Editing Hymen (section)

== Trauma ==
[[File:Hymen05.jpg|thumb|A hymen with a hymenal cleft visible on the left. ]]

Historically, it was believed that first sexual intercourse was necessarily traumatic to the hymen and always resulted in the hymen being "broken" or torn, causing bleeding. However, research on women in Western populations has found that bleeding during first intercourse does not invariably occur.<ref name=":3" /><ref name=":4" /><ref name=":5">{{Cite news|url=https://www.tijdschriftvoorseksuologie.nl/media/k2/attachments/loeberZtvsZ32-3.pdf|title=Over het zwaard en de schede; bloedverlies en pijn bij de eerste coïtus Een onderzoek bij vrouwen uit diverse culturen|last=Loeber|first=Olga|date=2008|work=Tijdschrift voor Seksuologie|access-date=2018-09-07|volume=32|pages=129–137|language=nl-nl|archive-date=November 5, 2019|archive-url=https://web.archive.org/web/20191105174514/https://www.tijdschriftvoorseksuologie.nl/media/k2/attachments/loeberZtvsZ32-3.pdf|url-status=dead}}</ref> In one cross-cultural study, slightly more than half of all women self-reported bleeding during first intercourse, with significantly different levels of pain and bleeding reported depending on their region of origin.<ref>{{Cite journal|last=Amy|first=Jean-Jacques|date=January 2008|title=Certificates of virginity and reconstruction of the hymen|journal=The European Journal of Contraception & Reproductive Health Care|language=en|volume=13|issue=2|pages=111–113|doi=10.1080/13625180802106045|pmid=18465471|s2cid=37484764|issn=1362-5187}}</ref><ref name=":5" /> Not all women experience pain, and one study found a correlation between the experience of strong emotions &ndash; such as excitement, nervousness, or fear &ndash; with experiencing pain during first intercourse.<ref name="Pain">{{Cite journal |doi = 10.1007/BF01542003|title = The experience of pain during women's first sexual intercourse: Cultural mythology about female sexual initiation|year = 1985|last1 = Weis|first1 = David L.|journal = Archives of Sexual Behavior|volume = 14|issue = 5|pages = 421–438|pmid = 4062539|s2cid = 6427129}}</ref>

In several studies of adolescent female rape survivors, where patients were examined at a hospital following sexual assault, half or fewer of survivors who had not had penetration previously had any injury to the hymen.<ref name=":6">{{Cite journal |vauthors=White C, McLean I |date=2006-05-01|title=Adolescent complainants of sexual assault; injury patterns in virgin and non-virgin groups|journal=Journal of Clinical Forensic Medicine|language=en|volume=13|issue=4|pages=172–180|doi=10.1016/j.jcfm.2006.02.006|pmid=16564196|issn=1353-1131|quote=Hymen injury was noted in 40 (50.6%) participants of the virgin group, but only 11 (12.4%) of the non-virgin group}}</ref><ref>{{Cite journal|last1=Adams|first1=Joyce A.|last2=Girardin|first2=Barbara|last3=Faugno|first3=Diana|date=May 2000|title=Signs of genital trauma in adolescent rape victims examined acutely|url=https://www.jpagonline.org/article/S1083-3188(00)00015-2/abstract|journal=Journal of Pediatric and Adolescent Gynecology|language=en|volume=13|issue=2|page=88|doi=10.1016/S1083-3188(00)00015-2|pmid=10869972|issn=1083-3188}}</ref><ref name=":7">{{Cite journal|date=2001-11-01|title=Adolescent Sexual Assault: Documentation of Acute Injuries Using Photo-colposcopy|journal=Journal of Pediatric and Adolescent Gynecology|language=en|volume=14|issue=4|pages=175–180|doi=10.1016/S1083-3188(01)00126-7|issn=1083-3188|quote=The incidence of hymenal tears in self-described virgins was higher than in nonvirgins (19% vs. 3%, P  .008);|last1=Adams|first1=Joyce A.|last2=Girardin|first2=Barbara|last3=Faugno|first3=Diana|pmid=11748013}}</ref> Tears of the hymen occurred in less than a quarter of cases.<ref name=":7" /> However, subjects that previously had not had penetrative intercourse were significantly more likely to have sustained injuries to the hymen than subjects who were found to have had penetrative intercourse.<ref name=":6" /><ref name=":7" />

