
screening for sexual abuse.45 If virginity testing is inevitable,
it should be done by experienced medical professionals e.g.
gynecologists or forensic physicians to avoid the danger of
over-interpreting small anatomic findings that may lie within
the range of normal variations. Many authors showed that
measurement of the hymenal diameter has no association
114 | theHealth | Volume 3 | Issue 4
Hymen: facts and conceptions
with sexual abuse.25, 27, 44 Furthermore, it is generally accept-
ed that the hymen is a poor indicator of penetrative sexual
activity in postpubertal girls.57, 61, 62 Given these facts, it is
obvious that hymenal bleeding on the wedding night might
not be a sign of virginity or even chastity. On the other hand,
if a girl does not bleed at the first experience of sexual in-
tercourse, it does not mean that she has lost her virginity be-
fore. Therefore, promoting the concept of bleeding on the
wedding night as a sign of virginity is nothing but
perpetuation of myth. Health education for youths is recom-
mended to eliminate such myths and wrong views about the
hymen and virginity.
Conclusion
The hymen is a thin embryological remnant, partially closing
the vaginal orifice. It is not an accurate indication of virginity.
It may be ruptured by sexual intercourse. However, some
hymens are elastic, allowing vaginal intercourse without be-
ing injured. At the same time, it may be broken accidentally
by tampon use or vigorous exercise.
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... Not being virgin at the time of marriage and even suspicion around this issue is considered a form of family and social stigma in addition to personal consequences (Bastami 2015;Eşsizoğlu et al. 2011;Hegazy and Al-Rukban 2012;Kaivanara 2016;Khalajabadi Farahani 2012;Odeh 2010;Robatjazi et al. 2017). In these countries, virginity is specifically considered by focusing on the existence of hymen and lack of premarital sex, and often is the only indicator of chastity and purity of the young women (Ahmadi 2016;Awwad et al. 2014;Aygunes 2017;Robatjazi et al. 2016a, b;Scorgie 2015). ...
... In such conservative cultures, the importance of virginity is such that the death of a young woman is regarded as less of a tragedy for the family than the lack of virginity (Ghanim 2015c). Women also resort to false methods of virginity such as hymenoplasty and the use of artificial hymen kits and other deceptive methods to protect themselves from such consequences (Ahmadi 2016;Ayuandini 2017;Cinthio 2015;Ghanim 2015a, d;Hegazy and Al-Rukban 2012;Juth and Lynoe 2015;Scorgie 2015;Moorst et al. 2012;Wild et al. 2015). ...
... Many young boys believe in freedom of premarital sex (Motamedi et al. 2016;Nikirashidi et al. 2019). However, paradox of permission and forbidding the premarital sex appears at the time of marriage (Farahani et al. 2011;Shahabaldiny 2016) when, the young man or his family ask the bride for a virginity certificate or look for traditional indicator of virginity and bleeding after the first intercourse (Ahmadi 2016;Ghanim 2015b, d;Hegazy and Al-Rukban, 2012;Leclerc-Madlala 2008;Robatjazi et al. 2017). However, according to scientific evidence, none of the methods of virginity examination and wedding night bleeding index are reliable to prove the virginity (Hedjazi et al. 2012(Hedjazi et al. , 2014Hegazy and Al-Rukban 2012;Robatjazi et al. 2016a, b;Van Moorst et al. 2012). ...
Article
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“Blood stained bed sheets” is considered as an index of virginity for the brides in most areas of Iran. The present study was conducted to determine the prevalence of bleeding at the first intercourse in brides who claimed to be virgin in Kerman city, Kerman province, Iran. Practices of the grooms encountering lack of bleeding were investigated. Totally, 52.5% of the brides reported bleeding at the first penile-vaginal intercourse. Among the grooms who encountered no bleeding at the first intercourse, half of them had a violent reaction. Findings of the study revealed that valuing bleeding as a virginity index will damage the couple’s relationship and sexual life of young brides, highlighting the need for more attention and education.
... Embryologically, theories abound on the genesis; such as excessive estrogen hypersecretion prenatally (or postnatally) with subsequent mucus secretion by (uterine) cervical glands [27]. Perforation of the hymen usually occur during embryonic period [28], while the vagina forms from the sinovaginal bulb and uterovaginal canal [28] at around 11 weeks GA. Formation of the urogenital sinus, paramesonephric and mesonephric ducts are separate with marched paracrine role in hymen genesis. ...
