62 TORTURE Volume 25, Number 1, 2015 statement istoprovide legal experts, the practiceisillegal. policies tocontrolsexuality. Inotherstates, prostitution; ofpublicorsocial andaspart women of whoareaccusedbyauthorities places; onwomen whoallegerape; on number ofcontexts, includingindetention many countries, andoftenforcibly, ina degree of vaginal penetrability. ofvaginal degree openingandtocheckthe of thevaginal toassessthesize intothe vagina more fingers test’, whichinvolves ofoneor theinsertion and isoftencombinedwitha ‘two-finger by visualinspectionofthehymenal region, sexual intercourse. The examisconducted whether afemalehashadorishabituated to previous sexualcontacttodetermine appearance ofthehymen infemaleswith thestatusthat and isintendedtocorrelate examinationexamination) isagynaecological toasvirginity testing(alsoreferred Virginity Introduction Independent Forensic ExpertGroup* Statement on Virginity Testing group.aspx. medical-and-psychological-case-support/forensic-expert- Group pleasevisithttp://www.irct.org/our-support/ For fulldetailsabouttheIndependentForensic Expert [email protected] Correspondence Binz, Felicitas Treue, Peter Vanezis, Nuno Duarte Viera Somasundaram, JørgenLange Thomsen, Morris Tidball- Reyes,Hernán SidselRogde, Antti Sajantila, Daya Payne-James, Jose Quiroga, Ole Vedel Rasmussen, MorcilloMendez,Maria-Dolores ÖnderÖzkalipci, Jason Louahlia, Mendonça, Cristina Maria Jens Modvig, Hougen, Vincent Iacopino, Peter Leth, Mygind Said Fincanci, SteenHolgerHansen, LillaHardi, HansPetter van Es,Adriaan Ravindra Fernando, SebnemKorur Beynon, Ana Deutsch, MaximoDuque, Duterte, Pierre *) Djordje Alempijevic, RusudanBeriashvili, Jonathan The purpose ofthismedico-legal The purpose examinations arepracticedin Virginity

i examinations onfemales effectsofforciblyconductingvirginity logical ofthephysicalunderstanding andpsycho- makers,policy amongothers, withan adjudicators, healthcareprofessionals and effects of torture andill-treatment.effects oftorture Consist- menting thephysical andpsychological Group(IFEG)indocu- Forensic Expert oftheIndependent ofmembers experiences standardsand the are basedoninternational examinations.applicable toallvirginity and issuesaddressedhereinaregenerally examinations,ed virginity many ofthefacts medico-legal implications offorciblyconduct- iii ii i this statement may beapplicable tothelatter. cavity searches, andissuesaddressedin althoughthefacts such asbody examinations conductedforotherpurposes standard on lack of consent in the crimes ofrape.standard onlackof consentinthecrimes concerns relating toprepubescentfemales. concerns andspecialised It doesnotaddresstheparticular forcibly conductedonpostpubescentfemales (women). consent.” genuine incapableofgiving person oppression orabuse ofpower, againstsuch of violence, duress, detention, psychological of forceorcoercion, suchascausedbyfear when itis “committed byforce, orbythreat an examination tobe ‘forcibly conducted’ ethical implications. This opinionconsiders relevance ofsuchexaminations andthe and addresses themedicalinterpretation torture. This medico-legalstatement also cruel, inhuman, treatment or ordegrading examinations constitute conducted virginity whether, basedontheseeffects, forcibly Virginity examinations donotincludesimilar Virginity This statement focuses on virginity examinations This statement focusesonvirginity The International Criminal Court hasadoptedthis Court Criminal The International The opinionsexpressedinthisstatement itselfwiththe While thisopinionconcerns iii, 1

