A Comprehensive Insight into Hymenoplasty and Its Intricacies
Our latest series, "Closer Look," provides an in-depth examination of the contentious, critical, and current challenges faced by both medical professionals and patients in the field of aesthetic medicine.
It is rare in journalism to encounter a situation where nearly all sources demand anonymity. However, during our investigation into hymenoplasty (hymen restoration), a legally permissible but discreet surgical procedure, the doctors we interviewed insisted on remaining unidentified. This is because this surgery is usually conducted not for medical reasons or aesthetic choices, but due to cultural mandates to pass a virginity test—a practice prevalent in at least 20 countries and deemed a human rights violation by both the United Nations and the World Health Organization.
Understanding Hymenoplasty: What It Entails
The hymen is a delicate, elastic tissue that partially or completely surrounds the vaginal opening. It is prone to tearing during puberty, through tampon use, sports activities, or sexual intercourse. The hymenoplasty procedure, typically performed under local anesthesia and completed in less than 30 minutes, involves the doctor locating the remaining hymen tissue, trimming its edges with scissors or a scalpel, and then stitching the pieces together, thereby narrowing the vaginal opening. This procedure is not part of labiaplasty or vaginoplasty unless specifically requested by the patient.
The Motivations Behind Hymenoplasty: Why Women Choose This Surgery
The prospect of undergoing a gynecological examination with in-laws before the wedding and presenting bloodied sheets the next morning can be daunting. Yet, these are considered moral requirements for women across various ethnic, religious, and cultural backgrounds, including those in America where this practice is legally permissible and unregulated. (In 2019, rapper T.I. caused controversy by openly stating that he accompanies his 18-year-old daughter to the gynecologist to ensure her hymen is intact.)
"I was set to marry a man chosen by my family. I had to be a virgin on our wedding night. The issue was that I had engaged in sexual activity with a boy when I was 16, and I knew I wouldn't bleed on my wedding night with my future husband," recounts a 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] safeguarded the honor of me and my family."
Another patient shares, "My husband couldn't tell I had undergone 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."
Failing to pass virginity tests can result in severe repercussions in certain communities, which is why many doctors who repair the torn hymen, which when intact signifies a woman's purity, take extensive measures to maintain patient confidentiality.
"I had parents bring their American-born daughter for a hymenoplasty," reveals a female OB-GYN in New Jersey. "She was a typical teenager with sexual experiences, but her family from Afghanistan was arranging her marriage there. They said, 'If she's not a virgin, they will shoot and kill her.' Naturally, my staff was deeply concerned about what might happen if anyone found out we restored her virginity. They were like, 'Are they going to come and shoot us too?' Anything is possible. It's akin to abortion rights—they despise the doctors for performing abortions. Anonymity is crucial for this reason."
She estimates conducting 50 hymenoplasties annually, on both U.S. citizens and patients from Egypt, Jordan, and Pakistan—and she assumes most are of Islamic faith. Other doctors highlight that they treat patients of all faiths, noting the significance of virginity in the Orthodox-Jewish community as well. Most women come with their mothers or a female friend, but she has seen two fathers accompany their daughters, and recently, an engaged couple who needed the surgery to deceive the man's mother after being sexually active. However, the New Jersey doctor notes that all women share one fear: "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, aged 13 to 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 for the surgery after ending their relationship so she can be "pure" for her next one—most 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."
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.