... Embryologically, theories abound on the genesis; such as excessive estrogen hypersecretion prenatally (or postnatally) with subsequent mucus secretion by (uterine) cervical glands [27]. Perforation of the hymen usually occur during embryonic period [28], while the vagina forms from the sinovaginal bulb and uterovaginal canal [28] at around 11 weeks GA. Formation of the urogenital sinus, paramesonephric and mesonephric ducts are separate with marched paracrine role in hymen genesis. ...
Article
Full-text available
Background: Imperforate hymen is an uncommon obstructive congenital anomaly of the female external reproductive channel due to lack of canalization (lower) vaginal plate between the vaginal and urogenital sinus; with a prevalence rate of less < 0.1%. Hematocolpos / imperforate hymen with heamatometra often presents as a pelvic mass that compresses the urinary bladder causing acute urine retention and pain. Case presentation: A 14-year-old presented with lower abdominal pain for 5 months. Patient physical examination revealed normal secondary sexual characteristics with a thickened than normal hymen. She presented with delayed menarche; a physician earlier prescribed analgesic and anthelmintic medication for pain management. After conservative hymenotomy about 360ml of dark-tan haem (blood) was drained in few minutes. Postoperative recovery was uneventful; normal menstruation occurred after 4 weeks. Conclusion: Diagnosis through physical examination and ultrasound requires vigilance and a high degree of suspicion; virginity sparing is a viable treatment option due to social reasons and religious beliefs.
... The hymen is a membrane which partially covers the external vaginal opening. 1 In early fetal life, the 3 It may remain as membrane with multiple small openings (or rupture sites), that partially cover the vagina leading to the hymenal variants seen in clinical practise. 2 Typically, the hymen is annular, crescentic or fimbriated in shape 4 5 however a wide variety of hymenal variants have been described including imperforate, septate and cribriform hymen. 2 Other reported features of hymens include polyps, tags, ridges or notches. 1 Typically, these are identified in the neonatal period or at the onset of puberty. ...
... 2 Typically, the hymen is annular, crescentic or fimbriated in shape 4 5 however a wide variety of hymenal variants have been described including imperforate, septate and cribriform hymen. 2 Other reported features of hymens include polyps, tags, ridges or notches. 1 Typically, these are identified in the neonatal period or at the onset of puberty. 6 The exact function of the hymen remains unknown. ...
Article
There is a wide range of hymenal variants which exist and usually become apparent to women during puberty. Our case describes a 16-year-old woman with a previously undiagnosed hymenal septum who presented with a retained tampon within the urinary bladder. This case report discusses a rare presentation of a hymenal variant and highlights the importance of understanding the difference in pelvic examinations in children and adolescents when compared with adults and awareness of the different hymenal variants.
... Moreover, confusion may occur where normal variations are mistaken for signs of sexual trauma or abuse, as in cases of genital erythema and nevi, anal fissures, hymenal opening enlargement, edge narrowing, clefts, partial notching of the hymen, and failure of its midline fusion (Hillard, 2013). Accordingly, a girl may be falsely labeled sexually experienced and thus are at risk for various adverse consequences, ranging from social stigmatization to honor killing (Hegazy & Al-Rukban, 2012). ...
Article
Full-text available
Virginity is the nullity of sexual experience in females. However, the use of virginity testing as proof of previous involvement in sexual relations is dependent on having an intact hymen, which refers to a hymen with no signs of previous penetrating injury. Although the quality of this evidence in questioned virginity is extremely poor and considered a violation of human rights, it still constitutes a major facet in medicolegal investigations of sexual assaults. This work evaluates virginity testing as currently practiced in many countries, including Egypt, in terms of medical and legal considerations.
... Hymen has attracted the attention of mankind throughout history, although there is only a fold of mucous membranes. Even today, it is accepted as a sign of virginity, and the cause of humiliation and murders of women in some societies, although an outdated belief in many societies (3). ...
