Research Article
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Hymenoplasty Experience: Factors Associated with Dehiscence (Hymenoplasty Complications)

Year 2025, Volume: 16 Issue: Erken Çevrimiçi Yayınlar

Erhan Hüseyin Cömert , Emre Köle , Ömer Doğukan Saraç , Ozan Doğan , Eray Çalışkan

Abstract

Purpose: To evaluate outcome of hymenoplasties in private clinics and investigate the factors affecting the risk of dehiscence
Method: A retrospective cross-sectional survey of Obstetrics and Gynecology specialists trained over the last five years was conducted. Specialists from private clinics completed surveys on hymenoplasties performed. Rates and types of complications were requested and factors associated with wound dehiscence in patients undergoing permanent hymenoplasty was investigated with multivariate analysis.
Results:. A total of 968 patients were included. Hymenoplasty was performed for revirgination in 874 cases (90.2%), incision of the hymen for gynecological procedures in 82 (8.4%) cases and trauma in 12 cases (1.2%). Complications included wound dehiscence (26.1%), infection (1.7%), bleeding (1.7%), pain (1.5%), itching (1.4%) and dyspareunia (0.5%). The technique was permanent in 714 cases and temporary in 254 cases. Among the permanent hymenoplaty cases, multivariate logistic regression analysis showed that obesity (OR=3.1, 95%CI: 1.5-6.2, p=0.001) and tobacco use (OR=2.2, 95%CI: 1.3-3.8, p=0.003) increases the risk of dehiscence. Sedation decreased the risk of dehiscence when compared to local infiltration anesthesia (OR=0.56, 95%CI: 0.33-0.99, p=0.04). Every decrease in the polyglactin suture caliber decreased the risk of dehiscence (OR=0.22, 95%CI: 0.16-0.3, p<0.001)
This study showed that using 5.0 sutures, omitting infiltration anesthesia, and avoiding tobacco use may help decrease wound dehiscence after hymenoplasty

Keywords

Hymenoplasty wound dehiscence complications suture surgical technique infiltration anesthesia

