| Revision as of 21:04, 20 February 2015 editBfpage (talk | contribs)Autopatrolled, Extended confirmed users, Pending changes reviewers, Rollbackers19,587 edits →Development and histology: Misplaced Pages probably should not be suggesting the proper procedures for a forensic physicianTags: Mobile edit Mobile app edit← Previous edit | Revision as of 21:04, 20 February 2015 edit undoFlyer22 Frozen (talk | contribs)365,630 edits Revert; "partially" was there for a reason.Next edit → | ||
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| The '''hymen''' is a ] that surrounds |
The '''hymen''' is a ] that surrounds or partially covers the external ] opening. It forms part of the ], or external genitalia, and is similar in structure to the vagina.<ref name=emans>Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in ''Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas'', Second edition, Oxford University Press. 61-65</ref><ref name="Perlman">{{Cite book|last=Perlman|first=Sally E. |coauthors=Nakajyma, Steven T. and Hertweck, S. Paige |title=Clinical protocols in pediatric and adolescent gynecology|year=2004|publisher=Parthenon |page=131 |isbn=1-84214-199-6 }}</ref> In children, although a common appearance of the hymen is ]-shaped, many shapes are possible.<ref name=emans/> | ||
| The effects of ] and ] on the hymen are variable. If the hymen is sufficiently elastic, it may return to nearly its original condition. In other cases, there may be remnants (carunculae myrtiformes), or it may appear completely absent after repeated penetration.<ref name="Knight">{{cite book|last=Knight|first=Bernard|title=Simpson's Forensic Medicine|edition=11th|year=1997|publisher=Arnold|location=London|page=114|isbn=0-7131-4452-1}}</ref><ref name="Jacoby">{{cite book|last1=Jacoby|first1=David B.|last2=Youngson|first2=Robert M.|title=Encyclopedia of Family Health|edition=3rd|year=2005|publisher=Marshall Cavendish|isbn=0-7614-7486-2|page=889}}</ref> Additionally, the hymen may be lacerated by disease, injury, medical examination, ] or physical exercise. For these reasons, the state of the hymen is not a conclusive indicator of ].<ref name="Perlman"/><ref name="Knight"/><ref name="Jacoby"/> | The effects of ] and ] on the hymen are variable. If the hymen is sufficiently elastic, it may return to nearly its original condition. In other cases, there may be remnants (carunculae myrtiformes), or it may appear completely absent after repeated penetration.<ref name="Knight">{{cite book|last=Knight|first=Bernard|title=Simpson's Forensic Medicine|edition=11th|year=1997|publisher=Arnold|location=London|page=114|isbn=0-7131-4452-1}}</ref><ref name="Jacoby">{{cite book|last1=Jacoby|first1=David B.|last2=Youngson|first2=Robert M.|title=Encyclopedia of Family Health|edition=3rd|year=2005|publisher=Marshall Cavendish|isbn=0-7614-7486-2|page=889}}</ref> Additionally, the hymen may be lacerated by disease, injury, medical examination, ] or physical exercise. For these reasons, the state of the hymen is not a conclusive indicator of ].<ref name="Perlman"/><ref name="Knight"/><ref name="Jacoby"/> | ||
| ==Development and histology== | ==Development and histology== | ||
| The |
The ] during ], from the third week of ] to the ], and the hymen is formed following the ]. At week seven, the ] forms and separates the ] from the ]. At week nine, the ]s move downwards to reach the urogenital sinus, forming the uterovaginal canal and inserting into the urogenital sinus. At week twelve, the Müllerian ducts fuse to create a primitive uterovaginal canal called unaleria. At month five, the vaginal canalization is complete and the fetal hymen is formed from the proliferation of the sinovaginal bulbs (where Müllerian ducts meet the urogenital sinus), and becomes perforate before or shortly after birth. | ||
| The hymen has no innervation. |
The hymen has no nerve innervation. In newborn babies, still under the influence of the mother's ], the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones that continue this effect.<ref name="McCann">McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, a)p.453, b)p.455 c)p.460.</ref> Their hymenal opening tends to be annular (circumferential).<ref name=heger>{{Cite book|last=Heger |first=Astrid | authorlink = Astrid Heppenstall Heger | coauthors=Emans, S. Jean and Muram, David |title=Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas |edition=Second |year=2000 |publisher=Oxford University Press |page=116 |isbn=0-19-507425-4 }}</ref> | ||