Article
ABSTRACT: Developmental abnormalities of hymen occur as a result of failures in breaking or rupturing the genital tubercle within embryological phase. Cribriform hymen, septal hymen, anterior displaced hymen, imperforate hymen and rigid or elastic hymen are variations of the embryologic development of the hymen. Also, microperforate hymen is defined as a different type of imperforate hymen which has a small opening. In this article, we reported a different type of microperforate hymen, which was reported limitedly in the literature. A 17-year-old female case applied forensic medicine polyclinic for sexual abuse examination at the request of the prosecutor. Any traumatic lesion was not seen in the extra-genital and genital examination. At first glance, hymen looked like an imperforate hymen. When it was carefully investigated and consulted to gynecology and obstetrics specialist, three crescent-shaped holes were seen on it. This was evaluated as a previously unspecified type in the literature of microperforate hymen. ****************************************************************************************************************************************************** ÖZET: Hymen gelişim anormallikleri, embriyolojik fazda genital tüberkülün kırılması veya yırtılmasındaki başarısızlıkların bir sonucu olarak ortaya çıkar. Kalburumsu hymen, septalı hymen, öne yer değiştirmiş hymen, deliksiz hymen ve sert veya elastik hymen; hymenin embriyolojik gelişiminin varyasyonlarıdır. Keza mikro delikli hymen, küçük bir açıklığa sahip deliksiz hymenin değişik bir tipi olarak tanımlanmıştır. Bu makalede literatürde sınırlı sayıda bildirilmiş olan mikro delikli hymenin farklı bir tipi tanımlanmıştır. 17 yaşındaki kadın hasta, savcının talebi üzerine adli tıp polikliniğine cinsel istismar muayenesi için başvurdu. Ekstra genital ve genital muayenede travmatik lezyon görülmedi. İlk bakışta hymen, deliksiz bir hymen gibi görünüyordu. Dikkatle araştırıldığında ve kadın hastalıkları ve doğum uzmanına danışıldığında, üzerinde üç hilal şeklinde delik görüldü. Bu, mikrodelikli hymenin literatüründe daha önce belirtilmemiş değişik bir tipi olarak değerlendirildi.
... In this context, we suggest that repeated unprotected anal intercourse adopted by some males to avoid the vaginal route in some communities could be ambiguous factors for renal failure. Some men might resort to abnormal anal intercourse in order to preserve the hymen integrity in virgins or to avoid occurrence of pregnancy [15,16]. Another form of abnormal use of anal canal in sexual intercourse could be the homosexuality prevalent among young males. ...
... Researchers have previously claimed that women's participation in strenuous physical sports could cause hymen rupture (Goodyear-Smith and Laidlaw, 1998). Hegazy and Al-Rukban (2013) argued that in various cultures the presence of an unruptured hymen in a virgin girl connotes a symbol of women's pride. For instance, in many Muslim countries (e.g. ...
Article
Women’s participation in sports and physical activities lags behind that of men, particularly among members of underrepresented or marginalized groups. Pakistani women from the rural areas of southern Punjab represent one such group. The aim of this study was to examine how traditional sports that are less well-known outside the Indian subcontinent offer opportunities for marginalized Pakistani women from Southern Punjab to participate in physical activities. Following a phenomenological approach, we conducted 16 semi-structured interviews with Kho-Kho and Kabaddi women athletes from underrepresented groups in Pakistan. Elo and Kyngäs’ three-phase content analysis process (preparation, organization and reporting) was used to examine interviews. The results of the study revealed that participants feel constrained by the systematic masculine hegemonic culture institutionalized by Pakistani society and the western sporting paradigm. However, the participants reported a sense of liberation and security via traditional sports. Our study contributes to the limited knowledge about women’s participation in traditional sports beyond the western world.
... See, for example, the article "Hymen: Facts and Conceptions" byHegazy and Al-Rukban (2012). ...
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“Little knowledge or false knowledge is always dangerous.” This book is about providing knowledge from a reliable and scientific source. This book is made to answer the curious minds, who are searching for answers on the internet or among peers. It is useful for school and college students, teachers, parents, guardians, counsellors, educators, NGOs, and health professionals. I believe that sex education (sexuality education) should be based on scientific knowledge, freely and easily accessible to everyone and be comprehensive. We often underestimate the benefits of sex education (reproductive health education). With the advent of mobile, the internet and TV, it is challenging to keep a child unexposed to the content related to adults. It’s the utmost need for every child to have a safe childhood. Unfortunately, even adults of our society lack basic knowledge about sexual health.