ii andtoassess STATEMENT

TORTURE Volume 25, Number 1, 2015 63 v the UN 4

3 all consider virginity 6 and the UN Special Rappor- 5 Virginity are often conduct- examinations A plethora of jurisprudence has found In 2005, the UN Committee on the In 2005, The World Health Organization, World The According to the World Health Organization, other Health Organization, World According to the Special Rapporteur on Torture and Cruel, and Cruel, Torture Special Rapporteur on or Treatment Inhuman or Degrading Punishment, teur on Violence Against Women, Its Causes Women, Against Violence teur on and Consequences examination to be a formexamination of sexual violence. against women who have previously engaged previously who have against women been used to and it has in sexual intercourse; are somehow those women suggest that perpetratedresponsible for the acts against them. the consent of the ed forcibly – without where women or in circumstances women are not capable of giving genuine consent. be presumed to be the case when This may in on women are conducted examinations allega- sometimes subsequent to detention, by tions of rape by victims or of prostitution the authorities. the practice of virginity to examination internationalviolate human rights standards. virginity are examinations countries, In many explicitly prohibited or criminalised under against sexual laws national the overarching According to the United assault and rape. of Treatment (UN) Rules for the Nations Prisoners and Non-custodial Women Offenders (the Women Measures for the right not have women “Bangkok Rules”), to their to undergo screening in relation health history. reproductive forms of sexual violence include, but are not limited to: are not limited to: but forms include, of sexual violence sexual harassment (including demands for sexual slavery; or sex in exchange for job promotion or advancement trafficking for purposes higher school marks or grades); forced exposure to pornography; of forced prostitution; forced abortion; sterilisation; forced forced pregnancy; and female genital mutilation. forced marriage; v Elimination of DiscriminationElimination against Its members iv 2 In the justice context, correlating In the justice context, The IFEG provides technical advice and The IFEG provides IFEG members also hold influential See e.g., Independent Forensic Expert Group. Expert Independent Forensic Group. See e.g., are global experts several on and include key the authors Protocol, of the Istanbul international standard-setting instrument on of and documentation the investigation torture and ill-treatment. iv Background Virginity are premised on a examinations the practice of sexual correlation between intercourse and immorality or criminal as they can only be By nature, deviancy. only conducted on females and are generally the conducted on those who are unmarried, are discriminatory. examinations virginity the repugnance of to purity elevates who are sexual violence against women it similarly diminishes the Yet, ‘virgins’. of sexual violence perception of the severity expertise of torture in cases where allegations made. are and/or ill-treatment ing of thirty-five independent preeminent eighteen countries, forensic specialists from collective a vast the IFEG represents - and documenta experience evaluation in the and psychological tion of the physical evidence of torture and ill-treatment. STATEMENT positions in and act as advisors- to govern professional international bodies, ments, non-governmental health associations, academic institutions and organisations, on forensics in general and more worldwide and docu- specifically on the investigation of torture.mentation Statement on Hooding. Torture. 2011; 21(3):186-189; 21(3):186-189; 2011; Torture. on Hooding. Statement on Statement ExpertIndependent Forensic Group. records and medical and other health access to relevant of evaluations legal records for forensic medical relevant alleged torture inhuman or degrading and other cruel, 22 2012; Torture. or punishment. treatment (Supplementum 1):39-48. 64 TORTURE Volume 25, Number 1, 2015 sexual violence. subsequenttoallegations of purportedly examinations withouttheirconsent,virginity ment whentheywere forcedtosubmit detention were subjectedtosevere ill-treat- in 2009heldthat two women inpolice without theirconsent. examinations tobeconductedonwomen the Republicof Turkey virginity permitted provisions oftheCivilandPenal Codesof Women that certain expressedconcern vi examinations causesignificantmentalpain sexual decision-making. Insodoing, these women inrelation totheirown bodyand tions onwomen violates theautonomy of examinations isespeciallyacute. causedbythese the painandsuffering bleeding, andto infection. Psychologically, and canleadtodamagethehymen, These examinations cancausephysical pain, examinations forciblyonwomen.virginity effects resultfromtheactofconducting A numberofphysical andpsychological A. GeneralEffects Physical and Psychological Effects 312. 2006. 2006Inter-Am. Ct. H.R. (ser. C)No. 160. para. v.Castro-Castro Prison Peru. Judgmentof25Nov. effects constitutedtorture.” Inter-Am. Ct. H.R. Miguel ‘examination’ constitutedsexualrapethat duetoits inmate was submittedunder anallegedfingervaginal that ruled “the actsofsexualviolencetowhichan in rapecasesagainstthewillofwomen. Turkey examination couldorder avirginity in that judgesandprosecutors concern Committee against Torture expressed serious depressiveserious disorder. disorder, andoneofthemsufferedfrom women sufferedfrompost-traumatic stress examinations,conducted virginity both Also, ofHumanRightshas Court theInter-American The European Court ofHumanRights The EuropeanCourt Forcibly examina- conductingvirginity

