Hymenoplasty Research Articles

A 7-Year Retrospective Analysis of Hymenoplasty: Profiles From a Specialized Gynecological Cosmetic Surgery Practice.

Hymenoplasty-surgical reconstruction of the hymen-is on the rise in Turkey, reflecting the enduring importance of virginity which is rooted in sociocultural and religious beliefs. Demographic factors shape women's decisions regarding this procedure. The aim of this investigation was to delve into the multifaceted perceptions around virginity and hymenoplasty in Turkey, examining the impact of sociocultural and religious beliefs on women's decisions. The study also explored demographic influences, offering insights into the societal and cultural backdrop of hymenoplasty. A 7-year retrospective analysis of 4259 patient records (2015-2022) at a private clinic was conducted, and statistical tools were used to meticulously analyze data on demographics and shared decision-making dynamics. In the examined cohort (83.3%), the choice of permanent hymenoplasty was prevalent among individuals aged 14 to 49 years, with 58.6% being engaged and seeking the procedure a week before marriage. Notably, 91.0% were accompanied by friends during consultations, and a minority disclosed a history of childbirth or experience of forced intercourse. An increasing trend in first-time and post-assault hymenoplasty procedures was observed in 2021. Geographically, the majority of individuals resided in Istanbul, but represented all Turkish regions. Additional procedures such as vaginoplasty were common, with mostly successful postprocedural outcomes and minor complications. This study highlighted the enduring social importance of virginity in Turkey, emphasizing hymenoplasty as a coping strategy for psychological and societal challenges. The study calls for comprehensive patient support and societal progress in respecting women's bodily autonomy, urging a shift away from the cultural fixation on virginity.

(084) Frequency of Bleeding at First Vaginal Intercourse and Stereotypes Surrounding it: A Pilot Survey of 6370 Russian-Speaking Women

Abstract Introduction Despite the fact not all women experience bleeding at first vaginal intercourse (BFVI), in some cultures failure to prove virginity on the wedding night (sheets/garments covered with blood) may have serious consequences for a woman (bullying, domestic violence, shame and even honor killings). Low awareness of the true frequency of BFVI and of individual variation of the anatomy of the hymen may lead to inaccurate conclusions in cases of sexual assault or “virginity testing” (VT) at schools and/or in clinical settings, which can have a drastic impact on the mental health of young women. In cultures where defloration is sacralized, young women tend to choose anal sex instead of vaginal, which bears further risks including higher hazard of HIV; women also tend to seek hymenoplasty often performed in secrecy (in many cases it cannot guarantee bleeding at following intercourse, as intended). Objective To evaluate the frequency of stereotypes surrounding BFVI among Russian-speaking women Methods An anonymous survey was completed by 6370 Russian-speaking women across different countries who have had at least one vaginal intercourse. We aimed to reach women from varying religious, socioeconomic and educational backgrounds. The survey included questions on whether women experienced BFVI and if not, whether it had any negative consequences; and list of questions regarding their feelings about virginity, hymen reconstruction and sex in general. The questionnaire was distributed by the authors and biomedical bloggers, via social media (Instagram, Facebook, and Telegram). Preliminary results are presented. Results Median age was 31 (15–70); 59% were married; 73.6% reported being raised in secular families. 21.2% - in religious families, and 2.1% - in strictly religious. 43,2% respondents denied having any BFVI; 42,3% confirmed BFVI; while 5,3% reported bleeding on following sexual encounters but not on first intercourse. A minority (3,6%) did not remember whether any bleeding was present. Among those who didn’t have BFVI, 75 (2,2%) reported long-lasting conflicts with partners, 166 (5%) reported withdrawal of their partners, 115 (3,5%)– mistrust, 88 (2,7%)– constant blaming, 37 (1,1 %) – emotional abuse, 2 (0,1%) – physical violence. Two hundred twenty-three (3.5%) women experienced VT at school, 76 (1.2%) referred themselves for VT, and 25 (0.4%) did so at the demand of their own family. Conclusions Traditions demonstrating BFVI associate with negative emotions and affect marital relationships as well as sexual health of women. Medical professionals should be aware of the frequency of BFVI; anatomy and gynecology books should reflect corresponding scientific findings. Myths about virginity should be addressed via media and opinion leaders to prevent gender based violence. Disclosure No.

