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Hymenoplasty (Hymen Reconstruction)

Hymenoplasty (also called hymenorrhaphy or hymen reconstruction) sutures hymenal remnants or reconstructs a hymen, usually aiming to produce bleeding at later intercourse.[1][2] In one STSI series,28/51 patients who reported intercourse reported bleeding at first intercourse.[8] It is one of the least described vulvovaginal procedures in plastic surgery, with no surgical standard.[1] In the single-center Lahlali 2021 retrospective series, 227 of 529 restoration procedures in 518 patients were hymenorrhaphies.[1] No failure was reported in that group; those who reported intercourse within 15 days also reported bleeding.[1] For positioning versus other female cosmetic options see Cosmetic Genital Surgery — Female.

Society positioning and ethical context. ACOG Committee Opinion No. 795 (2020) classifies hymenoplasty as elective female genital cosmetic surgery. It states that such procedures are not medically indicated in the absence of a clinical indication, that women should be told high-quality data are lacking, and that patients should be assessed for body dysmorphic disorder (BDD) if indicated.[3] The FIGO 2025 statement defines cosmetic genital surgery as aesthetic alteration in women without structural or functional abnormalities and says it is ethically inappropriate for obstetrician-gynecologists to recommend, perform or refer patients for those procedures.[11] Legal status varies by jurisdiction. In the United Kingdom, the Health and Care Act 2022 made carrying out, offering, or facilitating hymenoplasty an offence in England and Wales, Scotland, and Northern Ireland from 1 July 2022. Verify local law before offering or facilitating a procedure.[12] A case report described a hymenorrhaphy that narrowed the introitus by suturing the labia minora; its authors classified that procedure under WHO definitions of female genital mutilation.[15]

Definition and terminology​

ProcedureDescription
HymenorrhaphyDirect suturing of existing hymen remnants together[1]
Hymenal-flap hymenoplastyReconstruction using the patient's own hymen remnant tissue as flaps[1]
Vaginal-flap hymenoplastyCreation of a neo-hymen from vaginal mucosal flaps when remnants are insufficient[1]

The procedure is classified by ACOG under elective female genital cosmetic surgery.[3]

Indications and motivations​

Elective hymenoplasty intended to simulate bleeding at later intercourse is not medically indicated; repair after trauma and procedures for symptomatic hymenal variants require separate clinical assessment.[3][13][14] Requests are driven primarily by sociocultural factors in communities where premarital virginity is expected and bleeding at first intercourse is considered proof of virginity.[2][5] Reported motivations include[5][6]:

  • Fear of social consequences: humiliation, ostracism, divorce, and in extreme cases "honor" violence or killing.
  • Desire to marry and become a mother in cultures where perceived virginity is a prerequisite.
  • Recovery from past sexual trauma, including rape or coercion.
  • Psychological well-being and a sense of bodily autonomy.

The clinician’s role includes a private assessment of coercion, threatened violence, immediate safety and informed consent; non-judgmental counseling that hymenal appearance and bleeding cannot establish sexual history, alongside the lack of high-quality outcome data, sociocultural pressures and alternatives; access to confidential psychosocial or safeguarding support; assessment for BDD when indicated; age-specific safeguarding (the 2023 S2k expert-consensus recommendation, consensus +++, states that non-medically indicated female genital surgery must not be performed during childhood[17]); and informed-consent documentation.[3][5][6][14]

Surgical techniques​

In Lahlali’s series, timing was the first decision: direct hymenorrhaphy when intercourse was planned less than 15 days after surgery; for longer intervals, hymenal flaps were used if remnants were present and vaginal mucosal flaps if they were absent.[1]

1. Hymenorrhaphy (temporary / simple repair)​

The edges of existing hymen remnants are approximated and sutured with absorbable suture (typically 5-0 polyglactin), leaving a small central opening. The simplest technique. It is considered temporary because absorbable sutures dissolve over weeks. In Lahlali 2021, 227 of 529 restoration procedures among 518 patients were hymenorrhaphies. There was no reported failure, and all patients who had intercourse within 15 days bled.[1]

2. Hymenal-flap hymenoplasty​

When sufficient hymenal remnants were present, Lahlali’s method incised and sutured them as flaps, with posterior perineorrhaphy to reduce suture tension and midline levator approximation to narrow the introitus.[1] In the same Moroccan series, 39% of the 529 restoration procedures used hymenal flaps.[1]

3. Vaginal-flap hymenoplasty​

When remnants were absent, Lahlali’s vaginal-flap method used posterior perineorrhaphy and donor-site closure, then de-epithelialized, overlapped, and sutured vaginal mucosal flaps to create a neo-hymen.[1] In Lahlali 2021, 19% of the 529 restoration procedures used vaginal flaps, with only 1 reported failure among 99 vaginal-flap procedures.[1]

