A Cerclage Method for Hymenoplasty

Abstract

Hymen repair is ethically and culturally controversial, but is seen as an acceptable part of plastic and reconstructive surgery in many countries [1,2], especially for an intact hymen disrupted by a surgery. However, only two studies of outcomes from hymen repair have been reported to date; one did not describe the method used [3] and the other used approximation of the hymenal remnants [1]. We developed a cerclage method and compared it with the approximation method for the effectiveness of hymen repair. From 1991 through 2005, six women received the hymen repair operation. Their average age was 23.8 ± 2.4 years (range, 21–27 years). Two women underwent an approximation operation. The approximation method was performed as described by Logmans and colleagues [1]. The epithelium and scar tissue of the adjacent margins of hymenal remnants were removed. The neighboring hymenal remnants were then approximated with a 5-0 chromic catgut suture with a left-toright suture. The other four women underwent the cerclage operation. In this procedure, a 5-0 chromic catgut suture was introduced at the 6-o’clock position, about 2 to 3 mm into the edge of the hymenal remnants. Then, the suture was run clockwise into the submucosa to the 12-o’clock position, where the needle was pulled out. The needle was then re-introduced into the same small pore where it came out, and the suture was run clockwise back to the original 6-o’clock position. The needle was then pulled through the original needle pore. The ends of the suture were tied together around a 12-mm Hegar dilator to form an annular hymen, and the tie was placed under the mucosa. All the patients received consultation and evaluation before and after the operation to discuss the emotional and physical aspects of the procedure: the patient in 2005 was administered by a gynecologist and the other five by a social worker. All the patients returned to the clinic 1 week later to check the integrity of the hymen. In both patients who underwent the approximation method, the examination showed that some approximated wounds of the repaired hymen healed, while some had detached from each other with granulation tissue growth, and required a repeat procedure (Figure). In the four patients who received the cerclage method, the examination showed an intact annular hymen with a transhymenal diameter of about 1 cm in all four patients (Figure).