9 As aresultoftheforcibly 7 In2010, theUN vi

8

ability to maintain familial andsocial ability tomaintain familial thewomen’sthese examinations corrode integrity. Together, thetraumatic effectsof women becauseitviolates theirpersonal forcibly onwomen oftenstigmatises these behaviour.self-harming symptoms) aswell and asself-destructive distressthat manifestsasphysicallogical psychosomatic symptoms(psycho- serious examinations mayvirginity alsoexhibit guilt andshame. and aggressive behaviour; andoverwhelming hopelessness; outbursts, irritability, angry changes inthinkingandmood; feelingsof distress andphysical reactions; negative ornightmares;memories severe emotional among them, anddistressing recurrent toms ofpost-traumatic stressdisorder– include anxiety, depression, andthesymp- ofphysical andmentalviolence.other forms respond tothepassageoftimeasquickly cal symptomsanddisabilitiesthat donot likely tocausesevere- andlastingpsychologi examinations are forcibly conductedvirginity indailylife.in functioningnormally withdrawal, todifficulties whichcontribute byapathy,stricken emotionalnumbing, and gust, andworthlessness. Women areoften women tofeelintensehumiliation, self-dis- tions, conductingthemforciblyalsoleads Irrespective ofthefindingstheseexamina- fear, asenseofpowerlessness ordenial. manifest assevere emotionalpain, aswell as examinations mayconducting virginity vulnerability andweakened resistance. in whichthestate exploitsthesewomen’s traumatic becauseoftheease be particularly ina detentionsetting, theycan undertaken inalmostallinstances.and suffering When Conducting virginity examinations Conducting virginity Women whoaresubjectedforciblyto conditions psychological Long-term Due totheirsexualandinvasive nature, causedbyforcibly The painandsuffering STATEMENT 10 TORTURE Volume 25, Number 1, 2015 65

1, viii 1,

2 In addition, threats, threats, In addition, 2 In detention settings, virginity examina- In detention settings, is also a frequent part nudity Forced of “It is noteworthy that other forms of sexual violence, other forms that “It is noteworthy of sexual violence, the forcibly undertakenthe forcibly of an sexual invasion international legal body, physical individual’s “of jurisprudence an invasion defines such the body of a person by conduct resulting in part of any of the slight, however penetration, the perpetratorbody of the victim or with a anal or genital opening sexual organ or of the other or any object of the victim with any as rape. part of the body” coercion, or physical force are often applied. force are often applied. or physical coercion, tions have been conducted forcibly in the been conducted forcibly tions have and including male guards, view of others, and and sexual threats incident to verbal enhance the sense of These abuses mocking. degradation, humiliation, fear, helplessness, and and stigma experienced by these women their subsequent pain and suffering. the experience and magnifies the psychologi- cal terror of every ill-treatment, aspect of itself and any including the examination and humiliation. threats whether defined as rape or not, may constitute torture may whether defined as rape or not, and must not be dealt with as minor or ill-treatment Promotion and protection of United Nations. offences.” social and economic, political, civil, all human rights, including the right to development: cultural rights, and Other Torture report of the Special Rapporteur on or Treatment Inhuman or DegradingCruel, 2008 United Nations; Manfred Nowak. Punishment, para 35. A/HRC/7/3. Jan. viii C. Additional Factors virginity circumstances when exami- In many they are are forcibly conducted, nations For accompanied by other forms of abuse. are likely to involve examinations instance, unconsented touching or groping, which is traumatic. always In other instances, women have have women In other instances, vii When the examination is applied incident When the examination pain and suffering Because of the severe The findings of the virginity examination, virginityThe findings of the examination, have women cases, in some Ultimately,

