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New York Times Is Wrong about Hymens--But They Are Not Alone

The Times shouldn't feel bad that it's wrong about the hymen.

The New York Times shouldn't feel bad that it's wrong about the hymen. When I was doing a recent update on the hymen for the next edition of my book, I learned that a large number of health care providers can't even correctly locate it. More to the point, I was humbled (okay, mortified) to find that I'd written incorrect information about the hymen in the past.

So let's start with one of the statements that was in today's New York Times in an article titled "Surgery Offers Muslim Women Illusion of Virginity." The Times describes the hymen as "the vaginal membrane that normally breaks in the first act of intercourse." This aligns closely with the popped cherry myth that still echoes through the pillars of popular culture.

The cherry-popping myth has us believe that the hymen covers the opening of the vagina like a layer of Saran Wrap over a bowl of last night's leftovers. The penis is like a finger that's being poked through the Saran Wrap (aka, losing your virginity). Fortunately, the myth has it all wrong.

A young woman's hymen usually changes as much as the rest of her body when she enters puberty. It not only changes shape, but it becomes more elastic—and it rarely goes pop. But first, let's see what modern science has to say about the Time's idea that the hymen normally "breaks" during the first act of intercourse.

A 2004 study published in the Archives of Pediatric Adolescent Medicine reported: "Subjects who admitted having past intercourse still had non disrupted, intact hymens in 52 percent of cases." This study of teenage girls found that "the mean width of the hymenal rim was 2.5 mm among the subjects admitting past intercourse and 3.0 mm among the group who denied past intercourse. This difference was not statistically significant..." The difference between the rim on a hymen that is 3.0 mm and 2.5 mm thick is .12 inches versus .1 inches, or 2/100s of an inch difference. Good luck telling which is which with the naked eye!

A study of the genitals (especially the hymens) of pregnant girls published that same year in Pediatrics found that "Despite definitive evidence of sexual contact (pregnancy), only 2 of 36 adolescents had genital changes that were diagnostic of penetrating trauma."

A 2002 study in Pediatrics investigated the question of whether hymenal measurements were useful in diagnosing previous penetration. After examining 386 children, the authors concluded, "Hymenal measurements are rarely useful as a diagnostic tool."

As for the ability of the hymen to heal when it is injured, a 2007 study in Pediatrics on hymens that had been injured reports, "The hymenal injuries in these prepubertal and adolescent girls all healed rapidly and frequently left little or no evidence of the previous trauma... These findings reaffirm the remarkably complex healing process that occurs after a hymenal injury. So even when the hymen does tear, it appears to have an amazing ability to heal and repair itself, at least in young women.

Another article in Pediatrics (2002) reported on two cases where girls had sustained a significant genital injury while on inline skates. Each of the girls had suffered accidental "rapid-splits" injuries that resulted in genital trauma and bleeding. Yet the authors found that "None of the children from this series was noted to have any significant injuries to the hymen."

Experts with sophisticated techniques can find clefts in some hymens that are consistent with the idea that a penis has been no stranger. But good luck finding the hymen that will provide undisputed proof.

It appears that the majority of sexually active women don't have clefts in their hymens. More importantly, the techniques and experience to make such conclusions are beyond the skills of the average physician, let alone a woman's boyfriend or boyfriend's mother.

Few people understand the extent to which the hymen changes at the time of puberty, give or take a few years. This change is due to the effect of estrogen on the hymenal tissue, which contains estrogen receptors. As was described in the 2007 Pediatrics article quoted above, hymens that do not yet have any estrogen effects tend to be "thin, delicate membranes with relatively smooth edges." The hymens of older girls which have been affected by estrogen tend to be "thicker and more redundant, and frequently had scalloped edges."

One of the reasons why hymens rarely "pop" during intercourse is because estrogen tends to make the hymen more elastic. It is as if nature anticipates that intercourse will begin shortly after puberty, and prepares the female body accordingly. Then again, there is only so much nature can do when faced with clumsy young couples and their rushed first intercourse. If there is pain from first intercourse, it is more likely because the woman is not adequately aroused and is proceeding without the benefit of lubrication and sexual swelling that nature intended, or she is so anxious or tense that the muscles in her pelvis are tightly clenched.

Also, the estrogen effect on some women's hymens is not as pronounced as on others, so there can be some hymenal stretching and pain during the first intercourse. I was told by one health care provider who does premarital exams that when she discovers a young woman's hymen is not fully estrogenized, she will often suggest that the woman use a bit of estrogen cream on her hymen to help the elasticity process.

Bleeding during one's first intercourse is not part of a secret arrangement or covenant between human beings and nature to certify female chastity. So if there is bleeding during the first intercourse, and it's not related to menstruation, it could be an indicator of what went wrong rather than what went right—although scientific studies on bleeding during first intercourse appear to be few and far between.

There are also cases where the hymen does stretch across the vaginal opening in ways that can most certainly cause pain or bleeding, but those are the exception rather than the rule. If there is a problem of this nature, a girl might notice it when trying to insert a tampon, or more likely when trying to pull the tampon out. (This is not meant to be medical advice. You are strongly advised to take it up with your health care provider if you have any questions or concerns.)

And what happens to the hymen over a woman's lifetime? Unfortunately, I know of no studies where odometers have been placed between women's legs and the wear and tear on their hymens evaluated over the long haul.

For the first time, we are now learning more about hymens for forensic reasons. In cases where the evidence for sexual abuse has been overwhelming, examinations have shown that the hymen looked perfectly normal. To better understand this seeming contradiction, most of the studies on the hymen have been related to injury and abuse rather than normal sexual behavior. So we are limited in what we can say about the hymen of a woman who has been in a loving sexual relationship.

So what are surgeons doing when they perform a "hymenoplasty?" You've got me. I would have liked to have seen The Times inquire further as to what "one semicircular cut" and "10 dissolving stitches" might do in reconstructing a woman's hymen. Are they trying to make it look like the non-estrogenized hymen of an 8-year-old instead of the estrogenzied hymen of an 18-year-old? These are questions I would hope we could hear answered by gynecologists who aren't financially and culturally invested in hymenoplasty.

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