Our new series, "Closer Look," delves profoundly into the controversial, crucial, and current issues confronted by doctors and patients in aesthetic medicine.
It's an uncommon situation, when reporting a story, to have nearly all your sources demand anonymity. However, in the course of exploring an under-the-radar yet fully legal surgical procedure known as hymenoplasty (hymen restoration), the doctors we conversed with who carried it out requested not to be identified. This is because this surgery is typically performed not due to medical necessity or aesthetic longing but the cultural obligation to pass a virginity test – a routine practice in at least 20 countries and one that both the United Nations and World Health Organization have declared a violation of human rights.
What is hymenoplasty ?
The hymen is a thin, flexible tissue that surrounds or partially covers the vaginal opening. It becomes more susceptible to tearing during puberty, with tampon usage, and when women engage in sports or have sexual intercourse. During the hymenoplasty process, which can be conducted under local anesthesia and often within less than half an hour, the doctor will identify the remaining portion of the hymen, remove the edges using scissors or a scalpel, and then stitch the fragments together – a procedure that narrows the vaginal opening. Hymenoplasty is not performed during a labiaplasty or vaginoplasty, unless requested by the patient.
Why do women undergo hymenoplasty surgery ?
The idea of having to undergo a gynecological examination with one's in-laws before the wedding ceremony and hand over bloodstained bedsheets to them the following morning can be incomprehensible. But these are so-called virtue requirements for women of all diverse ethnic, religious, and cultural backgrounds – including those residing in America, where the practice is legal and unregulated. (In 2019, rapper T.I. provoked outrage by proudly revealing that he accompanies his 18-year-old daughter to the gynecologist to ensure she has an intact hymen.)
"I was set to marry a man arranged by my family. I had to be a virgin on our wedding night. The issue was that I'd had sexual relations with a boy when I was 16 years old and I wasn't going to bleed on my wedding night with my future husband," writes one RealSelf user, who journeyed from the Middle East to Ohio for the reconstruction of the hymen. "When I got married, the new hymen broke and I bled … [My doctor] safeguarded the honor of me and my family."
Another reports, "My husband couldn't tell that I had the hymenoplasty. YES, I DID BLEED on my wedding night after having sex. I had to show the bed sheet to my family, and they were extremely proud that there was blood."
Related: 5 Common Reasons Plastic Surgeons Will Refuse to Operate On You
Failing to pass virginity tests can lead to fatal consequences in some communities, which is why many doctors who repair the thin, torn piece of the hymen that, when intact, proves a woman's chastity to her family, take all precautions to prevent the revelation of the patient's secret.
"I had parents bring in their daughter, who is American, born and raised, for a hymenoplasty," says a female OB-GYN in New Jersey. "She was a typical teenager who had engaged in sexual activity, but her family was from Afghanistan and arranging for her marriage to a man there. They said, 'If she's not a virgin, they will shoot and kill her.' Of course, my staff was very concerned about what might occur if anyone discovered we restored her virginity. They were like, 'Are they going to come and shoot us too?' Anything is possible. It's like the issue of abortion rights – they despise the doctors for performing abortions. Anonymity is crucial for this reason."
She estimates that she performs 50 hymenoplasties annually, on both U.S. citizens and patients who travel from Egypt, Jordan, and Pakistan – and she assumes the majority are of the Islamic faith. Other doctors emphasize that they treat patients of all faiths and note that virginity is particularly significant in the Orthodox-Jewish community as well. The vast majority of women come accompanied by their mothers or a female friend, she says, but she has witnessed two fathers accompany their daughters, and most recently, an engaged couple who had been sexually active and now needed the revirginization surgery to deceive the man's mother. But there is one aspect that every woman coming in shares, as stated by the New Jersey doctor, and that is "they fear for their lives, either from their own parents or their future spouse and in-laws."
"100% of them are extremely worried that it won't be successful or that someone will discover it," says a female OB-GYN in Southern California, who conducts one to three surgeries per month on patients ranging from Christian to Muslim, Caucasian to Chinese, as young as 13 to as old as 50. "They don't want to use a credit card or provide me with their ID. They appreciate that I don't have electronic health records, so no one can hack into my computer and find out they were here. They are panicked that someone might hire a private investigator and follow them. I had one from Afghanistan who said she might be stoned. It's heartrending." The New Jersey doctor says that many of her patients do not provide working phone numbers or emails on the intake forms and tend to pay in cash. "They don't want to leave any paper trail."
Although not all the women coming in for hymenoplasty are preparing for an arranged marriage – the California OB-GYN says it's not uncommon for a man to bring his mistress once they have ended their relationship, so that she can be pure for her next one – the majority are pressed for time and anticipate being required to undergo a gynecological examination, either in the U.S. or their home country, before a wedding. For this reason, the doctors interviewed unanimously agreed that six to eight weeks is the safe period in terms of how long it takes for the hymen to heal and the stitches to dissolve. After that point, there is no evidence of surgical interference.
"Think about planning a wedding and the sheer panic involved in hoping everything will turn out well. Now consider being a woman who has to prove she's a virgin on that day. That surpasses everything – anything you could imagine is insignificant compared to what they endure," says the California OB-GYN.
Many women have no option but to fly home after the procedure and hope for the best, though one Illinois-based plastic surgeon says he always attempts to have a follow-up appointment with his local patients to check that there is no sign of sutures. "I don't want to be the one responsible for telling them it's healed and then something goes wrong," he says. "As a surgeon, it makes me feel like I'm involved in a cover-up rather than what we've been trained to do, but ultimately, it's reconstructive surgery for cosmetic purposes."
Three male doctors who were interviewed all expressed some discomfort regarding their role in a dishonest process. "Being part of deceiving someone is the most challenging aspect of doing this," said one urogynecologist who was reluctant to share his location. "I justify it because she is in a difficult situation and I'm not going to change that culture or that mentality."
Related: 8 Assumptions You Should Never Make About Your Doctor
In contrast, three female doctors stated that they have never struggled with any sense of guilt for helping women lie. The California OB-GYN simply remarks, "My job is to assist my patients. I don't feel guilty for deceiving the family, because they're not my patients."
"We're doing what causes the least harm," says the New Jersey OB-GYN, who recalls a frantic patient who called her, weeping, only two weeks after the hymenoplasty, saying that her mother-in-law, unaware that she'd just undergone the procedure, was taking her to New York University for an examination to check her hymen.
"I asked [my patient], 'Is it an American female doctor?' She gave me the name and it was, so I told her, 'You're going to be fine, she'll lie for you.' She asked how I could be certain and I said, 'Because if you were on my operating table with your in-laws standing behind you, asking if you were a virgin, I would look them in the eyes and lie.' The patient called the next day, relieved to report that the NYU doctor had indeed declared her a virgin to her new family. "A week later, she returned to my office and I took a photo to show her that all the stitches were still there."
As long as virginity testing persists in the United States and abroad, so will the demand for hymen repair surgery. And although the American College of Obstetricians and Gynecologists has expressed concern over "the ethical issues associated with the marketing of these procedures and the national franchising in this field," stating that "such a business model that controls the dissemination of scientific knowledge is troubling," it has not prohibited hymenoplasty or provided any guidelines to physicians regarding how they should handle requests for virginity tests.
Of course, similar to abortion, a ban will only expose women to a greater risk of violence until these cultures dismantle the misogynistic framework on which they are based. As the New Jersey OB-GYN puts it: "Why is it that [in these cultures], men are permitted to have sex but women aren't? Why is the woman's life in danger, while the man who took her virtue is not?" As we know, it's never truly been about the hymen.
