Laser ablation of hymenal fissures

Four patients presented with linear ulcers (hymenal fissures) that had not responded to conventional local therapy or oral antibiotics. These sexually active women had experienced dyspareunia for 8-24 months. Cultures for venereal agents were negative. One patient had two linear ulcers, and the others had only one; all the ulcers were restricted to the hymenal ring at either the 4 or 8 o'clock position. The lesions usually were obscured when the hymen was collapsed, but they were obvious when the ring was expanded. The lesions varied in length from 0.5 to 2 cm and were very shallow, generally 1 mm deep. The ulcers were linear streaks that could be stretched to 3-4 mm wide. Laser ablation of the lesions to a depth of at least 5 mm resulted in complete resolution of the ulcer in two cases. A third patient had almost complete resolution of the lesion after two laser treatments. The fourth patient failed treatment and refused additional treatment. The underlying nature of this recalcitrant condition may be as much an enigma as that of the anal fissure. Laser treatment seems the best approach at present.