Re: GYN: Hymenectomy
From: steve (steve@dhngwe2.db.healthlink.org.za)
Sun Feb 27 01:35:29 2000
We see quite a lot of imperforate hymen - there were two in one
week, and one the next last month. For these we just make a
cruciate incision and enlarge the introitus digitally to between one
and two fingers. For your patient a digital enlargement under
anaesthesia to the same calibre should suffice and there should be
no need to cut or stitch. This way you won't have as much scar
tissue so the risk of dyspareunia will be less.
--
Steve Raymond
> 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
