The Impact of Hymenectomy on Future Gynecological and Obstetrical Outcomes

Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hemtometra, endometriosis and infertility. The accepted surgical treatment for imperforated hymen as well as some other hymental malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood.

Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy.

Methods: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988-2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy.

Results: During the study period, 56 out of 74,598 nulliparous women who delivered at the Soroka University Medical center had previously undergone a hymenectomy. In a univariate analysis, caesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4% vs 17.6% p=0.01) as were infertility treatments (10.7% vs 4.4% p=0.04) and dyspareunia (42.9% vs 0.2% p<0.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; P=0.001).

Conclusion: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.