The case of the pregnant virgin
A young nursing student came to my clinic with a complaint of delayed menstruation. From her menstrual history, it was established that she had been regularly having her period every month until this month when she was already delayed by two weeks. Being a standard-operating-procedure (SOP), I asked about intimate sexual relations which she, and her boyfriend who came along with her, vehemently denied. I explained to her that for us obstetricians, pregnancy or a consequence thereof is the first consideration in any delay in menstruation.
What can cause absence of menstruation?
For the record, there are conditions that can cause delayed menses or an absence of menses from someone previously having it. Some of these conditions are:
• Pregnancy or a complication thereof (i.e. abortion, ectopic pregnancy)
• PCOS or polycystic ovarian syndrome
• Intake of certain drugs like non-steroidal anti-inflammatory drugs (NSAIDs) such as mefenamic acid, hormones, chemotherapeutic agents (anti-cancer)
• Stress, whether emotional or physical (as in athletes)
• Premature ovarian failure (aka premature menopause)
Was she pregnant?
Even with their denial, I had to do a pregnancy test, which turned out to be positive or (+), meaning she was pregnant. With this result in hand, I proceeded to do a physical examination to verify the pregnancy. She refused a speculum and internal examination (IE) as she still maintained she was a virgin. To my surprise, her hymen indeed was intact. As promised, I didn’t do an IE but requested for a transabdominal (through the abdomen) pelvic ultrasound instead. To their surprise, the ultrasound result showed a live pregnancy of about six weeks duration. She indeed was pregnant.
How did I determine whether she was a virgin?
The all too important hymen takes center stage here. The hymen is a thin tissue right at the opening of the vagina. It is not totally closed but has a small central opening where menstrual blood can flow out of. The opening is about 1 to 1.2 cm. Being so, one can use a tampon for menstruation and not cause any damage to the hymen. The large size tampon is only about 1 cm in diameter. Therefore, mothers need not worry about their daughters losing their virginity with the use of tampons.
So, what does it mean to lose virginity? Simply put it means there was already intimate sexual relation which connotes actual penetration of the man’s sexual organ into the female’s vaginal canal. The penis is 2cm or more in diameter. On first sexual contact, the penetration of the penis causes this membrane to be broken as the penis is larger than the hymenal opening. The hymen then breaks causing some amount of bleeding.
Therefore, on physical examination, we determine whether the hymenal ring is still intact (virgin) or the hymen has already been broken (non-virgin). Sometimes, it can also be determined whether the penetration occurred recently (fresh tears) or some time before (healed tears). There are some exceptions to the rule. In some women, this membrane may not break because it has been shown that there are those who have resilient hymen. In addition, there are those who have done some sexual acts without resorting to actual penetration. So, frankly speaking, they are not actually “virgins” in the real sense but only physical virgins, i.e. intact hymen.
The mystery solved
Needless to say, the couple had a very intense argument with the boyfriend accusing the girl of infidelity. He was very sure he has not penetrated the girl’s vaginal canal. She adamantly insisted she had no other man in her life. I had to show the man that indeed the girlfriend’s hymen was intact. I had to solve the mystery myself so I sat them down together to get a clearer view of the circumstances. Being nursing students, I had hoped they were able to understand the situation as I am now going to narrate.
The couple in this story had been doing heavy petting, or in other words, sexual foreplay. Not wanting to have a resulting pregnancy, the man sees to it that he does not penetrate. However, there are times when he ejaculates right at the hymenal opening. During ejaculation, the semen comes out in bursts with some degree of force. It could have happened that some semen, with the concomitant sperms, were able to enter the vaginal canal. The sperms then could now travel upward through the fallopian tube and meet the ovum or egg resulting in a fertilized egg, thereby resulting in pregnancy.
If you find that hard to believe, imagine the man in this story. I had hoped he would understand but I later found out he could not fathom the explanation which eventually led to the break up.
How about the woman? The last I heard from her, she called me up to speak to her mother and to assure the mother she was a virgin. I refused. I told her you may be a virgin in the physical sense but we both know you have had an intimate relation with a man. She never came back.
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- Myss Lafunky