References

  • 1. Logmans A, Verhoeff A, Raap RB, Creighton F, Van Lent M. Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Who wants the procedure and why. BMJ [Internet]. 1998 Feb 7 [cited 2024 Mar 10];316(7129):459. Available from: https://pubmed.ncbi.nlm.nih.gov/9492678/
  • 2. Foldès P, Droupy S, Cuzin B. Chirurgie cosmétique de l’appareil génital féminin. Progres en Urologie. 2013 Jul;23(9):601–11.
  • 3. Mirzabeigi MN JSMRAGJ. The nomenclature of “vaginal rejuvenation” and elective vulvovaginal plastic surgery. Aesthet Surg J. 2011;31(6):723–4.
  • 4. Essén B, Blomkvist A, Helström L, Johnsdotter S. The experience and responses of Swedish health professionals to patients requesting virginity restoration (hymen repair). Reprod Health Matters [Internet]. 2010 [cited 2024 Mar 10];18(35):38–46. Available from: https://pubmed.ncbi.nlm.nih.gov/20541082/
  • 5. Tschudin S, Schuster S, Dumont dos Santos D, Huang D, Bitzer J, Leeners B. Restoration of virginity: Women’s demand and health care providers’ response in Switzerland. Journal of Sexual Medicine. 2013;10(9):2334–42.
  • 6. Moore KL, Persaud TVN, Torchia MG. Embryologic Development of the Urogenital System. In: Moore KL, Persaud TVN, editors. The Developing Human: Clinically Oriented Embryology. 7th ed. Philadelphia: Saunders; 2003. p. 312.
  • 7. Stewart ST. Hymenal characteristics in girls with and without a history of sexual abuse. J Child Sex Abus [Internet]. 2011 Sep [cited 2024 Mar 10];20(5):521–36. Available from: https://pubmed.ncbi.nlm.nih.gov/21970644/
  • 8. Ou MC, Lin CC, Pang CC, Ou D. A cerclage method for hymenoplasty. Taiwan J Obstet Gynecol [Internet]. 2008 [cited 2024 Mar 10];47(3):355–6. Available from: https://pubmed.ncbi.nlm.nih.gov/18936008/
  • 9. Berenson A, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics [Internet]. 1991 [cited 2024 Mar 10];87(4):458–65. Available from: https://researchexperts.utmb.edu/en/publications/appearance-of-the-hymen-in-newborns
  • 10. Cook RJ, Dickens BM. Hymen reconstruction: ethical and legal issues. Int J Gynaecol Obstet [Internet]. 2009 [cited 2024 Mar 10];107(3):266–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19717149/
  • 11. Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med [Internet]. 2004 Mar [cited 2024 Mar 10];158(3):280–5. Available from: https://pubmed.ncbi.nlm.nih.gov/14993089/
  • 12. Prakash V. Hymenoplasty — how to do. Indian J Surg [Internet]. 2009 Sep [cited 2024 Mar 10];71(4):221. Available from: /pmc/articles/PMC3452628/
  • 13. Eserdaǧ 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 [Internet]. 2021 Mar 1 [cited 2024 Mar 10];41(3):333–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32236424/
  • 14. 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 Sep 16;44(10):NP722-NP729. doi: 10.1093/asj/ sjae117. PMID: 38789097.
  • 15. Ou MC, Lin CC, Pang CC, Ou D. A cerclage method for hymenoplasty. Taiwan J Obstet Gynecol [Internet]. 2008 [cited 2024 Mar 10];47(3):355–6. Available from: https://pubmed.ncbi.nlm.nih.gov/18936008/
  • 16. Ahmadi A. Ethical issues in hymenoplasty: views from Tehran’s physicians. J Med Ethics [Internet]. 2014 [cited 2024 Mar 10];40(6):429–30. Available from: https://pubmed.ncbi.nlm.nih.gov/23764547/
