Pelvic Pain in teens and young women: is hymenectomy the answer?

The hymen is a thin tissue that lines and sometimes covers the vaginal opening in females.  This tissue varies in thickness, shape and elasticity between women.  Having an opening in the hymen is critical for the menstrual flow.  An imperforate hymen is the term used to describe the vaginal opening being covered by the hymen.  This is usually caught in teenage girls whose periods are painful due to a buildup of menstrual blood, or urinary retention. When this occurs, a surgical procedure called a hymenectomy is performed to open the vagina and allow for normal menstrual flow.

It happens often that the hymen is blamed for pain with insertion of tampons in teen girls.  While the hymen can be tender if there are dermatologic changes or muscle tension, it is important to understand it is not the only contributor to pain.  Unfortunately, in teen girls with painful insertion of tampons or pelvic exams, a hymenectomy can be recommended to the teen and her parents.  This should be approached with caution, removal of the hymen surgically does not remove the pain. 

In pelvic floor physical therapy, we see patients who have had hymenectomy, but still have pain with tampon use, speculum exams or vaginal penetration, often diagnosed as vaginismus or dyspareunia.  It is important to note that a hymenectomy is not considered a treatment for these pain conditions.  Unfortunately, the hymen is easy to blame, and is something a surgeon can remove in hopes of “cutting out the painful structure”.   We see this often: painful periods get a hysterectomy, but the pain does not stop; ovarian pain may get removal of ovaries, but the pain does not stop; coccyx pain and it is suggested to remove the coccyx…the story never ends.

Often, pelvic pain or vaginismus is related to tension in the pelvic floor muscles.  When this is the case, the surgical pain from the removal of the hymen feeds into the increased muscle tension causing more pain and more muscle tension.  The brain expects pain, and continues to feed this vicious cycle. 

Pelvic floor physical therapy is a gold standard treatment in breaking this pain cycle.  In our initial assessment, we look at the vulvar skin and the introitus or opening of the vaginal canal where the hymen lies.  We can gently palpate the tissue to assess hypersensitivity to light touch or if there is thickening of scar tissue of the hymenal ring.  Hypersensitivity can indicate a skin change, inflammation of the tissue, or a nerve concern.  A thickening of the hymenal ring can indicate a skin change or scar tissue.   With understanding and knowledge we can develop a plan of care that is specific to that patient’s needs.

In Pelvic Floor PT we will palpate the muscles of the pelvic floor to assess for trigger points and pain that reproduces the patient’s pain. We determine the muscular strength and coordination patterns. From there, we can develop an exercise program to help decrease the tension in the pelvic floor and improve the ability of the pelvic floor muscles to contract and relax.   

If you are having pain with putting in a tampon, it is important to see your OBGYN, but to also seek the care of a pelvic floor physical therapist to help you determine the best plan of care for you. Sometimes, surgery is a good option, but it is not always the best treatment for pelvic pain.  Your pelvic floor PT will work with your doctor to come up with the best plan for you.  We offer a free, 15 minute phone consultation to answer any questions and make sure you are in the right place to heal.