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Backgrounds of Women Applying for Hymen Reconstruction, the Effects Of The European Journal of Contraception & Reproductive Health Care ISSN: 1362-5187 (Print) 1473-0782 (Online) Journal homepage: https://www.tandfonline.com/loi/iejc20 Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction Bianca R. van Moorst, Rik H. W. van Lunsen, Dorenda K. E. van Dijken & Concetta M. Salvatore To cite this article: Bianca R. van Moorst, Rik H. W. van Lunsen, Dorenda K. E. van Dijken & Concetta M. Salvatore (2012) Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction, The European Journal of Contraception & Reproductive Health Care, 17:2, 93-105, DOI: 10.3109/13625187.2011.649866 To link to this article: https://doi.org/10.3109/13625187.2011.649866 Published online: 31 Jan 2012. Submit your article to this journal Article views: 630 Citing articles: 30 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=iejc20 The European Journal of Contraception and Reproductive Health Care, April 2012; 17: 93–105 Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction Bianca R. van Moorst ∗ , Rik H. W. van Lunsen † , Dorenda K. E. van Dijken ∗ and Concetta M. Salvatore † ∗Department of Obstetrics and Gynaecology, St Lucas/Andreas Hospital, Amsterdam, the Netherlands, † Department of Sexology and Psychosomatic Ob/Gyn, Division of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands . ABSTRACT Objective To study the backgrounds of women requesting hymen ‘ repair ’ , to assess the effects of extensive counselling, and the effects of hymen reconstruction. Methods A two-centre qualitative study, consisting of a semi-structured interview, education, discussion of alternatives, and instructions for self-examination (fi rst visit), educa- tional examination (second visit), decision on operation or alternative (third visit), and follow-up (fourth visit). Results Eighty-two women were interviewed at fi rst visit. Sixty-eight women were fol- lowed until their decision to be operated upon or not. Forty-eight percent of all subjects reported a history of sexual violence, and 37% had had one or more abortions. Only 29% eventually decided to be operated. Seventeen of the 19 women who submitted to an oper- ation and attended the follow-up visit reported no blood loss at fi rst marital intercourse. Conclusions Most women requesting hymen reconstruction had a history complicated by critical life events related to their request. All women were afraid they would not bleed and/or would not be ‘ tight ’ enough during the wedding night. For 75% of the women empowerment by means of extensive counselling resulted in a decision against operation. Hymenoplasty alone does not help women because most operated women will not bleed and because they often also have to prove to be ‘ tight ’ enough. KEYWORDS Culture ; Genital surgery ; Hymen ; Hymen reconstruction ; Hymenorrhaphy ; Hymenoplasty ; Hymen repair ; Revirgination; Religion ; Virginity . Correspondence: Rik H. W. van Lunsen, MD, PhD, Department of Sexology & Psychosomatic Ob/Gyn, Division of Obstetrics & Gynaecology, Academic Medical Centre H4-205, University of Amsterdam, PO Box 22660, NL-1100 DD Amsterdam, The Netherlands. Tel: ϩ 31 20 566 4456. Fax: ϩ 31 20 696 3489. E-mail: [email protected] © 2012 The European Society of Contraception and Reproductive Health DOI: 10.3109/13625187.2011.649866 Counselling of women applying for hymen reconstruction van Moorst et al. INTRODUCTION anymore who fear the wedding night. Therefore, in many cultures women are secretly instructed by elderly Over the past 15 years gynaecologists and other health women on how to use deception in case of a lack of care professionals in the United States, Canada, and blood loss, for example by hiding a little sac fi lled with several European countries have reported growing animal blood or a needle in the wedding gown to give numbers of women requesting hymen reconstruction oneself a fi nger puncture, or by the use of a blood 1 – 3 or a ‘ certifi cate of virginity ’ . Most authors see this stained sheet that the elderly women in the family as a result of the increasing number of immigrants 11 – 13 saved for the younger ones . A harsher method 1,3 – 5 from countries with an Islamic culture . consists in applying nettles or other herbs a few days In many religions, like Judaism, the various Christian before marriage, to make the vagina raw, dry and vul- faiths, Islam and Hinduism, virginity before marriage nerable. Women migrated to western countries are traditionally has been associated with the integrity of often cut off from this transgenerational information the hymen. Even though Buddhism is generally less on how to ensure nuptial bleeding or otherwise mimic strict where premarital sex is concerned, in some virginity. mixed Buddhist populations, like in Japan, the hymen The faith in the myth that an intact hymen proves should be ‘ intact ’ as well. However, although