Microperforate hymen hurts!

Dear Nervous and Concerned,

The instructions included with tampon packages make it look so simple to use tampons. Nevertheless, not everyone is able to insert them effortlessly. Other women share your concern as well.

As you discovered in your own research, congenital malformation of the hymen can make it difficult or even impossible to insert tampons without pain. According to the Children's Hospital Boston, a microperforate hymen is a membrane that is present at birth and covers the area of the hymen but has a very small opening. The opening may get bigger as a girl grows older.

Women with microperforate hymens may have periods that last longer than four to seven days because the menstrual blood cannot come out at the rate that it typically would. During sex, the extra tissue may tear and cause pain. Some women with microperforate hymens may choose to have surgery to remove the extra hymeneal tissue. Alternately, a septate hymen, which is characterized by extra hymeneal tissue that runs vertically in the area of the normal hymen, may also make it painful to use tampons.

Anatomical anomalies are not always the reason why women have pain when trying to insert a tampon. Women with vaginismus experience involuntary muscle spasms that close the vagina, making it painful to insert a tampon, have sex, or have a pelvic exam, according to the National Institutes of Health. Vaginismus can be treated with a combination of vaginal dilation using plastic dilators, counseling, education, and behavioral exercises. For more information on vaginismus, check out the Go Ask Alice! Sexual and Reproductive Health archives.

A pelvic exam can diagnose what may be causing you pain down south. You can request a pelvic exam with a health care provider even if you have not had sex yet or are under 21 (FYI, a Pap smear is just one part of a woman's pelvic exam, your provider may not need to do a Pap in order to examine the source of pain). Once a health care provider has made a diagnosis, s/he can recommend next steps to help you start using tampons comfortably, and eventually enjoy pain-free sex.