HYMENOPLASTY SURGERY SOCIO-LEGAL ASPECT: A REVIEW

This article is a reflection of the rising complexity of the contemporary world, which is characterised by a rich variety of culture, morality, the legal system, and religion, all of which are capable of having a significant impact on medical practise. It is possible to rupture a hymen via sexual activity as well as through a number of other activities. In societies that place a high value on a woman retaining her virginity after marriage, a woman and her family may be stigmatised for having done so. Women, particularly brides whose virginity is not established at the time of marriage, face the risk of humiliation, ostracism, divorce, and violence; in the most severe cases, women risk being killed in the name of "honour." However, doctors may be opposed to hymen reconstruction on the grounds that it is dishonest, not necessary for medical reasons, discriminates against women, and promotes subjecting women to greater standards of virtue than are demanded of men. Many doctors explain that the operation by stating that it serves the patient's health, which may include the patient's emotional and social well-being as well as women's human rights to have control over their own bodies. In addition, many young people lose their virginity unintentionally as a result of rape or compulsion, and if women do not have their hymens reconstructed, they are at risk of physical assault and even death. In the surgery does not violate any laws but in the most cases women suffer from some risk and it should be confused with female genital cutting or mutilation.

YouTube as a Source of Information on Hymenoplasty

Aim: The aim of this study was to evaluate the quality, validity and reliability of YouTube videos regarding hymenoplasty. Methods: On 01/03/2021, the terms "Hymenoplasty", "Hymen Repair", "Hymenoplasty Surgery" and "Virginal Membrane" were entered separately in the YouTube search bar, and the videos were listed by selecting "relevance" from the filtering options. After excluding non-English videos, videos shorter than 60 seconds and longer than 20 minutes, entertainment videos, news and repeat videos, the most relevant and most watched 100 videos were included in the study. Results: While 50% of these videos were uploaded by physicians and 40% by private clinics, 64% were contained information about surgical technique and 28% general information. While the mean DISCERN score of the videos uploaded by physicians was 2.96 ± 0.83, it was 2.84 ± 1.27 for those who were not uploaded by physicians. While the mean GQS score of the videos uploaded by doctors was 2.96 ± 0.75, it was 2.74 ± 1.24 for the videos that were not uploaded by physicians. According to the scores given by the researchers on both DISCERN and GQS scales, 38 videos were found to be of poor quality and misleading, 31 videos were of medium quality, 23 videos were of good quality, and 8 videos were of excellent quality. Conclusion: While general information videos uploaded by physicians and private clinics contain useful and educational information, we found that surgical technique videos provide incomplete and misleading information. We think that all videos with health content should only be uploaded by specialist doctors and health channels and these videos should be subjected to peer review.

Experience of obstetricians and gynecologists in the management of medicolegal cases in Egypt

BackgroundObstetrics and gynecology (OB/GYN) is concerned with both fetal and maternal wellbeing with doubled professional responsibilities. Also, OB/GYN specialists are engaged in management of medicolegal cases (MLC). This study had an in-depth look at handling of MLC by obstetricians and gynecologists in Egypt. Also, influence of religious and cultural norms on OB/GYN practice was investigated.MethodsA questionnaire was formulated in compliance with literature and modulated according to religious and cultural background.ResultsResponses were received from practitioners in 19 governorates. 28% of respondents were accused of malpractice. 87.3% of participants denoted increasing rate of litigations over last years. The commonest mentioned error is intra-operative problems (60%), whereas the commonest harm is neonatal deaths (46.7%). The mean participants' awareness score regarding elements of malpractice was 1.49 ± 0.76 (maximum possible score is 4). 18.7% of respondents managed cases of sexual assaults and premarital sexual relations. Hymen repair is not justified by 53.3% of participants. Termination of pregnancy before 16 weeks without medical indication is unaccepted by 96.7% of participants. The mean participants' awareness score regarding precautions of therapeutic abortion was 3.34 ± 1.63 (maximum possible score is 5).ConclusionsOB/GYN specialists are at high risk of accusation with inadequate measures to guard against malpractice claims in Egypt. High controversy among respondents regarding management of cases with premarital sexual acts and termination of pregnancy was elucidated.

Commentary on: Hymen Restoration: An Experience From a Moroccan Center.

Commentary on: Hymen Restoration: An Experience From a Moroccan Center.

Commentary on: Hymen Restoration: An Experience From a Moroccan Center.

Commentary on: Hymen Restoration: An Experience From a Moroccan Center.

Hymen Restoration: An Experience From a Moroccan Center.