  • 17. Placik OJ, Devgan LL. Female Genital and Vaginal Plastic Surgery: An Overview. Plast Reconstr Surg [Internet]. 2019 Aug 1 [cited 2024 Mar 10];144(2):284E-297E. Available from: https://pubmed.ncbi.nlm.nih.gov/31348366/
  • 18. Corvera S, Gealekman O. Adipose Tissue Angiogenesis: Impact on Obesity and Type-2 Diabetes. Biochim Biophys Acta [Internet]. 2014 Mar [cited 2024 Mar 10];1842(3):463. Available from: /pmc/articles/PMC3844681/
  • 19. Lempesis IG, van Meijel RLJ, Manolopoulos KN, Goossens GH. Oxygenation of adipose tissue: A human perspective. Acta Physiol (Oxf) [Internet]. 2020 Jan 1 [cited 2024 Mar 10];228(1). Available from: https://pubmed.ncbi.nlm.nih.gov/31077538/
  • 20. Ye J. Emerging role of adipose tissue hypoxia in obesity and insulin resistance. Int J Obes (Lond) [Internet]. 2009 Jan [cited 2024 Mar 10];33(1):54–66. Available from: https://pubmed.ncbi.nlm.nih.gov/19050672/
  • 21. Ruthenborg RJ, Ban JJ, Wazir A, Takeda N, Kim JW. Regulation of Wound Healing and Fibrosis by Hypoxia and Hypoxia-Inducible Factor-1. Mol Cells [Internet]. 2014 Sep 9 [cited 2024 Mar 10];37(9):637. Available from: /pmc/articles/PMC4179131/
  • 22. Nauta TD, van Hinsbergh VWM, Koolwijk P. Hypoxic signaling during tissue repair and regenerative medicine. Int J Mol Sci [Internet]. 2014 Oct 31 [cited 2024 Mar 10];15(11):19791–815. Available from: https://pubmed.ncbi.nlm.nih.gov/25365172/
  • 23. Larouche J, Sheoran S, Maruyama K, Martino MM. Immune Regulation of Skin Wound Healing: Mechanisms and Novel Therapeutic Targets. Adv Wound Care (New Rochelle) [Internet]. 2018 Jul 1 [cited 2024 Mar 10];7(7):209–31. Available from: https://pubmed.ncbi.nlm.nih.gov/29984112/
  • 24. Barchitta M, Maugeri A, Favara G, San Lio RM, Evola G, Agodi A, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci [Internet]. 2019 Mar 1 [cited 2024 Mar 10];20(5). Available from: /pmc/articles/PMC6429075/
  • 25. Xanthakos SA, Khoury JC, Inge TH, Jenkins TM, Modi AC, Michalsky MP, et al. Nutritional Risks in Adolescents After Bariatric Surgery. Clin Gastroenterol Hepatol [Internet]. 2020 May 1 [cited 2024 Mar 10];18(5):1070. Available from: /pmc/articles/PMC7166172/
  • 26. Waisbren E, Rosen H, Bader AM, Lipsitz SR, Rogers SO, Eriksson E. Percent body fat and prediction of surgical site infection. J Am Coll Surg [Internet]. 2010 Apr [cited 2024 Mar 10];210(4):381–9. Available from: https://pubmed.ncbi.nlm.nih.gov/20347729/
  • 27. Ozimek A, Clavien PA, Nocito A. Wound Dehiscence. Totally Implantable Venous Access Devices: Management in Mid- and Long-Term Clinical Setting [Internet]. 2023 May 1 [cited 2024 Mar 10];157–60. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551712/
  • 28. Drucker M, Cardenas E, Arizti P, Valenzuela A, Gamboa A. Experimental studies on the effect of lidocaine on wound healing. World J Surg [Internet]. 1998 Apr [cited 2024 Mar 10];22(4):394–8. Available from: https://pubmed.ncbi.nlm.nih.gov/9523522/
  • 29. Morris T, Appleby R. Retardation of wound healing by procaine. Br J Surg [Internet]. 1980 [cited 2024 Mar 10];67(6):391–2. Available from: https://pubmed.ncbi.nlm.nih.gov/7388335/
  • 30. Nwaoz B, Sinnott CJ, Kuruvilla A, Natoli NB. Outcomes After Central Wedge Labiaplasty Performed Under General Versus Local Anesthesia. Ann Plast Surg. 2021 Jul 1;87(1s):S17–20.