4. Vestibulo-introital tightening technique (Eserdağ 2021)​

A diamond-shaped incision is made in the vestibulum with the base at the posterior midline and the superior corner 2–3 cm above the hymen. The submucosal layer is closed from the apex downward, incorporating vaginal mucosa. This reduces tension on the hymen alone and adds introital tightening. In this retrospective series of 145 procedures, satisfaction was 99.3% and no adverse events were observed.[7]

5. STSI (Suture Three Stratums around the Introitus)​

The STSI technique sutures three tissue layers around the introitus. In this retrospective series (n = 125), healing was recorded in 91.9% (91/99 who returned at 1 month). Among the 51 patients who had intercourse afterward, 92.2% (47/51) were satisfied and 54.9% (28/51) reported bleeding at first intercourse.[8]

6. Introital fascial approach — temporary vs permanent (Dogan 2024)​

A 2024 retrospective comparison of temporary and permanent introital fascial repairs reports an internally inconsistent cohort: 246 analyzed patients versus 146 temporary plus 140 permanent (286 total); its abstract gives 2015–2023 and Methods give January 2018–June 2023.[9] The paper inconsistently labels this patient-reported endpoint as adequacy of bleeding amount in Methods/Table 2 and as duration in its abstract/results; report it as bleeding satisfaction without specifying which construct was measured.[9]

EndpointTemporaryPermanent
Bleeding satisfaction100%78.6% (110/140)
Pain at first intercourse (VAS)7.0 (IQR 6–7)4.0 (IQR 2–5)
Median age27 yr24 yr
DurabilityDays–weeksMonths–years

Temporary vs permanent hymenoplasty​

FeatureTemporaryPermanent
Timing before intercourseLahlali direct repair: less than 15 days; Dogan temporary fascial repair: within 5 daysDogan permanent fascial repair: allow 6–8 weeks for initial healing[1][9]
Proposed bleeding mechanismSuture or mucosal disruption is plausible but was not measuredDisruption of reconstructed tissue is plausible but was not measured[9]
Bleeding satisfaction100%78.6%[9]
Pain at first intercourse (VAS)7.04.0
Typical ageOlder (median 27 yr)Younger (median 24 yr)[9]
DurabilityDays–weeksMonths–years

Anesthesia and perioperative management​

  • Anesthesia. Typically local with epinephrine as an outpatient procedure; sedation or general anesthesia per preference and technique complexity.[1][7]
  • Operative time. Lahlali reported an overall mean of 25 min (range 10–40 min) across its repair types.[1]
  • Preoperative exclusions. Lahlali deferred procedures for active genital infection, vestibular inflammatory disease, menstruation, or delayed menses before pregnancy was excluded.[1]
  • Postoperative care.
    • Topical emollients (petroleum jelly, zinc-based cream) to the surgical site.
    • Pain management with NSAIDs or topical anesthetic jelly (typically minimal).
    • In Lahlali’s series, tampons were avoided after surgery; intercourse timing should be specific to the repair. Dogan’s temporary fascial protocol advised intercourse within 5 days, whereas its permanent repair required 6–8 weeks for wound healing.[1][9]
    • Keep the introitus clean and dry.

Complications​

Complication reporting varied across early series: Lahlali reported 20/203 hymenal-flap wound dehiscences before intercourse and 3/203 postcoital hemorrhages requiring surgery; Eserdağ reported no adverse events in 145 vestibulo-introital procedures, and Wei reported one early uncontrolled bleed in 125 STSI patients.[1][7][8] In a 2025 retrospective survey of private clinics, 968 fully completed records from 1,171 reported procedures included cosmetic and clinically indicated hymenal procedures; 253 permanent-hymenoplasty cases had wound dehiscence requiring revision within 1–3 months (253/714 permanent cases; 253/968, or 26.1%, of all completed records).[13] The survey’s incomplete records and discordant technique labels limit interpretation of its 253/714 permanent-repair ratio as a technique-specific incidence or a generalizable rate.[13] ACOG lists pain, bleeding, infection, scarring, adhesions, altered sensation, dyspareunia and need for reoperation as potential complications of female genital cosmetic surgery.[3]

