A large majority of women with vaginismus imagine that the hymen is the source of their suffering and that if, through a lifesaving operation, it were to be removed for good—namely with a hymenotomy—their sexuality would finally be liberated. Alas, it is not as easy as that; the problem is much more complicated than a simple membrane to be excluded!
The hymen has very few nerves; it constitutes a sort of ring one or two centimeters from the entrance of the vagina, and it has a hole that authorizes the flow of menstruation and discharge, so it is not an impassable wall as most think. Society, especially Arab-Muslim society, has sacralized this membrane; if a lady does not bleed, she is impure by definition. Stories abound in popular culture regarding wives who saw themselves repudiated during their wedding night just because there was no blood.
In the brain of a woman with vaginismus, the hymen automatically forms the dam that does not allow her to have penetration. The misfortune is that this false belief is supported by a large number of doctors who, once the woman tells them about the symptoms, almost always give the same diagnosis: hard hymen, an operation is needed.
I have thought at length about the question: why does this term come up often, and why do many professionals fail to identify the type of virginity and mechanically request a hymenotomy? It is very important to know the exact type of hymen.
Types of Hymen and Medical Interventions
- Annular Hymen: The most common is the annular or circular hymen with a variable central opening.
- Imperforate Hymen: There is the imperforate hymen with a membrane that lines the entrance of the vagina and does not let menstrual flows pass; therefore, this kind of case is easy to detect seeing as the girl will not have her period, and here the operation is required. A tiny notch is made to create the orifice, thus allowing the woman to live her cycles normally.
- Microperforate Hymen: The microperforate hymen covers almost the entire entrance of the vagina; generally, menstruation flows, but the person will not be capable of inserting a tampon or removing it. Due to the overly tiny size of the opening in this case, a small incision is necessary to enlarge it.
I must admit that I have only dealt with this type of membrane once. The lady had lost a lot of time not knowing what she had, thinking towards the end that she was suffering from vaginismus. A doctor gave her the right diagnosis: microperforate hymen. He was able to perform a small intervention on her, thus finally helping her to heal and have a fulfilled sex life.
It is for this reason that we, before starting the accompaniment, insist on the medical visit to rule out physical possibilities: type of hymen, malformation, or any other cause of a gynecological order. But unfortunately, many women I was able to coach were victims of a bad diagnosis, especially “hard hymen”; they had the intervention and it did not improve their case at all—on the contrary, some even had complications.
I remember a coachee, Jamila, married for eight years and still suffering from vaginismus. She also had an infantile uterus which reduced her possibility of having children. She had performed the hymenotomy and she bled for fifteen days. She reported to me that she had suffered a lot and that following the operation, she had a sort of small piece of membrane that grew in its place. She saw the doctor again, and they proposed a new intervention to enlarge the vagina, and it was the excessively high cost that dissuaded her! After two months of coaching, she was cured and was able to have the sexuality to which she aspired so much!
Other Hymen Variations
- Septate Hymen: There are other types of hymen like the bridged or septate hymen; it presents two tiny openings on the vagina instead of just one. Minor surgery is sufficient to remove the band of tissue in order to create a normal orifice.
- I accompanied a girl, Hanane, who had the septum and all the doctors advised her to have the operation; she categorically refused to undergo it. We were able to perform enormous work and finally she is cured, but what was stunning was not a drop of blood! She often repeated to me: “But where did the middle membrane go?”. What happened is simply that by dint of exercising and relaxing, her vagina reacted intuitively: opening to welcome the penis in the waltz of love and enjoyment because she was able to accept at the mental level that her body is created ingeniously and that her vagina dilates like a lotus flower to profit from sexuality in all its forms.
- Cribriform Hymen: There is also the cribriform or sieve-like hymen which comprises a membrane pierced with multiple small orifices; with that type, bleeding can sometimes be significant.
- Sclerotic or Carinate Hymen: Called by some doctors “vascularized hard,” with a thick and resistant membrane that hinders sexual relations.
- Other Forms: There exist others like the semi-lunar or falciform hymen with an opening that recalls the half-moon, the tabbed or pendant hymen with natural notches that resembles angina a bit by its shape, the fimbriated hymen or one with a sinuous edge, and the lobed hymen with congenital notches.
- Compliant Hymen: The compliant, tolerant, or labial hymen with an elastic membrane that dilates without bleeding and without tearing.
- Absent Hymen: Finally, the absent hymen; these are women who are born without a hymen.
Myths Surrounding Bleeding and Virginity
I often think of strict cultures that have wrongly accused young brides of being libertines because of the lack of blood the first time, knowing that more than 50% of women do not bleed. If the person is calmed and lubricated and appreciates the sexual act, the membrane relaxes, especially when foreplay has lasted long enough; penetration happens fluidly without causing the ravages so many individuals expect. If there is hemorrhaging, it is because the walls of the vagina are too vascularized or have presented an injury.