| Past ] stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age.<ref name="WebMD" /> During ], the hymenal opening can also be enlarged by ] or ] use, ]s with a ], regular physical activity or sexual intercourse.<ref name=emans/> Once a girl reaches puberty, the hymen tends to become very elastic. In one survey, only 43% of women reported bleeding the first time they had intercourse, indicating that the hymens of a majority of women are sufficiently open to prevent tearing.<ref name=emans/><ref name="McCann" /> | Past ] stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age.<ref name="WebMD" /> During ], the hymenal opening can also be enlarged by ] or ] use, ]s with a ], regular physical activity or sexual intercourse.<ref name=emans/> Once a girl reaches puberty, the hymen tends to become very elastic. In one survey, only 43% of women reported bleeding the first time they had intercourse, indicating that the hymens of a majority of women are sufficiently open to prevent tearing.<ref name=emans/><ref name="McCann" /> | ||
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| Prepubescent girls' hymenal openings come in many shapes, depending on hormonal and activity level, the most common being crescentic (posterior rim): no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1–2 to 10–11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on ] and activity levels, the hymenal tissue may be thicker, and the opening is often ] or erratically shaped.<ref name=heger/> In younger children, a torn hymen will typically heal very quickly. In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases.<ref name=emans/> | Prepubescent girls' hymenal openings come in many shapes, depending on hormonal and activity level, the most common being crescentic (posterior rim): no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1–2 to 10–11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on ] and activity levels, the hymenal tissue may be thicker, and the opening is often ] or erratically shaped.<ref name=heger/> In younger children, a torn hymen will typically heal very quickly. In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases.<ref name=emans/> | ||
| A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called Glaister Keen rod, is used for close examination of hymen or the degree of its rupture. In cases of suspected ] or ], a detailed examination of the hymen may be performed, but the condition of the hymen alone is often inconclusive.<ref name="Perlman"/> | A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called Glaister Keen rod, is used for close examination of hymen or the degree of its rupture. In forensic medicine, a physician who must swab this area of a prepubescent girl should avoid the hymen and swab the outer ] instead.<ref name=McCann>McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London. p.459.</ref> In cases of suspected ] or ], a detailed examination of the hymen may be performed, but the condition of the hymen alone is often inconclusive.<ref name="Perlman"/> | ||
| After giving birth, the vaginal opening usually has nothing left but hymenal tags (carunculae myrtiformes) and is called ''] introitus.'' | After giving birth, the vaginal opening usually has nothing left but hymenal tags (carunculae myrtiformes) and is called ''] introitus.'' | ||
Revision as of 21:04, 20 February 2015
"Himen" redirects here. For the village in Iran, see Himen, Iran. This article is about the vaginal membrane. For the god and other uses, see Hymen (disambiguation).| Hymen | |
|---|---|
 External genital organs of female. The labia minora have been drawn apart. | |
| Details | |
| Identifiers | |
| Latin | hymen vaginae |
| MeSH | D006924 |
| TA98 | A09.1.04.008 |
| TA2 | 3530 |
| FMA | 20005 |
| Anatomical terminology[edit on Wikidata] | |
The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina. In children, although a common appearance of the hymen is crescent-shaped, many shapes are possible.
The effects of sexual intercourse and childbirth on the hymen are variable. If the hymen is sufficiently elastic, it may return to nearly its original condition. In other cases, there may be remnants (carunculae myrtiformes), or it may appear completely absent after repeated penetration. Additionally, the hymen may be lacerated by disease, injury, medical examination, masturbation or physical exercise. For these reasons, the state of the hymen is not a conclusive indicator of virginity.
