Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction

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 (first visit), educational examination (second visit), decision on operation or alternative (third visit), and follow-up (fourth visit). Results Eighty-two women were interviewed at first visit. Sixty-eight women were followed 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 operation and attended the follow-up visit reported no blood loss at first 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.

Hymen reconstruction as pragmatic empowerment? Results of a qualitative study from Tunisia

“…Such pressures generated anxiety for women before and during the procedure (Ph2). Two physicians confirmed the findings from prior studies (Van Moorst et al 2012;Loeber 2015) that many women seeking HR had previously been victims of sexual violence (Ph3, Ph4). One physician explicitly characterized HR itself as a form of patriarchal oppression, not entirely dissimilar to other forms of gender based violence, in that it amounts to a "reduction" of and "assault" on individual women (Ph2).…”

“…These results complement the other two studies that engaged women about their HR (Van Moorst et al 2012, Loeber 2015. We agree with their core recommendations: the clearest need, and the clearest medical duty, is to provide women considering HR with knowledge of their own anatomy, including sexual and reproductive health information, so that they understand both how many cultural beliefs about virginity are biologically false and misleading, and how limited are the prospects for "reconstructing virginity" surgically.…”

“…In fact, a literature search (in MedLine, Google Scholar, and Sociological abstracts, using an expansive list of search terms for HR, up to summer 2014) uncovered only seven empirical studies (Ahmadi 2014, Awwad et al 2013, Zeyneloğlu et al 2013, Essén et al 2010, Tschudin et al 2013, Van Moorst et al 2012, Juth et al 2013, Wild et al 2010. A few others have recently been published (Steinmueller & Tan 2014;Loeber 2015).…”

“…There is, however, an overall lack of data drawn directly from women who have undergone the procedure or are contemplating doing so. Only two published studies, both from the Netherlands, employed interviews with women undergoing HR (Van Moorst et al 2012, Loeber 2015. Van Moorst et al embedded their interview study in a standardized protocol for acceding to HR requests, focused on empowering women to make autonomous decisions.…”

“…The widespread assumption of a correspondence between hymen, virginity, and blood on bed sheets has been called the "the myth of the intact hymen" (Van Moorst et al 2012:94) because of its biological implausibility: the form taken by the membranous fold of tissue at a woman's vaginal opening varies greatly among individuals, and often wears significantly away during childhood, even in the absence of sexual relations (Adams et al 2004). Virginity, moreover, is defined differently by different cultures and women, and vaginal sexual penetration cannot be medically or informally ascertained with certainty (Gay-y-Blasco 1997, Boddy 1989.…”