Hymenoplasty is one of the least described vulvovaginal procedures in plastic surgery without any surgical standard that attempts to restore the hymen's ability to bleed during sexual intercourse on a couple's wedding night. The objective of this study was to report outcomes from a Moroccan retrospective study of a series of 529 patients who underwent either a hymenorrhaphy or a hymenoplasty. This was a retrospective study of 529 patients who underwent hymen restoration at a center in Morocco between April 2010 and April 2019. The data were collected according to the requirements of the center through preoperative and postoperative consultations and in-person or phone post-coital interviews. The procedure consisted of suturing the edges of the hymen remnants with Vicryl 5-0, leaving a small opening in the newly reconstructed hymen. Two techniques-hymenal flap hymenoplasty and vaginal flap hymenoplasty-were employed depending on the presence or absence of hymen remnants. A total of 529 patients underwent hymen restoration, including 42% hymenorrhaphies, 58% hymenoplasties, 39% hymenal flap hymenoplasty, and 19% vaginal flap hymenoplasty. The mean age of the patients was 32 years. Of the 227 women who underwent a hymenorrhaphy, no failure was reported, and all the patients who had sexual intercourse within 15 days of the procedure experienced vaginal bleeding. Of the 99 hymenoplasties employing vaginal flaps, only 1 failure was reported. The techniques utilized in our cohort are safe and the complications are minor with general satisfaction of patients.

Commentary on: A New Practical Surgical Technique for Hymenoplasty: Primary Repair of Hymen With Vestibulo-Introital Tightening Technique.

Commentary on: A New Practical Surgical Technique for Hymenoplasty: Primary Repair of Hymen With Vestibulo-Introital Tightening Technique.

A New Practical Surgical Technique for Hymenoplasty: Primary Repair of Hymen With Vestibulo-Introital Tightening Technique.

Hymenoplasty is distinct from other genital surgeries with its ethical and psychological issues. It is performed to narrow the vaginal opening to ensure vaginal bleeding with penetration. There are various kinds of techniques with different success rates. The authors sought to report a new hymenal reconstruction technique with vestibulo-introital tightening with the results of 145 procedures. The new technique included a diamond-shaped incision to the vestibulum with the base in the posterior midline and superior corner 2 to 3 cm higher above the hymen. The angles were accommodated according to the degree of tightening, and the submucosal layer was closed from the apex downwards involving the vaginal mucosa. The satisfaction rate of the patients was 99.3%. No adverse events were observed. Compared with previous techniques described, this hymenal reconstruction technique is an alternative with the advantage of low risk of loosening because the tension on the hymen alone is decreased. Additional tightening of the introitus increases the satisfaction rates in some patients.

\u2018Doing hymen reconstruction\u2019: an analysis of perceptions and experiences of Flemish gynaecologists

BackgroundHymen reconstruction (HR) involves the restoration of the hymeneal membrane’s gross anatomical integrity. Among the medical profession, hymen reconstruction receives particular attention and its necessity is debated because the surgery is not medically indicated, and often reveals conflicting social norms on virginity and marriageability between health professionals and their patients. The focus of this paper is not to address the many open questions that the ethics and politics around HR reveal, but rather aims at contributing to the much-needed empirical evidence. It presents findings of a study conducted in Belgium (Flanders region), among gynaecologists that aimed at assessing their knowledge, views, and experiences on hymen reconstruction.MethodsA digital self-administered questionnaire-based survey was sent to Flemish gynaecologists and trainees in Flanders registered with the Flemish Society of Obstetrics and Gynaecology (VVOG).ResultsHundred-and-nine questionnaires were completed. The majority of the respondents (73%) had requests to perform HR. Knowledge and technical skills about HR were considered to be sufficient (69%), even though HR does not seem to be integrated in medical curricula or post-graduate training. Most respondents (72%) would favour the publication of a guideline by their professional organisation. Few respondents discuss alternative options with the patient (19%) and half of the respondents reject to perform HR (49%). The majority of our respondents are against reimbursement of the surgery (70%). Not even half of our respondents believes that a patient is at risk of further violence (47%). 7% of the respondents mentioned complications, but the majority was able to perform a follow up consultation.ConclusionsThe responses of this survey cannot be generalised to the entire population of gynaecologists in Flanders, but do provide insights in how gynaecologists confronted with HR are approaching such requests, and thus contributes to the empirical evidence. Our paper showed that many Flemish gynaecologist are likely to encounter requests for hymenoplasty, but that a majority would not perform the surgery. There seems to be a lack of guidance and debate in Flanders on the social and moral dimensions of HR, and a number of complexities were revealed when gynaecologists address HR that need further research.