Development and histology
The genital tract develops during embryogenesis, from the third week of gestation to the second trimester, and the hymen is formed following the vagina. At week seven, the urorectal septum forms and separates the rectum from the urogenital sinus. At week nine, the Müllerian ducts move downwards to reach the urogenital sinus, forming the uterovaginal canal and inserting into the urogenital sinus. At week twelve, the Müllerian ducts fuse to create a primitive uterovaginal canal called unaleria. At month five, the vaginal canalization is complete and the fetal hymen is formed from the proliferation of the sinovaginal bulbs (where Müllerian ducts meet the urogenital sinus), and becomes perforate before or shortly after birth.
The hymen has no nerve innervation. In newborn babies, still under the influence of the mother's hormones, the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones that continue this effect. Their hymenal opening tends to be annular (circumferential).
Past neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age. During puberty, the hymenal opening can also be enlarged by tampon or menstrual cup use, pelvic examinations with a speculum, regular physical activity or sexual intercourse. Once a girl reaches puberty, the hymen tends to become very elastic. In one survey, only 43% of women reported bleeding the first time they had intercourse, indicating that the hymens of a majority of women are sufficiently open to prevent tearing.
Prepubescent girls' hymenal openings come in many shapes, depending on hormonal and activity level, the most common being crescentic (posterior rim): no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1–2 to 10–11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on estrogen and activity levels, the hymenal tissue may be thicker, and the opening is often fimbriae of uterine tube or erratically shaped. In younger children, a torn hymen will typically heal very quickly. In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases.
A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called Glaister Keen rod, is used for close examination of hymen or the degree of its rupture. In forensic medicine, a physician who must swab this area of a prepubescent girl should avoid the hymen and swab the outer vulval vestibule instead. In cases of suspected rape or child sexual abuse, a detailed examination of the hymen may be performed, but the condition of the hymen alone is often inconclusive.
After giving birth, the vaginal opening usually has nothing left but hymenal tags (carunculae myrtiformes) and is called parous introitus.
Anatomic anomalies
Anomalies of the female reproductive tract can result from agenesis or hypoplasia, canalization defects, lateral fusion and failure of resorption, resulting in various complications.
- Imperforate: hymenal opening nonexistent; will require minor surgery if it has not corrected itself by puberty to allow menstrual fluids to escape.
- Cribriform, or microperforate: sometimes confused for imperforate, the hymenal opening appears to be nonexistent, but has, under close examination, small perforations.
- Septate: the hymenal opening has one or more bands of tissue extending across the opening.
Hymenorrhaphy
Main article: Hymenorrhaphy
In some cultures, an intact hymen is highly valued at marriage in the belief that this is a proof of virginity. Some women undergo hymenorrhaphy, a restoration of their hymen for this reason.
Womb fury
In the sixteenth and seventeenth centuries, medical researchers used the presence of the hymen, or lack thereof, as founding evidence of physical diseases such as "womb-fury", i.e. (female) hysteria. If not cured, womb-fury would, according to these early doctors, result in death.
Other animals
Due to similar reproductive system development, many mammals, including chimpanzees, elephants, manatees, whales, and horses retain hymens.
See also
References
- ^ Emans, S. Jean. "Physical Examination of the Child and Adolescent" (2000) in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, Second edition, Oxford University Press. 61-65
- ^ Perlman, Sally E. (2004). Clinical protocols in pediatric and adolescent gynecology. Parthenon. p. 131. ISBN 1-84214-199-6.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Knight, Bernard (1997). Simpson's Forensic Medicine (11th ed.). London: Arnold. p. 114. ISBN 0-7131-4452-1.
- ^ Jacoby, David B.; Youngson, Robert M. (2005). Encyclopedia of Family Health (3rd ed.). Marshall Cavendish. p. 889. ISBN 0-7614-7486-2.