Year 2025, Volume: 16 Issue: Erken Çevrimiçi Yayınlar

Erhan Hüseyin Cömert , Emre Köle , Ömer Doğukan Saraç , Ozan Doğan , Eray Çalışkan

Abstract

References

  • 1. Logmans A, Verhoeff A, Raap RB, Creighton F, Van Lent M. Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Who wants the procedure and why. BMJ [Internet]. 1998 Feb 7 [cited 2024 Mar 10];316(7129):459. Available from: https://pubmed.ncbi.nlm.nih.gov/9492678/
  • 2. Foldès P, Droupy S, Cuzin B. Chirurgie cosmétique de l’appareil génital féminin. Progres en Urologie. 2013 Jul;23(9):601–11.
  • 3. Mirzabeigi MN JSMRAGJ. The nomenclature of “vaginal rejuvenation” and elective vulvovaginal plastic surgery. Aesthet Surg J. 2011;31(6):723–4.
  • 4. Essén B, Blomkvist A, Helström L, Johnsdotter S. The experience and responses of Swedish health professionals to patients requesting virginity restoration (hymen repair). Reprod Health Matters [Internet]. 2010 [cited 2024 Mar 10];18(35):38–46. Available from: https://pubmed.ncbi.nlm.nih.gov/20541082/
  • 5. Tschudin S, Schuster S, Dumont dos Santos D, Huang D, Bitzer J, Leeners B. Restoration of virginity: Women’s demand and health care providers’ response in Switzerland. Journal of Sexual Medicine. 2013;10(9):2334–42.
  • 6. Moore KL, Persaud TVN, Torchia MG. Embryologic Development of the Urogenital System. In: Moore KL, Persaud TVN, editors. The Developing Human: Clinically Oriented Embryology. 7th ed. Philadelphia: Saunders; 2003. p. 312.
  • 7. Stewart ST. Hymenal characteristics in girls with and without a history of sexual abuse. J Child Sex Abus [Internet]. 2011 Sep [cited 2024 Mar 10];20(5):521–36. Available from: https://pubmed.ncbi.nlm.nih.gov/21970644/
  • 8. Ou MC, Lin CC, Pang CC, Ou D. A cerclage method for hymenoplasty. Taiwan J Obstet Gynecol [Internet]. 2008 [cited 2024 Mar 10];47(3):355–6. Available from: https://pubmed.ncbi.nlm.nih.gov/18936008/
  • 9. Berenson A, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics [Internet]. 1991 [cited 2024 Mar 10];87(4):458–65. Available from: https://researchexperts.utmb.edu/en/publications/appearance-of-the-hymen-in-newborns
  • 10. Cook RJ, Dickens BM. Hymen reconstruction: ethical and legal issues. Int J Gynaecol Obstet [Internet]. 2009 [cited 2024 Mar 10];107(3):266–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19717149/
  • 11. Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med [Internet]. 2004 Mar [cited 2024 Mar 10];158(3):280–5. Available from: https://pubmed.ncbi.nlm.nih.gov/14993089/
  • 12. Prakash V. Hymenoplasty — how to do. Indian J Surg [Internet]. 2009 Sep [cited 2024 Mar 10];71(4):221. Available from: /pmc/articles/PMC3452628/
  • 13. Eserdaǧ 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 [Internet]. 2021 Mar 1 [cited 2024 Mar 10];41(3):333–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32236424/
  • 14. 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 Sep 16;44(10):NP722-NP729. doi: 10.1093/asj/ sjae117. PMID: 38789097.
  • 15. Ou MC, Lin CC, Pang CC, Ou D. A cerclage method for hymenoplasty. Taiwan J Obstet Gynecol [Internet]. 2008 [cited 2024 Mar 10];47(3):355–6. Available from: https://pubmed.ncbi.nlm.nih.gov/18936008/
  • 16. Ahmadi A. Ethical issues in hymenoplasty: views from Tehran’s physicians. J Med Ethics [Internet]. 2014 [cited 2024 Mar 10];40(6):429–30. Available from: https://pubmed.ncbi.nlm.nih.gov/23764547/
  • 17. Placik OJ, Devgan LL. Female Genital and Vaginal Plastic Surgery: An Overview. Plast Reconstr Surg [Internet]. 2019 Aug 1 [cited 2024 Mar 10];144(2):284E-297E. Available from: https://pubmed.ncbi.nlm.nih.gov/31348366/
