The shape, size, and thickness of the hymen vary from person to person. Typically, the hymenal opening is located in the center and is crescent-shaped. Occasionally, a septum may be present, dividing the hymenal opening into left and right halves, known as a septate hymen or bifenestrated hymen. There is also a sieve-like hymen that covers the vaginal opening, called a cribriform hymen. If the hymenal folds are excessively developed, resulting in an imperforate hymen, this is known as hymenal atresia, which is one of the more common developmental abnormalities of the female reproductive system.

bubble_chart Clinical Manifestations

When examining a vaginal septum, the first step is to check for the presence of small openings (often in the central area) on the septum. If there are perforations, a probe can be inserted to explore the width and depth of the vagina above the opening to clarify the diagnosis.

bubble_chart Diagnosis

The thickness of the transverse septum also varies greatly, with some being as thin as paper and others being thicker (1-1.5 cm). The interstitial tissue between the two layers of the adherent membrane may contain abundant collagen fibers and smooth muscle, occasionally mixed with mesonephric-like tissue components. The presence of clinical symptoms depends entirely on whether there are small holes in the septum. Complete transverse septa are rare; most have a small hole in the center of the septum, sometimes only large enough for a fine probe to pass through. If menstrual blood can flow out, symptoms may not occur until after marriage, when difficulties with intercourse or childbirth due to obstruction of the fetal head are encountered. If there is no hole, symptoms will appear after menarche due to the retention of menstrual blood. When examining a transverse vaginal septum, the first step is to check for small holes (often in the central area). If a hole is present, a probe can be inserted to explore the width and depth of the vagina above the hole to confirm the diagnosis.

bubble_chart Treatment Measures

During surgical excision, using the small hole as a reference point, make an X-shaped incision around it until reaching the vaginal wall. If the membrane is thin, the excess tissue of the septal membrane can be circumferentially excised. The two layers of the mucosal membrane at the incision are slightly freed from the base and then sutured longitudinally, creating a zigzag suture line that avoids a single plane to prevent future annular stenosis. If the membrane is thick, first make an X-shaped incision on the outer mucosal surface to a depth of half the thickness of the transverse septum, then separate the mucosal flaps. Next, make a cross-shaped incision on the inner transverse layer and interlock the four pairs of mucosal flaps in a staggered manner for suturing, ensuring that postoperative scar contracture does not lead to restenosis. If pregnancy occurs later, childbirth often cannot proceed smoothly, necessitating a cesarean section to complete delivery.