Testimonies provided to members provided of the Independent Testimonies vii to an allegation of sexual violence, the of sexual violence, to an allegation alleged violence mimic the procedure may and constitute a second and repetitive The examina- for the victim. event traumatic because tion is also inherently coercive refusal to submit to the examination of sexual violence will an allegation following be interpreted as a sign of duplicity. is especially likely to occur as a result of that When a forcibly conducted virginity- exami of the invasion physical the involves nation ‘two-finger when the such as body, woman’s be especially trauma may is applied, test’ women’s of these Penetration pronounced. their bodies against their consent violates and further disem- their privacy, integrity, thereby leading to heightened them, powers or particularised traumas. B. “Two-Finger Test” Test” B. “Two-Finger whether accurate or not, may also have also have may or not, whether accurate consequences, adverse legal and social access to schooling or including the loss of exclusion from other social benefits, to access the and an inability marriage, obtain appropriatejustice system or to acts committed against redress for wrongful these women. - committed suicide incident to these exami or the effects and consequences nations thereof. relationships and may lead to the collapse of lead to the collapse and may relationships those relationships. STATEMENT Forensic ExpertForensic Group. - been assaulted and murdered when examina were those women that indicated tions have not virgins. 66 TORTURE Volume 25, Number 1, 2015 tions have noscientific value. examina- literature establishesthat virginity Published andpeer-reviewed medical course. tosexualinter- may exhibitchanges prior hymen configurations vary, andthe hymen and elasticity. Studiesdemonstrate that oestrogen, itsappearance, whichalters shape, lesion following sexualassault. There similarlymay benotraceofhymenal have penetrative experienced sexualcontact. with anundamagedhymen may ormay not orhabituation.intercourse An individual females, itisnotanindicator ofsexual diagnosis ofsexualassaultinprepubescent limitedcontexts,very beusefulinthe infections. the detectionofsexuallytransmitted examinations alsodonotassistin Virginity penis orany otherobjecthasoccurred. penetration ofthehymen bya orvagina ofwhether does notenableadetermination previous penetration orsexualcontact; it status ofthehymen with hasnocorrelation A. Reliability Medical Perspectives tioners or gynaecologists. or tioners practi general by made were findings tory contradic the cases, of those 73 percent In patient. same ofthe examination virginity arecent contradicted months twelve previous the in conducted examination virginity one least at from findings their that reported ofrespondents two-thirds Turkey, in conducted physicians forensic of asurvey in ofexamination, type this not occurred. ‘intact’ hymen meansthat penetration has the notionthat thepresenceofa ‘normal’ or isincorrect; is tion ofthevagina equallyfalse that therehasbeenpenetra- hymen confirms At puberty, thehymen isexposedto While examination ofthehymen may, in Further illustrating the non-utility of non-utility the illustrating Further

11, 12, 13 The beliefthat absenceofthe 12

11, 12, 13 The - - diminish because ahealthprofessionalisthe forcibly onwomen willnotnecessarily examinations caused byconductingvirginity depending ontheindividualcircumstances. treatment andmay amounttotorture constitute cruel, inhuman, anddegrading suffering. These examinations therefore es, tocausewomen significantpainand examinations arelikely, inalmostallinstanc- tions. When forciblyconducted, these examina- foundation forconductingvirginity ture. inhuman, treatment ortor- ordegrading procedure that may amount tocruel, ing inorcondoningany treatment or - prohibit healthprofessionalsfromparticipat standardsofprofessionalethics International C. ProfessionalandEthicalStandards of socialcontroltheirsexuality. towomen, and harmful asaform andserve examinations; theexaminations areirrelevant medical foundation forconductingvirginity assault moreorlesssevere. individual’s fromsexual painandsuffering makean necessarily ofvirginity does thefact woman hasbeensexuallyassaulted. Nor ofwhetherthat medical determination tothe addsnoinformation background assault. The knowledge ofawoman’s sexual tion, diagnosis, anddocumentation ofsexual relevance totheforensicmedicalexamina- and cultural. arewhollymoral,values tovirginity social, tovirginity.can beattributed Ascribed There isnomedicallysignificant value that virgin, theyarealsomedically irrelevant. whetherafemaleis less indetermining examinations arenotonlymeaning- Virginity B. Virginity The potential for pain and suffering The potentialforpainandsuffering There isnomedicalorhealthcare Health professionalsthereforehave no alsohasno The conceptofvirginity 14, 15 STATEMENT TORTURE Volume 25, Number 1, 2015 67

16 When virginity are forcibly examinations It is difficult to imagineIt is difficult in situation a conduct these that Health professionals Virginity are medically examinations unreliable and inherently discriminatory, when conducted in almost all instances, and, and result in significant physical forcibly, It is our opinion mental pain and suffering. forcibly conducted virginitythat examina- value and no clinical or scientific tions have degrading inhuman and constitute cruel, amount to torture and may treatment, depending on the individual circumstances. vaginal penetration, conducted and involve should be considered a formthe examination The involvement of sexual assault and rape. - of the health professional in these examina of the basic standards and tions is a violation ethics of our profession. Conclusion which virginity could meet this examinations are erroneousstandard since they and In no interpretableprovide information. are medically the examinations addition, women likely to cause unjustified and are sufferingsignificant pain and when they are conducted forcibly. violate upon women forcibly examinations ethics of the the basic standards and be reportedprofession and should by their colleagues to the appropriate authorities.

