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GYN: HymenectomyFrom: Garry Siegel (garrys@mindspring.com)Sat Feb 26 21:19:12 2000
I saw a 16 YO daughter of a patient of mine today who has, as best that I can tell, an imperforate hymen. The child had previously been seen by two gyns, and had bad experiences. Well, with that in mind, we chatted a good bit, looked at some pictures, and I just looked at her on the exam table, and was able to pass only a Qtip thru the hymen at the 6 o'clock position, and angle it upwards toward the urethra to demonstrate the hyment. I really couldn't inspect much more without her reacting, and she had been traumatized (their description) before, so I didn't push it, since we are headed for the OR. I had to run out of the office after the exam, and didn't have a chance to read my texts on the procedure. The pictures show that you make a cross type incision, and then stitch the borders with a running locked stich for hemostasis. In her case, all I think I will need to do is open the hymen superiorly, and suture the cut edges. What I'm wondering is whether I should resect it, or just open it, and let it retract. I favor the latter, but wonder if anyone has any practical experience. Also, what type of suture do you use--my preference for this mucosa would be a fine chromic so that it is absorbed quickly, as opposed to a vicryl which stays around longer (maybe vicryl rapide could be used). Any suggestions? Garry PS--an interesting sidebar--the Mom wrote me a letter about her daughter, so that she could tell me what had happened and what the problem was without the Mom getting emotional. She is a patient whom I've seen for several years once annually for paps, and I didn't deliver any of her children. In her letter, she said that she enjoyed my demeanor, but that she didn't feel as close to me as she did to her Ob who delivered her kids. This struck me as so true--how you bond with women when you care for them during a pregnancy, especially if you are a solo (I was for years) or in a small group, or if your situation allows you to see the gyn patients a good bit once pregnant. It also struck me that I have the same personality characteristics--favorable or not--for either the gyn or the ob patient, but that the Ob patient and I see each other so much more frequently, so we would be more likely to bond. This doesn't mean that you don't form relationships with nonOb patients; I guess you could consider surgery patients, with whom you have more contact, in a similar situation as compared to the ob ones. Food for thought. Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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