Excellent after simple resection; normal sexual function and fertility expected
Frequency
Rare
A septate hymen is a congenital variant of the hymen in which a persistent band of tissue divides the vaginal opening into two smaller openings. It often comes to attention when a person has difficulty inserting or removing tampons, a retained tampon, or painful penetrative sex, although menstrual flow is typically not obstructed.[1][2] Simple office resection under local anaesthesia is usually curative, and long-term sequelae are uncommon.[1] Medical bodies also note that hymenal appearance does not determine “virginity”, which is a sociocultural concept rather than a medical diagnosis.[3]
The hymen forms where tissue from the urogenital sinus meets the müllerian-derived vaginal canal. As the canal opens around birth, residual hymenal tissue typically retracts to a rim around the introitus. Variations in this remodelling produce several normal or clinically significant forms, including septate, microperforate, cribriform and imperforate hymens.[2] In a septate hymen, a midline band of persistent tissue creates two distinct openings.[4]
Morphology and classification
A septate hymen consists of a fibrous band that divides the hymenal opening into two orifices, most often vertically at the midline. Professional guidance groups septate hymen with microperforate and cribriform hymens as non-obstructive variants that may still cause symptoms, whereas imperforate hymen is obstructive.[2][5]
Signs and symptoms
Common presentations include difficulty inserting or removing tampons, a retained tampon, bleeding or pain with attempted vaginal penetration, or concern about a “double opening”. Menstrual efflux is usually present; malodorous discharge from partial retention is more often described with a microperforate hymen than with a septate hymen.[1] Atypical presentations have been reported, including inadvertent urethral insertion of a tampon with retention in the urinary bladder in the setting of an undiagnosed septum.[6]
Diagnosis
Diagnosis is clinical, based on inspection of the external genitalia with gentle labial traction. A cotton swab may be passed behind the tissue band to “tent” the septum and delineate its extent. If the swab cannot be passed posterior to an apparent band, a longitudinal vaginal septum should be suspected and pelvic ultrasonography considered; MRI is reserved for indeterminate cases or to delineate müllerian anomalies.[2][7] Referral studies indicate that initial hymenal variant diagnoses made in general settings may change after paediatric and adolescent gynaecology evaluation, underscoring the value of specialist assessment when the anatomy is unclear.[8]
Most septate hymens can be treated in a clinic setting with local anaesthesia using a tie-and-excision or incision technique, followed by trimming and absorbable sutures; general anaesthesia is usually unnecessary in adolescents.[2][4] After resection, emollients are applied during healing, and patients are advised to avoid tampon use and penetrative sex until discomfort resolves. Complications such as stenosis or adhesions are rare, and most patients resume usual activities within days.[1][4]
Outcomes
Published guidance and institutional overviews note excellent prognosis after simple resection, with normal sexual function and fertility expected.[1][9]
Epidemiology
Septate hymen is considered uncommon; estimates for congenital hymenal anomalies overall suggest rarity in the general population.[4] In a systematic newborn examination (n=468), septated or cribriform hymens together were observed in about 1% of neonates, with most configurations annular or fimbriated.[10] Reviews of gynaecologic findings in newborns and infants estimate that congenital hymenal anomalies (including imperforate, microperforate, cribriform and septate) collectively occur in roughly 3–4% of females.[11] Familial clustering is uncommon but has been documented, including dizygotic twins with sub-occlusive hymenal variants (microperforate and septate hymen).[12]
Society and culture
Professional guidance emphasises that hymenal findings do not establish sexual history. The concept of “virginity” lacks a medical definition, and hymenal shape or integrity is not a reliable indicator of sexual activity. Clinical descriptions should avoid terms such as “intact” or “broken” hymen in favour of specific anatomic findings.[2][3] Major medical and human-rights bodies state that practices marketed as “virginity testing” lack scientific validity and should be eliminated.[13][14][15]
1 2 3 4 5 6 "Diagnosis and Management of Hymenal Variants: ACOG Committee Opinion, Number 780". Obstetrics & Gynecology. 133 (6). American College of Obstetricians and Gynecologists: e372 –e376. June 2019. doi:10.1097/AOG.0000000000003283. PMID31135763.
↑ Watrowski, R.; Jäger, C.; Gerber, M.; Klein, C. (November 2014). "Hymenal anomalies in twins—review of the literature and case report". European Journal of Pediatrics. 173 (11). Springer: 1407–1412. doi:10.1007/s00431-013-2123-3. PMID23933671.
"Types of Hymens". Center for Young Women’s Health, Boston Children’s Hospital. Boston: Boston Children’s Hospital. 15 March 2023. Retrieved 14 September 2025.
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