  • 18. Corvera S, Gealekman O. Adipose Tissue Angiogenesis: Impact on Obesity and Type-2 Diabetes. Biochim Biophys Acta [Internet]. 2014 Mar [cited 2024 Mar 10];1842(3):463. Available from: /pmc/articles/PMC3844681/
  • 19. Lempesis IG, van Meijel RLJ, Manolopoulos KN, Goossens GH. Oxygenation of adipose tissue: A human perspective. Acta Physiol (Oxf) [Internet]. 2020 Jan 1 [cited 2024 Mar 10];228(1). Available from: https://pubmed.ncbi.nlm.nih.gov/31077538/
  • 20. Ye J. Emerging role of adipose tissue hypoxia in obesity and insulin resistance. Int J Obes (Lond) [Internet]. 2009 Jan [cited 2024 Mar 10];33(1):54–66. Available from: https://pubmed.ncbi.nlm.nih.gov/19050672/
  • 21. Ruthenborg RJ, Ban JJ, Wazir A, Takeda N, Kim JW. Regulation of Wound Healing and Fibrosis by Hypoxia and Hypoxia-Inducible Factor-1. Mol Cells [Internet]. 2014 Sep 9 [cited 2024 Mar 10];37(9):637. Available from: /pmc/articles/PMC4179131/
  • 22. Nauta TD, van Hinsbergh VWM, Koolwijk P. Hypoxic signaling during tissue repair and regenerative medicine. Int J Mol Sci [Internet]. 2014 Oct 31 [cited 2024 Mar 10];15(11):19791–815. Available from: https://pubmed.ncbi.nlm.nih.gov/25365172/
  • 23. Larouche J, Sheoran S, Maruyama K, Martino MM. Immune Regulation of Skin Wound Healing: Mechanisms and Novel Therapeutic Targets. Adv Wound Care (New Rochelle) [Internet]. 2018 Jul 1 [cited 2024 Mar 10];7(7):209–31. Available from: https://pubmed.ncbi.nlm.nih.gov/29984112/
  • 24. Barchitta M, Maugeri A, Favara G, San Lio RM, Evola G, Agodi A, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci [Internet]. 2019 Mar 1 [cited 2024 Mar 10];20(5). Available from: /pmc/articles/PMC6429075/
  • 25. Xanthakos SA, Khoury JC, Inge TH, Jenkins TM, Modi AC, Michalsky MP, et al. Nutritional Risks in Adolescents After Bariatric Surgery. Clin Gastroenterol Hepatol [Internet]. 2020 May 1 [cited 2024 Mar 10];18(5):1070. Available from: /pmc/articles/PMC7166172/
  • 26. Waisbren E, Rosen H, Bader AM, Lipsitz SR, Rogers SO, Eriksson E. Percent body fat and prediction of surgical site infection. J Am Coll Surg [Internet]. 2010 Apr [cited 2024 Mar 10];210(4):381–9. Available from: https://pubmed.ncbi.nlm.nih.gov/20347729/
  • 27. Ozimek A, Clavien PA, Nocito A. Wound Dehiscence. Totally Implantable Venous Access Devices: Management in Mid- and Long-Term Clinical Setting [Internet]. 2023 May 1 [cited 2024 Mar 10];157–60. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551712/
  • 28. Drucker M, Cardenas E, Arizti P, Valenzuela A, Gamboa A. Experimental studies on the effect of lidocaine on wound healing. World J Surg [Internet]. 1998 Apr [cited 2024 Mar 10];22(4):394–8. Available from: https://pubmed.ncbi.nlm.nih.gov/9523522/
  • 29. Morris T, Appleby R. Retardation of wound healing by procaine. Br J Surg [Internet]. 1980 [cited 2024 Mar 10];67(6):391–2. Available from: https://pubmed.ncbi.nlm.nih.gov/7388335/
  • 30. Nwaoz B, Sinnott CJ, Kuruvilla A, Natoli NB. Outcomes After Central Wedge Labiaplasty Performed Under General Versus Local Anesthesia. Ann Plast Surg. 2021 Jul 1;87(1s):S17–20.
There are 30 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Erhan Hüseyin Cömert 0000-0003-1431-2294

Emre Köle 0000-0002-4940-8862

Ömer Doğukan Saraç 0000-0002-9397-428X

Ozan Doğan 0000-0002-0016-8749

Eray Çalışkan 0000-0002-6799-5909

Early Pub Date June 18, 2025
Publication Date
Submission Date February 5, 2025
Acceptance Date April 3, 2025
Published in Issue Year 2025Volume: 16 Issue: Erken Çevrimiçi Yayınlar

Cite

EndNote Cömert EH, Köle E, Saraç ÖD, Doğan O, Çalışkan E (June 1, 2025) Hymenoplasty Experience: Factors Associated with Dehiscence (Hymenoplasty Complications). Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 16 Erken Çevrimiçi Yayınlar