Exploring Hymenectomy as a Clinical Response to Vaginal Penetration Distress: A Literature Review

Hymenal-related distress—experienced as fear, pain, or avoidance of penetration—arises from both physical factors, such as anatomical variations, and psychological influences, including cultural beliefs, limited anatomical knowledge, and experiences of abuse. Hymenectomy, a straightforward outpatient procedure that removes or modifies hymenal tissue, is a well-supported treatment for structural hymenal problems, with literature primarily supporting its use in the relatively rare cases where the diagnostic presentation is clearly physical. However, little empirical evidence exists regarding how the procedure functions when the primary source of fear or phobia is psychological and the anatomy is normal. Recent conceptual work distinguishes fear-based penetration avoidance without pain—termed vaginal penetration phobia (VPP)—as a separate clinical phenomenon (Rabinowitz et al., 2017), further underscoring the need to examine psychological contributors to penetration distress. Using a biopsychosocial‑spiritual framework, this review underscores that no empirical studies have examined individuals’ awareness of hymenectomy, their anticipated or lived experiences of the procedure, or how it is positioned in relation to psychological distress and perceived normalcy with vaginal penetration.