Wrestling with the Hymen: Consultations and Practical Solutions

OBJECTIVE:

To study the consultation and treatment options for young women who desire revirgination surgery, and to offer recommendations.

METHODS:

During her initial visit to a Dutch clinic, each of these women discussed with a physician her reasons for consulting and the treatment options.

RESULTS:

One hundred and fifty-four women sought advice for virginity-related issues. They were planning to marry or had experienced some form of sexual violence. Of these, 48 chose hymen reconstruction (HR), 26 a temporary hymen suture (THS), and 27 to resort to some expedient for staining the sheets or to another alternative for surgery. At follow-up, 13 of the 17 women who had THS and six of the 11 who had HR reported blood loss on their wedding night, whereas all six women who inserted a capsule with food colouring stated they had stained the sheets.

CONCLUSIONS:

Cost-effective procedures help young women who are no longer virgins to avoid reprisals by their husband or family. Pelvic floor exercises will tighten the vaginal opening. THS seems more effective than HR for producing blood loss. There are alternatives should no blood loss occur during penetration.

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By:   Loeber O1.

• 1Rutgershuis Oost , Arnhem , the Netherlands. 

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Zero Tolerance Against Patriarchal Norms? A Cross-Sectional Study of Swedish Physicians' Attitudes Towards Young Females Requesting Virginity Certificates or Hymen Restoration

Many countries, Sweden among them, lack professional guidelines and established procedures for responding to young females requesting virginity certificates or hymen restoration due to honour-related threats. 

The purpose of the present survey study was to further examine the attitudes of the Swedish healthcare professionals concerned towards young females requesting virginity certificates or hymen restorations. The study indicates that a small majority of Swedish general practitioners and gynaecologists would accommodate these patients, at least given certain circumstances. But a large minority of physicians would under no circumstances help the young females, regardless of speciality, years of practice within medicine, gender, or experience of the phenomenon. Their responses are similar to other areas where it has been claimed that society should adopt a zero tolerance policy against certain phenomena, for instance drug policy, where it has also been argued that society should never act in ways that express support for the practice in question. However, this argument is questionable. 

A more pragmatic approach would also allow for follow-ups and evaluation of virginity certificates and hymen restorations, as is demonstrated by the Dutch policy. Hence, there are some obvious advantages to this pragmatic approach compared to the restrictive one espoused by a large minority of Swedish physicians and Swedish policy-makers in this area.

Full article at:  http://goo.gl/F8uupm

By:  Juth N1, Lynöe N1.

• 1Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden. 

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Hymen Reconstruction as Pragmatic Empowerment? Results of a Qualitative Study from Tunisia

Hymen reconstruction surgery (HR), while ethically controversial, is now available in many countries. Little clinical evidence and hardly any surgical standards support the intervention. Nearly as scarce is social science research exploring women's motivations for the intervention, and health care professionals' justifications for its provision. 

In order to better understand decision-making processes, we conducted semi-structured interviews in metropolitan Tunis, in 2009, with six women seeking the procedure, four friends who supported such women, four physicians who perform the operation, and one midwife. 

Health care professionals and patient companions expressed moral ambivalence about HR: although they could comprehend the individual situation of the women, they expressed concern that availability of the procedure might further entrench the patriarchal norms that compel the motivation for seeking HR in the first place. Some women seeking HR shared this concern, but felt it was not outweighed by their personal aims, which were to marry and become mothers, or to overcome past violent sexual experiences. 

The women felt HR to be uniquely helpful in achieving these aims; all made pragmatic decisions about their bodies in a social environment dominated by patriarchal norms. The link between HR and pervasive gender injustice, including the credible threat of serious social and physical harm to women perceived to have failed to uphold the norm of virginity before marriage, raises questions about health care professionals' responsibility while facing requests for HR. 

Meaningful regulatory guidance must acknowledge that these genuine harms are at stake; it must do so, however, without resorting to moral double standards. We recommend a reframing of HR as a temporary resource for some women making pragmatic choices in a context of structural gender injustice. We reconfirm the importance of factual sexual and reproductive education, most importantly to counter distorted beliefs that conflate an "intact hymen" with virginity.

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By: Wild V1, Poulin H2, McDougall CW3, Stöckl A4, Biller-Andorno N5.

• 1University of Zurich, Switzerland; Ludwig-Maximilians-University, Munich, Germany. Electronic address: wild@ethik.uzh.ch.
• 2EHESS, Paris, France.
• 3University of Toronto, Canada.
• 4University of East Anglia, Norwich, Great Britain, United Kingdom.
• 5University of Zurich, Switzerland.  

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Are There Morally Relevant Differences between Hymen Restoration and Bloodless Treatment for Jehovah's Witnesses?

Hymen reconstruction is a controversial measure performed to help young females under threat of honour-related violence. Official guidelines often reject offering hymen reconstructions. On the other hand, extraordinary measures in order to enable operations of Jehovah's Witnesses who want a bloodless operation in order to avoid religiously related sanctions are often considered praiseworthy. The aim is thus to examine whether or not there are relevant differences between these two measures.

We identified twelve potential differences. One difference could be considered relevant (patient-safety), but in favour of hymenoplastic operations.

Since we did not identify enough relevant differences to justify offering bloodless operations to Jehovah's Witnesses but not offering hymen reconstruction due to honour-related norms, we conclude that these two groups of patients should be treated equally. This means that neither of the patient groups should be offered these extraordinary operations or that both groups of patients should be offered such operations. Similarly, there are no reasons for judging those who perform the operations differently.

Full article at: http://goo.gl/TVCWvh

By: Juth N1, Lynøe N.

• 1Stockholm Centre for Healthcare Ethics, Karolinska Institutet, LIME, 171 77 Stockholm, Sweden. niklas.juth@ki.se.  

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