In a study of adolescents who had previously had consensual sex, approximately half showed evidence of trauma to the hymen.<ref>{{Cite journal|last1=Adams|first1=Joyce A.|last2=Botash|first2=Ann S.|last3=Kellogg|first3=Nancy|date=March 2004|title=Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse|journal=Archives of Pediatrics & Adolescent Medicine|volume=158|issue=3|pages=280–285|doi=10.1001/archpedi.158.3.280|issn=1072-4710|pmid=14993089|quote=Subjects who admitted having past intercourse still had non disrupted, intact hymens in 52% of cases.|doi-access=free}}</ref><ref name=":8">{{Cite web|url=https://www.psychologytoday.com/gb/blog/you-it/200806/new-york-times-is-wrong-about-hymens-they-are-not-alone|title=New York Times Is Wrong about Hymens--But They Are Not Alone|website=Psychology Today|language=en-GB|access-date=2018-09-08}}</ref> Trauma to the hymen may also occur in adult non-virgins following consensual sex, although it is rare.<ref>{{Cite journal|last1=Slaughter|first1=Laura|last2=Brown|first2=Carl R.V.|last3=Crowley|first3=Sharon|last4=Peck|first4=Roxy|date=March 1997|title=Patterns of genital injury in female sexual assault victims|journal=American Journal of Obstetrics and Gynecology|volume=176|issue=3|pages=609–616|doi=10.1016/s0002-9378(97)70556-8|pmid=9077615|issn=0002-9378}}</ref> Trauma to the hymen may heal without any visible sign of injury.<ref name=":6" /><ref name=":8" /><ref name="emans" /> An observational study of adolescent sexual assault victims found that majority of wounds to the hymen healed without any visible sign of injury having occurred.<ref>{{Cite journal|last=Reading|first=Richard|date=2007-12-12|title=Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study|journal=Child: Care, Health and Development|language=en|volume=34|issue=1|pages=137–138|doi=10.1111/j.1365-2214.2007.00818_7.x|issn=0305-1862|quote=Of the girls who sustained 'superficial', 'intermediate,' or 'deep' lacerations, 15 of 18 prepubertal girls had smooth and continuous appearing hymenal rims, whereas 24 of 41 adolescents' hymens had a normal, 'scalloped' appearance and 30 of 34 had no disruption of continuity on healing. The final 'width' of a hymenal rim was dependent on the initial depth of the laceration. No scar tissue formation was observed in either group of girls.}}</ref>

Trauma to the hymen is hypothesized to occur as a result of various other behaviors, such as [[tampon]] or [[menstrual cup]] use, [[pelvic examination]]s with a [[Speculum (medical)|speculum]], [[masturbation]], gymnastics, or horseback riding, although the true prevalence of trauma as a result of these activities is unclear.<ref name="ucsb sexinfo" /><ref>{{Cite journal|date=1998-06-08|title=Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature|journal=Forensic Science International|language=en|volume=94|issue=1–2|pages=147–153|doi=10.1016/S0379-0738(98)00053-X|issn=0379-0738|last1=Goodyear-Smith|first1=Felicity A.|last2=Laidlaw|first2=Tannis M.|pmid=9670493}}</ref><ref>{{Cite journal|date=1994-07-01|title=Hymenal findings in adolescent women: Impact of tampon use and consensual sexual activity|journal=The Journal of Pediatrics|language=en|volume=125|issue=1|pages=153–160|doi=10.1016/S0022-3476(94)70144-X|issn=0022-3476|quote=Contrary to the popular belief that transections of the hymen are associated with gymnastics, horseback riding, and other vigorous sports, we found no relation between sports or gymnastics and hymenal changes. There was also no relation to prior gynecologic examination.|last1=Emans|first1=S.Jean|last2=Woods|first2=Elizabeth R.|last3=Allred|first3=Elizabeth N.|last4=Grace|first4=Estherann|pmid=8021768}}</ref>