Like a Virgin — Who’s Getting Hymenoplasties and Why as Told By the RealSelf Community

Elisabeth Kramer on 5 Mar 2015 at 5:00pm

Hymenoplasty

They were in love. RealSelf Top Doctor Michael P. Goodman could tell by the way the couple in his office looked at one another. Their story seemed a familiar one: Boy meets girl, boy and girl fall in love, boy and girl want to get married. But in this case, marriage wasn’t their choice to make.

“Basically, she’s of age and her family [in Saudi Arabia] has decided she’s going to get married,” Dr. Goodman recalls. “She would like [her boyfriend] to be the one who marries her. He would like to marry her, but the way it works is his family is petitioning her family for marriage. It’s up to the families.”

Uncertain of their future together, the couple found their way to Dr. Goodman’s office in Davis, California. A cosmetic gynecologist, he’s one of the few well-known doctors in the U.S. currently performing hymenoplasties.

In 30 minutes or less for between $2,000 and $4,500, a hymenoplasty restores a woman’s hymen, a thin membrane in the vagina that some cultures believe signifies virginity. The traditional thinking goes that if a woman is a virgin, then she should bleed on her wedding night when her hymen is broken. For those unwilling to rely on online products like the Artificial Hymen, surgery is the only option.

The Saudi couple sought out Dr. Goodman because they’d had premarital sex and wanted to make sure their families never found out. “If he’s the one the family chooses [as the groom], then no problem. She doesn’t have to bleed,” the doctor explains. “But she doesn’t know who she’s going to marry. It might not be him so she has an operation they hope she doesn’t need.”

Stuck Between a Rock and a Hard Place
Dr. Goodman doesn’t know the outcome of the couple’s story. In fact, in the decade since he added hymenoplasties to his practice, he’s had few opportunities to learn what happens after the procedure. The very nature of the surgery requires complete secrecy; most doctors perform hymenoplasties under local anesthesia so women can avoid asking friends and family to drive them to and from the appointment. Calling to follow up after the fact is out of the question.

Pull Quote 3 “They are so concerned, so worried,” Dr. Goodman says of his hymenoplasty patients. “The [risk of] family shame, the ostracism, and even the physical harm is significant … They’re really stuck between a rock and a hard place.”

That’s the reality Azal Ahmadi witnessed while researching her master’s dissertation in Iran. Currently a PhD candidate at Johns Hopkins University, Ahmadi spent several months in the capital of Tehran while studying at Oxford. In Iran, she interviewed five doctors who perform the procedure that, while not technically illegal, remains taboo.

One doctor she spoke with had a separate phone line installed exclusively for women seeking hymenoplasties. Another rented a series of different houses in which to perform the procedure. A third kept a piece of hair in his clinic’s doorway; if the hair moved overnight, he figured someone had broken in. “He was that paranoid but he also had this strong moral obligation to do the procedure,” Ahmadi says.

To not perform a hymenoplasty, the doctors felt, was to endanger their patients. As one gynecologist told Ahmadi, she “prevents something fatal from happening” when performing a hymenoplasty. According to that doctor, “something fatal” ranges from saving a woman from infection if she gets the surgery from a non-licensed practitioner to, in extreme, rare cases, an “honor killing” in the more conservative areas of the country.

“If you’re going through all this hassle to get this procedure you’re doing it out of either social or cultural pressure or a threat to your safety,” explains Ahmadi. “There’s a bigger issue involved.”

RELATED: Hymenoplasty: See How the Surgery Is Done (GRAPHIC)

Who’s Getting Hymenoplasties?
There are two types of patients who typically seek out a hymenoplasty. First, the woman who wants to “give” her virginity — or the semblance of it — as a gift to her lover. “They just want to go through the experience,” Top Doctor Marco A. Pelosi III of New Jersey says of those patients.

Pull Quote 2Much more common are women like the one in Dr. Goodman’s story. They’re in their late teens or early 20s, culturally orthodox, and likely having an arranged marriage. They’ve grown up in the U.S. or come to the States to work or study; now they're heading abroad for their wedding. Other times, they’ve flown in especially for the procedure. Universally, they’re getting the surgery done for everyone but themselves.

That’s what makes it so unlike every other plastic surgery, says Dr. Pelosi. “‘I want it done for me’ — I hear that all the time. But [for hymenoplasty] I’ve never heard it. Never. Not once.”

Of course, he adds, you can make the same “culture forced them into it” argument about any elective procedure but something about hymenoplasties is different. “People say it’s either right or wrong. I think that’s an overly simplistic way of interpreting it,” says Ahmadi. “The women’s stories are very complex. The situations are very complicated. I would refrain from the dichotomy of it’s good, it’s bad, it’s right, it’s wrong. It’s much more complicated.”