- ^ McCann, J; Rosas, A. and Boos, S. (2003) "Child and adolescent sexual assaults (childhood sexual abuse)" in Payne-James, Jason; Busuttil, Anthony and Smock, William (eds). Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media: London, a)p.453, b)p.455 c)p.460. Cite error: The named reference "McCann" was defined multiple times with different content (see the help page).
- ^ Heger, Astrid (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas (Second ed.). Oxford University Press. p. 116. ISBN 0-19-507425-4.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ "Imperforate Hymen". Web MD. Retrieved 2009-02-02.
Different normal variants in hymenal configuration are described, varying from the common annular, to crescentic, to navicular ("boatlike" with an anteriorly displaced hymenal orifice). Hymenal variations are rarely clinically significant before menarche. In the case of a navicular configuration, urinary complaints (e.g., dribbling, retention, urinary tract infections) may result. Sometimes, a cribriform (fenestrated), septate, or navicular configuration to the hymen can be associated with retention of vaginal secretions and prolongation of the common condition of a mixed bacterial vulvovaginitis.
- Steinberg, Avraham; Rosner, Fred (2003). Encyclopedia of Jewish Medical Ethics. ISBN 1-58330-592-0.
Occasionally, the hymen is harder than normal or it is complete and sealed without there being ... This condition is called imperforate hymen and, at times ...
{{cite book}}: Cite has empty unknown parameter:|coauthors=(help) - DeCherney, Alan H. (2002). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 602. ISBN 0-8385-1401-4.
Imperforate hymen represents a persistent portion of the urogenital membrane ... It is one of the most common obstructive lesions of the female genital tract. ...
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - "Muslim women in France regain virginity in clinics". Reuters. 2007-04-30.
'Many of my patients are caught between two worlds,' said Abecassis. They have had sex already but are expected to be virgins at marriage according to a custom that he called 'cultural and traditional, with enormous family pressure'.
- "The Hymen". University of California at Santa Barbara. Retrieved 2009-02-09.
The hymen can have very important cultural significance in certain cultures because of its association with a woman's virginity.
- ^ Sciolino, Elaine; Mekhennet, Souad (June 11, 2008). "In Europe, Debate Over Islam and Virginity". The New York Times. Retrieved 2008-06-13.
'In my culture, not to be a virgin is to be dirt,' said the student, perched on a hospital bed as she awaited surgery on Thursday. 'Right now, virginity is more important to me than life.'
{{cite news}}: Cite has empty unknown parameter:|coauthors=(help) - Hymenoplasty is depicted in a fictional context in "Everett Poe", an episode of the television series Nip/Tuck that was broadcast in 2007.
- Berrios GE, Rivière L. (2006) 'Madness from the womb'. History of Psychiatry. 17:223-35.
- The linkage between the hymen and social elements of control has been taken up in Marie Loughlin's book Hymeneutics: Interpreting Virginity on the Early Modern Stage published in 1997
- Blank, Hanne (2007). Virgin: The Untouched History. Bloomsbury Publishing. p. 23. ISBN 1-59691-010-0. Retrieved 2013-11-09.
- Blackledge, Catherine (2004). The Story of V. Rutgers University Press. ISBN 0-8135-3455-0.
Hymens, or vaginal closure membranes or vaginal constrictions, as they are often referred to, are found in a number of mammals, including llamas, ...
External links
- Magical Cups and Bloody Brides—the historical context of virginity
- Hymen gallery—Illustrations of hymen types
- 20 Questions About Virginity—Interview with Hanne Blank, author of Virgin: The Untouched History. Discusses relationship between hymen and concept of virginity.
- MedPix Teaching Case Radiology (US - ultrasound) of Hydrocolpos
- Evaluating the Child for Sexual Abuse at the American Family Physician
- My Corona: The Anatomy Formerly Known as the Hymen & the Myths That Surround It Scarleteen, Sex education for the real world
- The Hymen Myth
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