At month five, the vaginal canalization is complete and the fetal hymen is formed from the proliferation of the sinovaginal bulbs (where Müllerian ducts meet the urogenital sinus), and normally becomes perforate before or shortly after birth.The hymen has dense innervation. In newborn babies, still under the influence of the mothers hormones, the hymen is thick, pale pink, and redundant (folds in on itself and may protrude). For the first two to four years of life, the infant produces hormones that continue this effect. Their hymenal opening tends to be annular (circumferential). Post neonatal stage, the diameter of the hymenal opening (measured within the hymenal ring) widens by approximately 1 mm for each year of age. During puberty, estrogen causes the hymen to become very elastic and fimbriated. The hymen can stretch or tear as a result of various behaviors, by the use of tampons or menstrual cups, pelvic examinations with a speculum, sexual intercourse, insertion of multiple fingers or items into the vagina, and activities such as gymnastics (doing the splits), horseback riding or trauma caused by a "straddle injury". Remnants of the hymen are called carunculae myrtiformes.A glass or plastic rod of 6 mm diameter having a globe on one end with varying diameter from 10 to 25 mm, called a Glaister Keen rod, is used for close examination of the hymen or the degree of its rupture.
Malum perforans is a long-lasting, usually painless ulcer that penetrates deep into or through the skin, usually on the sole of the foot (in which case it may be called malum perforans pedis). It is often a complication in diabetes mellitus and other conditions affecting the nerves. Presentation
These ulcers have punched-out edge and slough in floor, resembling gummatous ulcer. Surrounding area might have loss of sensation. Cause
This condition results from denervation of areas exposed to day-to-day friction of bony prominences. The denervation may be result of any of the following diseases:
Spinal injuries
Leprosy
Peripheral nerve injury
Diabetic neuropathy
Tabes dorsalis
Transverse myelitis
Meningomyelocele
Syringomyelia

Pathophysiology
Normal pressure and pain sensations are essential for protecting the foot from excessive and prolonged pressures over bony prominences. In insensitive foot, such as in diabetic neuropathy, soft tissues are exposed to excessive pressures without knowledge of the individual. In other words, by nerve damage in the feet, the patients get no feedback on the impact of the feet when walking. These ulcers start with callosity under which suppuration takes place. The pus comes out and a hole forms under which the lesion grows deeper. This leads to punched-out, painless ulcers usually under metatarsal heads, tip of toe, or proximal interphalangeal joint of a hammertoe or on the heel. In non-ambulatory patients, these ulcers are found on buttocks and back of the heel. Diagnosis
Diagnosis is clinical. Sensation is tested using graded monofilament. Treatment
The underlying cause of the neuropathy is first treated. Necrotic portions of the wound are removed and the wound is kept moist at all occasions.