Our new series, Closer Look, takes a deeper dive into the controversial, critical, and of-the-moment issues facing doctors and patients in aesthetic medicine.
It’s a rare occurrence, when reporting a story, to have almost all your sources request anonymity. Yet in the process of digging into an under-the-radar but completely legal surgical procedure known as hymenoplasty (hymen restoration), doctors we spoke to who performed it asked not to be named. That’s because this surgery is usually done not out of medical necessity or aesthetic desire but the cultural obligation to pass a virginity test—a routine practice in at least 20 countries and one that both the United Nations and World Health Organization have declared a human rights violation.
What is hymenoplasty?
The hymen is a thin, elastic tissue that surrounds or partially covers the opening of the vagina. It becomes more prone to ripping during puberty, with tampon use, and when women play sports or have sexual intercourse. During the hymenoplasty procedure, which can be done under local anesthesia and often in less than half an hour, the doctor will locate what remains of the hymen, removes the edges with scissors or a scalpel, then suture the fragments together—a process that narrows the vaginal opening. Hymenoplasty is not done during a labiaplasty or vaginoplasty, unless a patient requests it.
Why do women get hymenoplasty surgery?
The thought of having to go for a gynecological exam with our in-laws before the wedding ceremony and turn over bloodied bedsheets to them the morning after can be unfathomable. But these are so-called virtue requirements for women of all different ethnic, religious, and cultural backgrounds—including those living in America, where the practice is legal and unregulated. (In 2019, rapper T.I. sparked outrage for proudly revealing that he accompanies his 18-year-old doctor to the gynecologist to ensure she has an intact hymen.)
“I was to be married to a man arranged by my family. I had to be a virgin on our wedding night. The problem was that I’d had sex with a boy when I was 16 years old and I was not going to bleed on my wedding night with my future husband,” writes one RealSelf user, who traveled from the Middle East to Ohio for reconstruction of the hymen. “When I got married, the new hymen broke and I bled … [My doctor] saved the honor of me and my family.”
Another reports, “My husband could not tell that I had the 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.”
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Failing to pass virginity tests can spell death in some communities, which is why many doctors who repair the thin piece of torn hymen that, when intact, proves a woman’s chastity to her family, take all precautions against revealing the patient’s secret.
“I had parents bring in their daughter, who is American, born and raised, for a hymenoplasty,” says a female OB-GYN in New Jersey. “She was a typical teenager who had sex, but her family was from Afghanistan and getting her married to a man there. They said, ‘If she’s not a virgin, they will shoot and kill her.’ Of course, my staff was very concerned about what might happen if anyone found out we gave her her virginity back. They were like, ‘Are they going to come and shoot us too?’ Anything’s possible. It’s like abortion rights—they hate the doctors for doing the abortion. Anonymity is important for that reason.”
She estimates that she performs 50 hymenoplasties a year, on both U.S. citizens and patients who travel from Egypt, Jordan, and Pakistan—and she assumes most are of the Islamic faith. Other doctors stress that they treat patients of all faiths and note that virginity is especially important in the Orthodox-Jewish community as well. The vast majority of women come with their mothers or a female friend, she says, but she’s seen two fathers accompany their daughters, and most recently, an engaged couple who had been sexually active and now needed the revirginization surgery in order to fool the man’s mother. But there is one thing every woman coming in has in common, says the New Jersey doctor, and it’s that “they fear for their lives, either from their own parents or their future spouse and in-laws.”
“100% of them are extremely anxious that it won’t work or that someone will find out,” says a female OB-GYN in Southern California, who does one to three surgeries per month on patients who run the gamut from Christian to Muslim, Caucasian to Chinese, as young as 13 to as old as 50. “They don’t want to swipe a credit card or give me their ID. They love that I don’t have electronic health records, so no one can hack into my computer and find out that they were there. They’re panicked that someone might hire a private investigator and follow them. I had one from Afghanistan who said she might be stoned. It’s heartbreaking.” The New Jersey doctor says that many of her patients don’t put working phone numbers or emails on the intake forms and tend to pay in cash. “They don’t want to leave any paper trail.”
Though not all the women coming in for hymenoplasty are preparing for an arranged marriage—the California OB-GYN says it’s not unusual for a man to bring his mistress once they have ended their affair, so that she can be pure for her next relationship—the majority are short on time and anticipate being made to undergo a gynecological exam, either in the U.S. or their home country, before a wedding. For this reason, the doctors interviewed all agreed six to eight weeks is the safe zone in terms of how long it takes the hymen to heal and the stitches to dissolve. After that point, there is no evidence it’s been surgically tampered with.
“Think about planning a wedding and the sheer panic that goes into hoping everything will turn out okay. Now think about being a woman who has to prove she’s a virgin that day. That trumps everything—anything you could think of is like nothing that they go through,” says the California OB-GYN.
Many women have no choice but to fly home after the procedure and pray for the best, though one Illinois-based plastic surgeon says he always tries to see his local patients for a follow-up appointment, to check that there is no evidence of sutures. “I don’t want to be the one responsible for telling them it’s healed and then something happens,” he says. “As a surgeon, it makes me feel like I’m doing something as a cover-up rather than what we’ve been trained to do, but at the end of the day, it’s reconstructive surgery for cosmetic purposes.”
Three male doctors who were interviewed all expressed some unease around playing a role in a dishonest process. “Being a part of fooling someone is the hardest thing about doing this,” said one urogynecologist who didn’t feel comfortable sharing his location. “I justify it because she is in a bad situation and I’m not going to change that culture or that mentality.”
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In contrast, three female doctors said they have never wrestled with any guilt over the fact that they’re helping women lie. The California OB-GYN states simply, “My job is to help my patients. I don’t feel guilty for deceiving the family, because they’re not my patients.”
“We’re doing what is the least harmful,” 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’d just had the procedure, was taking her to New York University for an exam 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 sure 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 came back to my office and I took a photo to show her that all the stitches were still there.”
So long as virginity testing continues in the United States and abroad, so will demand for hymen repair surgery. And though the American College of Obstetricians and Gynecologists has expressed concern over “the ethical issues associated with 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 banned hymenoplasty or offered any guidelines to physicians in terms of how they should handle requests for virginity tests.
Of course, as with abortion, a ban will only put women at greater risk of violence until these cultures dismantle the misogynistic framework on which they’re built. As the New Jersey OB-GYN puts it: “Why is it that [in these cultures], men are allowed to have sex but women aren’t? Why is the woman’s life in danger, whereas the man that took her virtue is not?” As we know, it’s never really been about the hymen.