premarital virginity is still so implicit, that in many countries sex is not acceptable in many cultures, religions and parents decide to have their daughters ‘ offi cially societies, the necessity of proving a woman ’ s prenuptial certifi ed ’ as a virgin by a gynaecologist 14 . When there chastity by blood loss at fi rst marital intercourse is is even the slightest suspicion that a girl might not restricted to cultures in the Islamic world, parts of Asia, be a virgin, she may be forced to undergo a vaginal and some isolated Christian and Jewish communities. examination by a lay person or a gynaecologist 8,14 . In those cultures this blood loss is seen as the ultimate Numerous suicide reports have documented the fact proof of virginity, testifying to the honour of the that this experience was so embarrassing for these woman concerned and that of her family: in the girls that they chose death rather than being touched absence of this proof the whole family is disgraced and by a stranger in an invasive manner 8,14 . The mere loses respect. Women who have lost their virginity existence of ‘ virginity certifi cates ’ and ‘ hymen exam- before marriage fear they will be expelled or even inations ’ illustrates that there are health care profes- murdered in the name of family honour when they sionals who claim to be able to establish the virginity do not bleed during their fi rst marital intercourse 1 . of women by assessing the condition of their hymen. Although the Qur ’ an requires that both wife and men In the scientifi c literature, however, there is a broad should marry as virgins, there is no mention of the consensus that ‘ the archaic assumption that virginity necessity of this blood loss during the wedding night. is diagnosable by external genital examination’ 8 is The Bible is the only religious book that – in Deu- yet another myth4,15 – 18 . For example, in one study it teronomy, Chapter 22 – actually refers to keeping was found that in 19% of sexually active female blood-stained sheets as legal proof of virginity. There- adolescents the hymen showed no tears, clefts or fore, the myth of theintact hymen is more likely to notches 17 . And in another study it was demonstrated have a cultural or Christian origin than an Islamic that even thorough inspection of the hymen with one. 6 The fact that men never have to prove their a colposcope could not demonstrate anatomical dif- premarital chastity should be regarded as a double ferences between 13 – 19-year-old girls with or with- standard of patriarchal societies, where the sexual out coital experience: the presence of hymenal oppression of women and the violation of their sexual notches or clefts was no proof of past intercourse, nor rights are not the result of an oppressive view of sexual- did the absence of notches or clefts rule out previous ity based on Islam, but of a combination of historical, penile-vaginal penetration 18 . socio-political, and economic factors 7 – 9 . The hymen reconstruction, also called hymenorrhaphy Although there is evidence that 40 – 50% of all or hymenoplasty , is supposed to restore the ability of women from different cultural backgrounds do not the hymen to bleed at intercourse, thus protecting the have any blood loss at fi rst coitus 10 , this does not seem woman from penalty should she fail to prove her vir- to alter the importance attached to staining the nuptial ginity on the wedding night by staining the linen of bed. Thus, it is not just women who are not virgins the nuptial bed. Although the assumption is that these 94 The European Journal of Contraception and Reproductive Health Care Counselling of women applying for hymen reconstruction van Moorst et al. operations guarantee post-coital blood loss, there is no ing the procedure are bound by ethical guidelines on record in the literature of follow-up studies ascertain- appropriate medical referral, according to which they ing this claim 19 . The fact that during ‘ hymen repair ’ , ‘ must give priority to their patients ’ lives, health and sometimes, a gelatine capsule containing a blood-like well-being 25 . substance that is supposed to burst during intercourse Several authors have expressed more balanced points is sutured in the vaginal wall, may be seen as a lack of of view, acknowledging the dilemma of women who confi dence in the hymenoplasty 5 . are in despair because of a male dominated view on Doctors facing requests for hymen reconstruction the controllability of women ’ s sexuality. To stop the are confronted with a moral dilemma, forcing them to spreading of myths about virginity and to end gender make a choice between preventing possible negative inequalities with regard to sexual behaviour, a shift in consequences for the woman and her family should mentality is imperative, requiring huge efforts of opin- surgery be refused or performing an unnecessary ion leaders within the cultures involved to change.
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