What Religion Doesn’t Have to Do With It
Despite common perception, religion isn’t always the biggest complication in play. While Ahmadi, who’s Iranian-American, says hymenoplasties are a “culturally ingrained” event “women from the Middle East are very aware of,” the practice isn’t sought out only by religious women — most patients in her research identified as secular — or solely by women of Middle Eastern heritage.

“It’s certainly not a phenomenon unique to Iran or the Middle East,” she adds, pointing to hymenoplasty patients ranging from conservative Catholics in Latin America to socially orthodox Americans in the South. “Hymenoplasty is really something that women from all socio-economic fields grapple with. It’s not something restricted to a certain religious class or ethnic group … There’s a deeper rooted issue, a common thread about the importance of virginity among these civilizations.”

Perhaps ironically, however, an intact hymen is not guaranteed proof of virginity. “The hymen is a very thin membrane with very few blood vessels,” explains Dr. Pelosi, who’s been performing hymenoplasties for 15 years. “The amount of blood vessels varies greatly from woman to woman.”

That means even when surgically restored, the hymen may bend without breaking or break without significant bleeding. Indeed, many women accidentally break their hymens long before they have sex through such commonplace activities as riding a bike or using a tampon.

Pull quote 1 Making matters more complicated is the fact that there’s no textbook-perfect version of a hymen. “It’s an elastic membrane; it can change shape as a woman grows,” says Dr. Pelosi. Finding a “perfect” hymen, he adds, is like “chasing a unicorn.” 

So while a hymenoplasty is inherently the “opposite” of all other surgeries because, as Dr. Goodman puts it, “you want to produce a situation where they’re going to bleed all over the place,” bleeding may not be possible no matter how skilled the surgeon.

“I think women need to be aware that this could fail,” Ahmadi says. “Just be ready. Ask yourself what will you do if this doesn’t work?”

How often does it fail? No one knows. Because of the secrecy patients require, they often don’t follow-up, leaving doctors unable to file the kind of medical studies that have standardized the field and would answer pressing questions.

“What is the best way [to perform a hymenoplasty]? What has the best outcome? What is least likely to be discovered? All of these questions we don’t have any answers to,” says Dr. Goodman. “Is it best to do the surgery a month before consummation? Three months before? Six months? No one knows. All you can do is make your best guess.”

The Healing Process
What doctors can agree upon is the importance of a woman giving herself time to heal. A fresh scar won’t bleed so doctors tell patients to leave at least six weeks between the day of the procedure and the day of consummation so they're not found out. More time is better, particularly if, as sometimes happens, the woman is physically examined before her wedding.

When one woman told Dr. Goodman she was going to be “inspected” by an imam so he could verify she was, as she claimed, a virgin (it really does happen), the doctor changed his surgical technique to better hide any incision lines. When anticipating such an inspection, which Ahmadi says results in a “virginity certificate” that identifies the woman as either “healthy” (an intact hymen) or “not healthy” (a broken hymen), a woman needs months, not weeks, to heal.

RELATED: Hymenoplasty: Quick Facts

It’s currently unknown how many hymenoplasties are performed annually, but doctors say demand remains constant. In Iran, a gynecologist told Ahmadi she performs an average of 10 hymenoplasties a month. Dr. Pelosi sees between three or four monthly and while it’s one of the least common procedures he performs, he has a steady stream of patients.

It wasn’t a RealSelf community member happy_d saw when her parents forced her to undergo a hymenoplasty. Nineteen years old at the time, happy_d, who elected not to share her real name for this story, says her parents made all the arrangements because they don’t believe in sex before marriage.

Pull quote 4“I’ve been struggling with anxiety after the surgery,” she says. “I felt like I couldn’t love someone again, be intimate with someone I cared about, and was forced to live a lie. I just felt violated, and I hated it.”

It had been several years since the procedure when happy_d reached out to RealSelf doctors to discuss treatment for undissolved stitches. She didn’t “want to be intimate,” she wrote, because “its embarrassing to have zillions of undissolved stitches down there.”

Happy_d has this perspective to offer other women in her situation: “My heart goes out to them. My advice would be to live their lives authentically. In this day and age, women shouldn’t have to live their lives in fear, guided by some archaic beliefs of their families, relatives, and religious communities. Someone who’s right for you will accept you and your past. Hymenoplasty and living a lie cannot possibly make your relationship stronger. I’m just convinced that a relationship based on lies and deceit can’t last long, and that a person who truly and selflessly loves you will be just fine with the fact he is not your first.”

Art by Anna Helland