An 17 17 ix In general, an individual has the In general, 17 Health professional ethics also dictate ethics also dictate Health professional Following from these core ethical Following Professional health ethics permit the Communications with the World Medical Association, Association, Medical World with the Communications right to give or withhold consent to any diagnostic procedure or therapy. May 2014. May individual’s right to self-determination may individual’s be breached only if there is a real and of harmimminent threat or to the patient others cannot be remedied and this threat otherwise. ix that health professionals must respect the health professionals that and rights of the individual, and preferences must nature, their whatever interactions, any be solely for the best interests of those the purpose of any In addition, individuals. intervention to must be clearly explained and individuals must give individuals, voluntary and informed consent for the undertaking intervention. of any one undertaking may the procedure and in or medical’ ‘diagnostic’ qualify it as the fact a that In some instances, nature. who has an ethical duty health professional – is – is the one that of care to individuals their trustviolating contribute to these may and should subsequent trauma, women’s subject to health professional render that body. censure by their professional STATEMENT standards, health professionals should never health professionals should never standards, forcibly conduct virginity – i.e., examinations against the will or without the consent of or in circumstances where women women are not capable of giving genuine informed consent. carrying procedures and out of diagnostic will only in against an individual’s treatment if specifically exceptional circumstances, if and only if then, and even permitted by law, conforming to the basic principles of medical ethics. 68 TORTURE Volume 25, Number 1, 2015 8. 7. 6. 5. 4. 3. 2. 1. References 2011. CAT/C/TUR/CO/3. on cluding Observations Turkey. UnitedNations; United Nations Committeeagainst Torture. Con- United Nations; 2005July. CEDAW/A/60/38. against Elimination ofDiscrimination Women. United Nations. oftheCommitteeon Report Nations; 1994Nov. E/CN.4/1995/42. on HumanRightsresolution1994/45. United Coomaraswamy, inaccordancewithCommission Women, ItsCausesandConsequences, Rashika on by theSpecialRapporteur Violence Against submitted United Nations. report Preliminary United Nations; 2008Jan. A/HRC/7/3. ing Treatment orPunishment, ManfredNowak. Torture- andOtherCruel, InhumanorDegrad on velopment: oftheSpecialRapporteur report and culturalrights, tode- including theright human rights, civil, political, economic, social United Nations. Promotionandprotectionofall World HealthOrganization; 2003Jan. Medico-legal Carefor Victims ofSexual Violence. World HealthOrganization. Guidelinesforthe United Nations; 2010Oct. A/C.3/65/L.5. for Women (the Offenders “Bangkok Rules”). Women andNon-custodialMeasures Prisoners United Nations. Rulesforthe Treatment of Nations; 2004. HR/P/PT/8/Rev.1. or Punishment(the “Istanbul Protocol”). United Other Cruel, InhumanorDegrading Treatment vestigation andDocumentation of Torture and for HumanRights. ManualontheEffective In- United Nations OfficeoftheHighCommissioner (xxii)-1, &8(2)(e)(vi)-1, pp. 8, 28, 36. Crimes, 2011; RC/11. Arts. 7(1)(g)-1, 8(2)(b) Court. Elementsof Criminal International

17. 16. 15. 14. 13. 12. 11. 10. 9. Assembly; 1981. Rev. 2005. bon ontheRightsofPatient. World Medical World Medical Association. Declaration ofLis- 1949. Rev. 2006. of MedicalEthics. World Medical Assembly; World Medical Association. Code International A/RES/43/173. tion orimprisonment. United Nations; 1988Dec ofdeten- underany form tection ofallpersons United Nations. forthepro- Bodyofprinciples bly; 1975. Rev. 2006. tion andImprisonment. World Medical Assem- Treatment orPunishmentinRelation toDeten- Torture andotherCruel, InhumanorDegrading of Tokyo -GuidelinesforPhysicians Concerning World Medical Association. WMA Declaration 2007, May;119(5):e1094-106. Epub2007 Apr 9. adolescent girls: adescriptive study. Pediatrics and Healing ofhymenalinprepubertal injuries McCann J, Miyamoto S, Boyle C, K. Rogers 3053. Epub2009 Aug 3. Sep;124(3):e403-9. doi: 10.1542/peds.2008- finitive evidenceofpenetration. Pediatrics 2009, tive penile-genitalpenetration oftenhave node- J,Anderst KelloggN, JungI. ofrepeti- Reports JAMA 1999, Aug; Vol. 282(5); 485-90. forensic physicians incontrollingfemalesexuality. pino V. examinations in Virginity Turkey: Roleof Frank M, BauerH, N,Arican Fincanci S, Iaco- 57/1996/676/866. 25Sept. 1997. Eur. Ct. H.R. Aydin v. Turkey. , Judgment Judgment 15828/03. 17Jun. 2009. Eur. Ct. H.R. SalmanogluandPolattas v. Turkey. STATEMENT