ComplicationNotes
PainPain at first intercourse was higher after temporary than permanent hymenoplasty (median VAS 7.0 vs 4.0).[9]
BleedingWei reported one uncontrolled early postoperative bleed among 125 STSI patients (0.8%); a later private-clinic survey recorded bleeding in 17/968 mixed-technique records (1.7%).[8][13]
InfectionA retrospective private-clinic survey recorded infection in 17/968 completed records (1.7%); the sample included cosmetic and clinically indicated procedures.[13]
Scarring / adhesionsLahlali reported tight scars requiring resection after 5/99 vaginal-flap procedures; adhesions were not separately quantified.[1]
Altered sensationNot quantified in the cited series.
DyspareuniaIn the 125-patient STSI series, long-term telephone follow-up suggested no persistent dyspareunia, menstruation changes, or other health problems.[8]
Introital narrowingLahlali reported difficult penetration requiring surgical separation after 5/203 hymenal-flap procedures and suture resection after 10/99 vaginal-flap procedures; narrowing was not separately measured. A 2023 case report described painful, obstructed penetration after labial apposition, treated with inferior defibulation and suture removal.[1][15]
ReoperationA retrospective private-clinic survey reported dehiscence revisions in 253/968 completed records (26.1%) within 1–3 months; in records labeled permanent repair, obesity and tobacco use were associated with dehiscence in multivariable analysis (OR 3.1 and 2.2, respectively).[13]

Outcomes​

Retrospective STSI and vestibulo-introital series reported outcome satisfaction of 47/51 (92.2%) among STSI patients who reported intercourse and 99.3% after 145 vestibulo-introital procedures, with few reported complications.[7][8] In a separate retrospective comparative study, 110/140 (78.6%) permanent-repair patients reported satisfaction with bleeding, but the publication inconsistently labels this endpoint as amount versus duration.[9] After STSI, 28/51 patients who reported intercourse (54.9%) also reported bleeding at first intercourse.[8] In a separate Dutch two-center cohort, 17/19 women who underwent reconstruction and attended follow-up reported no bleeding at first marital intercourse.[16] ACOG states that the safety and effectiveness of female genital cosmetic procedures have not been established.[3]

DomainKey points
In favor (clinician-side arguments)Patient autonomy and bodily self-determination; protection from violence, ostracism, or death; mental and social well-being as components of health; pragmatic empowerment in some patients' own framing.[5][6]
Against (clinician-side arguments)Inherently deceptive in some framings; reinforces patriarchal norms and gender inequality; not medically necessary; perpetuates the myth that an "intact hymen" equates to virginity.[5][6]
ACOG 2020Not medically indicated; counsel about lack of high-quality data and potential complications; assess for BDD if indicated, and refer for evaluation before surgery when psychological concerns are suspected.[3]
FIGO 2025Ethically inappropriate for obstetrician-gynecologists to recommend, perform or refer for cosmetic genital surgery; counsel that procedures are not medically indicated and carry potential risks.[11]
Legal statusCook and Dickens's 2009 ethical and legal analysis described hymen reconstruction as generally lawful and distinguished it from female genital cutting under the law discussed at that time.[4] The Health and Care Act 2022 prohibits carrying out, offering, or aiding hymenoplasty throughout the UK; specified offences also apply to UK nationals and habitual residents abroad.[12][14] Check applicable local law before proceeding.
Islamic ethico-legal perspectivesTwo opinions: always impermissible; or generally impermissible but licit when risks of not having post-coital bleeding are sufficiently great (e.g., threat of violence).[10]
Practice variabilityNo standard of practice; institutional consultation approaches vary widely (pedagogical / counseling-first vs more practical), producing significantly different surgical rates.[2][6]

Key takeaways​

  • Technique complexity and risks differ by repair.[1][3][9][11][13][16]
  • A retrospective comparative study reported 110/140 (78.6%) satisfaction with bleeding after permanent introital-fascial repair, with the endpoint inconsistently labeled amount versus duration[9] and 99.3% patient satisfaction after 145 vestibulo-introital tightening procedures[7]. A separate private-clinic survey reported wound-dehiscence revisions in 253/968 completed records involving cosmetic and clinically indicated procedures.[13] The absence of a standard technique, inconsistent outcome measures, and limited comparative data constrain inference.[1][3]
  • Obtain informed consent, assess for BDD when indicated, and take the sociocultural context of the request into account.
  • Check local law. Hymenoplasty is prohibited throughout the UK.[14]

Postoperative management​

  • Activity restriction. Set intercourse, tampon-use, and strenuous-exercise restrictions for the chosen repair and wound healing. Lahlali's retrospective hymenorrhaphy series reported bleeding at intercourse within 15 days in a subgroup whose size was not specified.[1]
  • Wound care. Topical emollient and loose-fitting clothing; follow repair-specific bathing instructions. Lahlali’s series advised avoiding baths, tampons, and self-examination after surgery.[1]
  • Counseling. Bleeding at first intercourse is not guaranteed even with successful reconstruction (28/51 [54.9%] STSI patients who reported intercourse reported bleeding at first intercourse[8]; 110/140 [78.6%] permanent introital-fascial repair patients reported satisfaction with bleeding (labeled amount and duration in different sections of the publication)[9]).

