Hymenoplasty

The hymen is a thin, pinkish membrane that covers the vaginal entrance. It lies about half an inch inside the vagina and is a part of the vulva (the external part of the vagina). 
The exact function of the hymen is not known. It may prevent pathogens from entering the vagina until puberty. It usually ruptured during the first sexual experience that one has. But, it may also rupture while performing strenuous activities like swimming, gymnastics, or riding a cycle. Sometimes, it my rupture while using tampons and in some cases, a woman may be born without a hymen altogether.

Types:
The different types of abnormal hymen tissues which may need repair include:
Imperforate hymen: This type of hymen is seen when the entire vaginal opening blocks the menstrual flow. A hymenoplasty procedure called hymenotomy is done in such cases to make a small hole in the membrane and allow menstrual flow.
Septate hymen: It is a rigid and thick type of hymen or a hymen that has split into rope-like bands. The condition can be corrected by penile penetration, use of tampons, or by performing a hymenotomy.
Microperforate hymen: This type of hymen has a small opening allowing menstrual flow. It usually does not need any treatment. Hymenoplasty may be performed only in cases of women who wish to use tampons.
Cribriform hymen: This is a rare type of hymen that has many openings. This makes it difficult for a woman to insert a tampon or experience sexual pleasure. Hymenoplasty may be needed to correct this condition.

Eligibility:
The following women are eligible for undergoing hymenoplasty procedure:

• Women of consensual age
• Non-smoker
• Healthy woman with no serious conditions or illnesses like cancer

Contra-indications:
Hymenoplasty is generally not recommended in the following cases:

• Genital cancers
• Sexually transmitted diseases
• Girls below 18 years of age

Symptoms

The following are the reasons for undergoing a hymenoplasty procedure:

• Blocked hymen creating problems with menstrual flow
• Hymen having a complicated and thick structure (septate hymen)
• Treatment of accidental hymen rupture
• Tightening of vaginal muscles after childbirth or to repair flaccidity due to old age
• For cultural and psychological reasons

Diagnosis

1. Physical examination: The doctor will first physically examine the patient. The patient’s complete medical history and sexual history is noted by the doctor.
2. Pelvic exam: The doctor will insert one or two gloved, lubricated fingers into the vagina to check if the hymen is torn or intact. If the hymen is intact, the doctor will check for its thickness and if it is obstructing the flow of the blood during menstruation by blocking the vagina.
3. Pelvic or vaginal ultrasound: Sound waves are used to create clear pictures of the female reproductive organs. It helps the doctor in confirming the diagnosis of a septate hymen or an imperforate hymen.

Treatment

Hymenoplasty can be performed using the following different techniques:
The basic technique:

• This procedure can be done under local anesthesia (the surgical site is numbed) or general anesthesia (the patient will be put to sleep before the procedure).
• This technique is used when there are hymen remains present.
• The hymen remains are stitched back together using dissolvable sutures or stitches.
• After the stitches dissolve, the scars will start dissolving within the vaginal lip folds, and it will then appear exactly like an intact hymen.
• The procedure takes about 30 to 45 minutes to complete and is usually done on an outpatient basis (the patient goes home on the same day of the surgery).

The alloplant technique:

• This technique is performed under local anesthesia.
• It is performed when the hymen remnants cannot be stitched back together.
• The surgeon inserts a biomaterial which is chemically processed, known as an alloplant, into the vagina and this tear-through material will then function like a hymen.
• This procedure takes approximately two hours to complete.

Hymen reconstruction:

• The surgeon creates a new hymen using the tissues from the lips of the vagina in this procedure.
• Sexual intercourse needs to be avoided for a minimum of three months after this procedure.

Laser reconstruction hymenoplasty:

• This procedure involves complete hymen reconstruction using laser beams.
• Following recovery, the hymen will replicate a natural hymen.

Laser vaginal rejuvenation:

• Laser beams are used in this procedure to fix a torn hymen and also tighten, restore the natural lubrication, and improve the appearance of the vagina.
• This is a non-invasive procedure having a quicker recovery, and fewer complications than other procedures.

Risks

The complications associated with a hymenoplasty procedure are:

• Inflammation or swelling near the surgical area
• Spot bleeding for a few days after the surgery
• Itchiness due to the stitches
• Allergic reaction to the anesthetic agent used
• Foul-smelling, unusual discharge from the vagina
• Nausea
• Vomiting
• Blood clot formation
• Numbness
• Discoloration of the hymen
• Infection
• Hematoma (collection of blood outside of the blood vessels)

After Procedure

• The patient usually goes home on the same day after a hymenoplasty procedure.
• The patient can resume work 3 to 4 days after the surgery. Complete healing my however take approximately 4 to 6 weeks.
• Keep the surgical area clean and hygienic.
• Take all the medications prescribed by the doctor to prevent any infections.
• Avoid smoking or alcohol consumption for three to four weeks after hymenoplasty surgery.
•  Avoid strenuous activities and heavy lifting for two to three weeks after a hymenoplasty.
• Avoid any sexual activity for six to eight weeks after a hymenoplasty surgery.
• Avoid public swimming pools and saunas for a minimum of four to six weeks after surgery.
• Do not use tampons, instead use sanitary pads for at least four to six weeks after surgery.

Home-remedies:

Certain home remedies can help you in recovering quickly after a hymenoplasty surgery and may include the following:

• Use an ice pack or warm compress to relieve pain and swelling after the surgery.
• Clean the perineum area by washing it using gentle soap and water. Avoid cleaning the interiors of the vagina.
• Avoid any movement for two to three days after the surgery to prevent the disruption of the wound.
• Use sanitary wipes after passing urine for about two weeks after the surgery to keep the surgical wound dry and free of any moisture to promote quicker healing.
• Take a shower only two to three days after surgery to minimize the risk of an infection.

Cost of hymenoplasty in India-

The cost of hymenoplasty in Mumbai is between INR 20,000 to INR 40,000.
The cost of hymenoplasty in Delhi is between INR 18,000 to INR 35,000.
The cost of hymenoplasty in Bangalore is between INR 18,000 to INR 35,000.
The cost of hymenoplasty in Chennai is between INR 15,000 to INR 30,000.