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इस पुस्तक की हार्डकॉपी ऑर्डर करने के लिए - https://bit.ly/3rnEp6X Coupon code (25% off) - SEXEDUCATION मेरा मानना है कक सेक्स एजुकेिन (यौन स्वास््य) वैज्ञाननक ज्ञान पर आधाररत होना चादहए, स्वतंत्र रूप से और आसानी से सभी के शलए सुलभ हो और व्यापक हो। हम अक्सर यौन शिक्षा (यौन स्वास््य) के लाभों को कम आंकते हैं। मोबाइल, इंटरनेट और टीवी के आगमन के साथ, यह एक बच्चे को यौन सामग्री या यौन शिक्षा के प्रनत अप्रभापवत रखने के शलए चुनौतीपूर्क है। प्रत्येक बच्चे के शलए सुरक्षक्षत बचपन होना अत्यंत आवश्यक है। िुभाकग्य से, हमारे समाज के बडे लोगों में भी यौन शिक्षा के बारे में बुननयािी ज्ञान की कमी है । "थोडा ज्ञान या गित ज्ञान हमेशा खतरनाक होता है।" यह पुस्तक एक पवश्वसनीय और वैज्ञाननक स्रोत से ज्ञान प्रिान करने वाली है । यह पुस्तक उन जजज्ञासु दिमागों को जवाब िेने के शलए बनाई गई हैं, जो इंटरनेट / सोिल मीडिया पर उत्तर खोज रहे हैं। यह पुस्तक स्कूल और कॉलेज के छात्रों, शिक्षकों, अशभभावकों, माता पपता, एनजीओ (NGO), स्वास््य पेिेवरों के शलए उपयोगी हैं ।
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Article
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 ( χ 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.
Article
Alexander (1979) has invited "⋯ biologists to contribute to the analysis of human behavior on all legitimate fronts⋯" He considered it "⋯ especially relevant that [they] take up the problem of relating human attributes to evolutionary history." The analysis of human sexual behavior surely qualifies as a legitimate topic in evolutionary biology. This chapter represents a contribution to the argument that sperm competition does occur in humans and has been a selective force in the evolution of certain human characteristics. There has been considerable controversy over what may be the "natural" sexual inclinations (promiscuous, polygynous, serially polygynous, monogamous, or some mixture of these) of human males (e.g., Trivers 1972; Wilson 1975; Alexander 1977; Short 1977, 1979, 1981; Daly and Wilson 1978; Symons 1979; Lovejoy 1981; Barash 1982; Harvey and Harcourt, this volume), but relatively much less debate over the sexual predilections of human females (Hrdy 1981). Females are widely assumed to be monogamous, with little formal recognition of alternative female strategies (but see Hrdy 1981, and Knowlton and Greenwell, this volume). The compromise view of human male mating strategy proposes mixed tactics (Trivers 1972) where males attempt to pair-bond with one or more females by high investment, and opportunistically (more or less promiscuously) mate with other females. All combinations of male tactics from rape (Shields and Shields 1983, Thornhill and Thornhill 1983) to high investment (Trivers 1972) and the environmental and social circumstances that occasion their expression have received analysis in the literature. As Hrdy (1981) observed: "The sociobiological literature stresses the travails of males - their quest for different females, the burdens of intra-sexual competition, the entire biological infrastructure for the double standard. No doubt this perspective has led to insights concerning male sexuality. But it has also effectively blocked progress toward understanding female sexuality - defined here as the readiness of a female to engage in sexual activity." The biological irony of the double standard is that males could not have been selected for promiscuity if historically females had always denied them opportunity for expression of the trait. If strict monogamy were the singular human female mating strategy, then only rape would place ejaculates in position to compete and the potential role of sperm competition as a force in human evolution would be substantially diminished. Here I shall explore the literature for evidence of the evolutionary significance of sperm competition in humans. I present data on the circumstances that would place ejaculates from different human males together in the reproductive tract of a female during a single reproductive cycle. I summarize the evidence that human sperm competition actually occurs. And, finally, I speculate on how selection within the context of potential or actual sperm competition may have operated in human evolutionary history to shape some aspects of human anatomy, physiology, behavior, and culture. © 2006 Springer Science+Business Media, Inc. All rights reserved.