STOP PRESS; The Hymen is NOT a membrane that partially covers the vaginal opening?

After 24 years of nursing experience, the majority of this in women’s health, I have always thought that the Hymen was a thin membrane that partially covers the vaginal opening which could in some cases be torn by having sex or during sports. That is what it says in the anatomy books anyway.

So I was fascinated to hear about some exciting work which is being carried out by the RFSU (the Swedish Association for Sexuality Education). The RFSU are actively challenging and attempting to dispel myths and eradicate this description of the Hymen. They are carrying out informative campaigns in schools, educating professionals who work with women and have renamed the ‘Hymen’, now calling it the ‘Vaginal Corona’ (slidkrans in Swedish). Vaginal Corona has since been recognised by the Language Council of Sweden as a new word (Cinthio 2015).

I decided to look into this further to see if they were onto something or not.

What do the RFSU say about the Hymen?

“Known by the established term “hymen,” the vaginal corona is the subject of many myths and misunderstandings. The most important of these is the notion that a woman’s vaginal opening is covered by a membrane that ruptures on penetration. This is incorrect. There is no such membrane. RFSU wishes to dispel the myths and promote knowledge of the true facts. In this booklet, we aim to give you a more accurate idea of what you will find just inside the vaginal opening of every woman.”

The content in the following booklet is reviewed by Lena Marions, gynecologist at KI and Södersjukhuset.

http://www.rfsu.se/Bildbank/Dokument/Praktikor/praktika-Vaginal_corona2009.pdf?epslanguage=sv

What Anatomy and Gynaecology textbooks say

There is no mention of the term vaginal corona in any of the medical text books I sourced. However many of these have been written years before the word and concept was recognised. I am informed by the Midwives at RFSU that it is discussed in the 2 Gynaecology books (Lundberg and Löfgren-Mårtensson 2010 and Landgren 2011). Unfortunately I have been unable to find these in English, so cannot confirm that this is the case.

What is the hymen?

Historically the hymen has been generally described as a thin membrane that partially covers the vaginal entrance (Wilson 1987). It has also been described as a ‘circumferential skin structure composed of non hair-bearing skin’ that varies greatly in terms of size, shape, form and presence (O’Connell et al 2008). The vaginal opening changes in appearance from birth to puberty and is strongly influenced by Oestrogenic factors (Stewart 2011).

It is also believed that the hymen is an embryological remnant that mostly disappears or ‘perforates’ during the fifth gestational month (Stewart, 2011) or before the female child is born (Dane et al, 2007).

Statistically, 1 in 1000 to 1 in 10 000 girls are born with a ‘hymen imperforate’, (Parazzini and Cecchetti 1990) which is when the ‘membrane’ covering the vaginal entrance has not perforated in the fifth gestational month (Stewart, 2011) .

What is the Vaginal Corona?

The vaginal corona is located 1–2 cm inside the vaginal opening (RFSU 2009). The vaginal opening is encircled by elastic folds of mucous tissue, individually shaped in every female (H. Cinthio 2015).

Sex and the Hymen/vaginal corona

Bleeding on the night of the wedding was, and still is in some cultures, thought to be ‘proof’ of virginity and a sign of a ruptured hymen. However, this theory is being challenged by Medical Doctors and Academics who believe this is a widespread myth (Mernissi, 1982; Welchmann and Hossein, 2005; Essizoglu et al, 2011).

According to Essén et al (2010), factors that can increase the likelihood of bleeding include forced sex, lack of lubrication, physical anomalies or if the girl is very young. Therefore, voluntary sexual intercourse seldom leaves any visible changes.

If there is bleeding then it will be minor ruptures in the mucous folds and there may be discomfort which resolves with 24 hours (RFSU 2009). It is also now believed that the majority of women do not bleed during their first vaginal intercourse (H. Cinthio 2015).

Consequently virginity is not an anatomical characteristic that can be verified by a gynaecological examination but is viewed by some writers as a sociocultural construct that puts women in a subordinated position to men, (Christianson and Eriksson, 2011; van Moorst et al, 2012) which in turn leads to health disparities (Shalhoub-Kevorkian, 2005; Eich, 2010).

Does sport and physical activity break the Hymen/Vaginal Corona?

Some medical literature says that the hymen can be torn during sport or exercise (Goodyear-Smith et al 1998 and Adams et al 2004). However more recent literature reports that physical activity does not rupture the vaginal opening (Christianson M, and Eriksson C 2013).

Hymen or Vaginal Corona?

This is a very emotive and complex subject. Unfortunately most of the more recent literature is written by academics and medics in Sweden.

I have also discussed this issue with gynaecologists and women’s health specialists in the UK who are not aware of this pioneering work. Will other countries follow in the footsteps of the Swedish? Watch this space!