See Also​

References​

1. Lahlali A, Sawan D, SidAhmed-Mezi M, Meningaud JP, Hersant B. Hymen restoration: an experience from a Moroccan center. Aesthet Surg J. 2021;41(12):NP2053–NP2059. doi:10.1093/asj/sjab276

2. Ayuandini S. How variability in hymenoplasty recommendations leads to contrasting rates of surgery in the Netherlands: an ethnographic qualitative analysis. Cult Health Sex. 2017;19(3):352–365. doi:10.1080/13691058.2016.1219919

3. Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. Elective female genital cosmetic surgery: ACOG Committee Opinion No. 795. Obstet Gynecol. 2020;135(1):e36–e42. doi:10.1097/AOG.0000000000003616

4. Cook RJ, Dickens BM. Hymen reconstruction: ethical and legal issues. Int J Gynaecol Obstet. 2009;107(3):266–269. doi:10.1016/j.ijgo.2009.07.032

5. Wild V, Poulin H, McDougall CW, Stöckl A, Biller-Andorno N. Hymen reconstruction as pragmatic empowerment? Results of a qualitative study from Tunisia. Soc Sci Med. 2015;147:54–61. doi:10.1016/j.socscimed.2015.10.051

6. Anderson C, Cresswell J, Tetz G, Zare S. Do you do hymenoplasty? Doctors' ethical, cultural and social dilemmas when faced with this question. Cult Health Sex. 2025;1–15. doi:10.1080/13691058.2025.2498425

7. Eserdağ S, Kurban D, Kiseli M, Alan Y, Alan M. A new practical surgical technique for hymenoplasty: primary repair of hymen with vestibulo-introital tightening technique. Aesthet Surg J. 2021;41(3):333–337. doi:10.1093/asj/sjaa077

8. Wei SY, Li Q, Li SK, et al. A new surgical technique of hymenoplasty. Int J Gynaecol Obstet. 2015;130(1):14–18. doi:10.1016/j.ijgo.2014.12.009

9. Dogan O, Ucar Kartal D, Aktoz F, Yassa M. Patient satisfaction and bleeding rates following an introital fascial approach for temporary and permanent hymenoplasty techniques: a comparative study. Aesthet Surg J. 2024;44(10):NP722–NP729. doi:10.1093/asj/sjae117

10. Bawany MH, Padela AI. Hymenoplasty and Muslim patients: Islamic ethico-legal perspectives. J Sex Med. 2017;14(8):1003–1010. doi:10.1016/j.jsxm.2017.06.005

11. Capito L, Antsaklis A, Gupte S; FIGO Committee on Ethical Aspects of Human Reproduction and Women's Health. FIGO statement: cosmetic genital surgery. Int J Gynaecol Obstet. 2025;170(1):11-14. doi:10.1002/ijgo.70203

12. United Kingdom Parliament. "Health and Care Act 2022, Part 5, Chapter 2: Hymenoplasty offences." legislation.gov.uk. 2022. https://www.legislation.gov.uk/ukpga/2022/31/2022-07-01?view=extent

13. Cömert EH, Köle E, Saraç ÖD, Doğan O, Çalışkan E. "Hymenoplasty experience: factors associated with dehiscence (hymenoplasty complications)." Acibadem Univ Saglik Bilim Derg. 2025;16(3):362-366. doi:10.31067/acusaglik.1633538

14. United Kingdom Government. "Virginity testing and hymenoplasty: multi-agency guidance." GOV.UK. 2022. https://www.gov.uk/government/publications/virginity-testing-and-hymenoplasty-multi-agency-guidance/virginity-testing-and-hymenoplasty-multi-agency-guidance

15. Pace M, Broquet C, Peter C, Abdulcadir J. "Complications of hymenoplasty." BMJ Case Rep. 2023;16(10):e251008. doi:10.1136/bcr-2022-251008

16. van Moorst BR, van Lunsen RHW, van Dijken DKE, Salvatore CM. "Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction." Eur J Contracept Reprod Health Care. 2012;17(2):93-105. doi:10.3109/13625187.2011.649866

17. Beckmann MW, Borkenhagen A, Fahlbusch C, et al. "Reconstructive and Aesthetic Surgeries on the Female Genitalia. Guideline of the DGGG, DGPRÄC, OEGGG and SGGG (S2k-Level, AWMF Registry No. 009/019, May 2022)." Geburtshilfe Frauenheilkd. 2023;83(7):802–826. doi:10.1055/a-2065-4458