Especially in the case of girls who are contracted. The first time, the perineum can close automatically, and if the man tries to force it, damage is inevitable. There will be a sort of cut at the level of her perineum. A sexual relationship is a beautiful energy exchange; it is not a race or a sort of performance. The companion must take his time; if he feels that his partner is afraid, he must try to de-stress her to the maximum and things will happen naturally.
How is a Hymenotomy Performed and is it a Solution for Vaginismus?
The importance accorded to the hymen and the rituals around blood and the first penetration have contributed enormously to the vaginismus of several women; they were so afraid that it would hurt them that just thinking about it, they contract automatically. In popular culture, the hymen guarantees purity and virginity, but this is completely false; the person can have an active sex life—fellatio, sodomy—and keep her so-called hymen. Yet another may have never had intercourse and yet one can condemn her just because she did not bleed.
The reasons can be: either she was born without a hymen, or she has a compliant elastic hymen that does not bleed. Otherwise, in rare cases, she may have lost it while being young by riding a bike, horse riding, or gymnastics.
Hymenoplasty: Restoring the Hymen
In certain cultures, the certificate of virginity is still requested, which is in my sense a total aberration; it is for that reason that many girls, even educated ones of a certain level, have recourse to hymenoplasty to restore their hymen in order to avoid problems.
This intervention lasts approximately thirty minutes; the doctor uses an absorbable thread and general or local anesthesia depending on the patient. The surgeon sutures the remnants of the hymen to reform a fine membrane; if the remains of the hymen are not sufficient, he can harvest surrounding mucous membranes. The threads used disappear in two or three weeks. The person can leave the same day.
A friend reported to me that one day, one of her girlfriends who had lost her hymen following a long relationship that ended in failure, wanted to restart her life with another and she did not dare tell him the truth, so she went to have a hymenoplasty. Her husband could not conclude the sexual act because the lady was too tight. When she consulted her doctor again, he announced to her: “There, I made you impassable stitches; it looks like that of jeans.” Thus, your penetration will be of such difficulty that he will see nothing.
With this kind of story, one asks oneself the question: who is deceiving whom? Many Maghrebi and Arab women choose to live their sexuality freely, but always in a clandestine way, whereas men can strut about with the incalculable number of their female conquests, but the one he is going to marry would necessarily have accounts to render to him, and for him, impossible—it is his right!
All of this is a great aberration! The only explanations she would have to provide are to God according to her belief; fornication and adultery are forbidden for both sexes. Nevertheless, among certain couples, even Arab ones, we notice small changes starting to settle in, but there remains a way to go.
Hymenotomy for Vaginismus
For women with vaginismus, the question goes in the other direction: how do I get rid of my hymen, because it constitutes the barrier to my sexuality?
Quite a bizarre thing, many men consent and are willing for her to do it despite their quite present cultural heritage which says: it is I who should deflower her, make her a woman; it is the proof of my virility and her innocence. But by dint of attempts doomed to failure and the frustrations that come with them, they end up yielding and seeking hymenotomy or hymenectomy, which is basically a small intervention.
Some doctors can propose it without anesthesia, others with local anesthesia; the surgeon will use special tools to cut the membrane of the hymen in order to practice an opening. The size of the latter will depend on the thickness of the hymen, the fact that there was already an orifice, or other conditions to take into account. Once the opening is practiced, the surgeon will use stitches to secure these incisions; these points will be absorbed naturally as the body heals.
In the first days, urinating may be painful. It is to be noted that the person who undergoes this intervention can leave the hospital the same day; furthermore, she can feel quite well after a week or about a month. But in certain cases, the discomfort can persist for a few months.
The Reality of Surgical Interventions
The question I ask myself is: if the surgery happens as I mentioned and with all these precautions, how is it that there are many women with whom I have had the chance to exchange who have endured this operation without all these precautions? A phrase is always repeated: the doctor told me: “I made an opening and the husband can continue the work,” sometimes they ask them to do it the same day!
My sister Zoubida did this without anesthesia, without anything, and during all her intercourse, it was pain. She had to give birth vaginally to finally overcome all these discomforts caused by penetration.
Conclusion and Advice
In the context of vaginismus, it is fundamental to consult people well-sensitized to this problematic. For my part, I saw four of them and each one of them gave me a different type of hymen; the second had proposed the intervention, and it is for this motive that I have always recommended women to be sure before undertaking anything whatsoever, for the simple reason that I have been there and I know the torments and sufferings that a woman with vaginismus can go through.
What we must retain: no surgery unless being certain that it is inevitable; a vaginismus woman has enough fears and phobias as it is, adding to it with an operation really has nothing attractive!
I asked the question once to a doctor, Gislaine, who was also suffering from vaginismus. She was an angiologist I was accompanying in the framework of coaching. I wanted to know how is it that many gynecologists are not sensitized enough to the problematic of vaginismus. She answered me that in the modules studied, there is no specialization in vaginismus, so one must orient the affected persons towards a sexologist who can begin the psychological and even physical work. One can of course have recourse to a midwife or physiotherapist for more effectiveness in the results, otherwise training alone at home with one’s dilators can be of very precious help.
