A Deeper Exploration into Hymenoplasty and Its Complexities
Our new series, "Closer Look," delves profoundly into the controversial, critical, and contemporary issues faced by doctors and patients in aesthetic medicine.
It is an uncommon phenomenon when reporting a story to have nearly all sources insist on anonymity. However, in the course of investigating an under-the-radar yet entirely legal surgical procedure known as hymenoplasty (hymen restoration), the doctors we spoke to who carried out this procedure requested not to be identified. The reason for this is that this surgery is typically performed not due to medical necessity or aesthetic preference but rather the cultural obligation to pass a virginity test – a practice that occurs routinely in at least 20 countries and has been declared a violation of human rights by both the United Nations and the World Health Organization.
What Exactly Is Hymenoplasty?
The hymen is a thin and elastic tissue that encircles or partially covers the vaginal opening. It is more prone to tearing during puberty, with the use of tampons, when women engage in sports, or have sexual intercourse. During the hymenoplasty procedure, which can be conducted under local anesthesia and often takes 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 process that narrows the vaginal opening. Hymenoplasty is not performed during a labiaplasty or vaginoplasty unless requested by the patient.
Why Do Women Opt for Hymenoplasty Surgery?
The idea of having to undergo a gynecological examination with one's in-laws before the wedding ceremony and presenting bloodied bedsheets to them the following morning can be unimaginable. But these are so-called virtue requirements for women of various ethnic, religious, and cultural backgrounds – including those residing in America, where this practice is legal and unregulated. (In 2019, rapper T.I. sparked outrage by proudly revealing that he accompanies his 18-year-old daughter to the gynecologist to ensure she has an intact hymen.)
"I was supposed to marry a man arranged by my family. I had to be a virgin on our wedding night. The problem was that I had sexual relations with a boy when I was 16 years old and I was not going to bleed on my wedding night with my future husband," writes one Ruli user, who traveled from the Middle East to Ohio for hymen reconstruction. "When I got married, the new hymen broke and I bled... [My doctor] preserved the honor of me and my family."
Another reports, "My husband could not 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 so proud that there was blood."
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Failing to pass virginity tests can lead to dire consequences in some communities, which is why many doctors who repair the fragile torn hymen that, when intact, proves a woman's chastity to her family, take every precaution to keep 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 sexual experiences, but her family was from Afghanistan and was arranging her marriage there. They said, 'If she's not a virgin, they will shoot and kill her.' Of course, my staff was extremely 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 similar to abortion rights – they despise the doctors for performing abortions. Anonymity is crucial for this reason."
She estimates that she conducts 50 hymenoplasties per year, 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 with 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 thing that every woman who comes in shares, according to 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 work or that someone will find out," says a female OB-GYN in Southern California, who performs 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 discover their presence. They are terrified that someone might hire a private investigator and follow them. I had one from Afghanistan who said she might be stoned. It's heart-wrenching." The New Jersey doctor states 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 trace."
Although not all women seeking 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 undergoing a gynecological examination, either in the U.S. or their home country, before the wedding. For this reason, the doctors interviewed unanimously agreed that six to eight weeks is the safe period 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 go well. Now consider being a woman who must prove she's a virgin on that day. That surpasses everything – anything you could imagine pales in comparison to what they go through," says the California OB-GYN.
Many women have no choice but to fly home after the procedure and hope for the best, although one Illinois-based plastic surgeon says he always attempts to schedule a follow-up appointment with his local patients to check for any evidence of sutures. "I don't want to be 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 I'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 mentality."
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In contrast, three female doctors stated that they have never struggled with any guilt over the fact that they are helping women lie. The California OB-GYN simply states, "My job is to assist my patients. I don't feel guilty for deceiving the family because they are 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, crying, only two weeks after the hymenoplasty, saying that her mother-in-law, unaware that she had 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 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, the demand for hymen repair surgery will continue. And although the American College of Obstetricians and Gynecologists has expressed concerns about "the ethical issues related to 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 on how they should handle requests for virginity tests.
Of course, similar to abortion, a ban will only expose women to a higher 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 jeopardy, while the man who took her virtue is not?" As we know, it has never truly been about the hymen.