Luminal Reduction Hymenoplasty: A Canadian Experience With Hymen Restoration.

Luminal Reduction Hymenoplasty: A Canadian Experience With Hymen Restoration.

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

Hymen reconstruction surgery (HR), while ethically controversial, is now available in many countries. Little clinical evidence and hardly any surgical standards support the intervention. Nearly as scarce is social science research exploring women's motivations for the intervention, and health care professionals' justifications for its provision.In order to better understand decision-making processes, we conducted semi-structured interviews in metropolitan Tunis, in 2009, with six women seeking the procedure, four friends who supported such women, four physicians who perform the operation, and one midwife.Health care professionals and patient companions expressed moral ambivalence about HR: although they could comprehend the individual situation of the women, they expressed concern that availability of the procedure might further entrench the patriarchal norms that compel the motivation for seeking HR in the first place. Some women seeking HR shared this concern, but felt it was not outweighed by their personal aims, which were to marry and become mothers, or to overcome past violent sexual experiences. The women felt HR to be uniquely helpful in achieving these aims; all made pragmatic decisions about their bodies in a social environment dominated by patriarchal norms. The link between HR and pervasive gender injustice, including the credible threat of serious social and physical harm to women perceived to have failed to uphold the norm of virginity before marriage, raises questions about health care professionals' responsibility while facing requests for HR. Meaningful regulatory guidance must acknowledge that these genuine harms are at stake; it must do so, however, without resorting to moral double standards. We recommend a reframing of HR as a temporary resource for some women making pragmatic choices in a context of structural gender injustice. We reconfirm the importance of factual sexual and reproductive education, most importantly to counter distorted beliefs that conflate an “intact hymen” with virginity.

Virginity dilemma: Re-creating virginity through hymenoplasty in Iran

Bridal virginity retains undeniable value in Iran’s contemporary cultural landscape. Widely regarded as a sign of chastity and purity for unmarried girls, failure to prove virginity on the wedding night may have serious consequences for a girl. In this context, there has been a recent growth in the rate of hymen restoration surgery (hymenoplasty) due to an increase in the number of girls who engage in premarital sexual relationships. The present study attempts to elucidate the processes through which particular physical features come to be considered culturally meaningful, and explores the phenomenon of hymen-reconstructing surgery from the perspective of young Tehrani girls and boys. Applying anthropological insights into gender roles, I explore how so-called ‘rebellious’ Iranian girls find – through the surgical reconstruction of their hymen – a means to negotiate between dominant models of gender and their own subjective experiences. While their actions challenge the premarital sex taboo, Iranian girls who participate in hymen restoration surgery also conform to the values that require them to be a virgin at the time of marriage, thus reinforcing existing power relations.

The Value of Virginity

Hymen reconstruction surgery is a simple procedure to repair a woman's hymen, requested by women who, for religious and cultural reasons, believe they must appear to have an intact hymen on their wedding night. Debates surrounding possible ethical justification for the procedure are complex and heated. These articles from the Harvard Ethics Consortium present and explore the case of a young woman who asked a young female physician on call for a referral for the procedure.

When Bleeding Is Vital: Surgically Ensuring the “Virginal” State

A young woman called me to ask for a referral to a physician who provided hymen reconstruction surgery. She had had premarital intercourse and came from a cultural background in which it was very important to "prove virginity" on the wedding night. This article deals with my internal struggle whether or not to provide the referral. I felt that providing it would have made me complicit in supporting gender inequality, as men are not required to "prove virginity" to get married. At the same time, I was concerned about the repercussions of not being able to "prove virginity" would have on the caller. I had no explicit guidance on what to do in such a situation--it was not covered by the professional responsibilities I had as a research assistant.

Doctoring the Genitals: Towards Broadening the Meaning of Social Medicine

Doctoring the genitals is compatible with a recognizable conception of social medicine. This commentary critically examines the distinction between medical and nonmedical procedures; presents an alternative account of Sohaila Bastami's personal reaction to the anonymous caller's request for referral information concerning hymen reconstruction surgery; and makes use of Yelp to simulate the caller's procedure for locating a helpful practitioner. Yelp is a very useful informational search engine that does not subject its users to a moral examination.

Like a virgin? Hymen restoration operations in contemporary China (Respond to this article at https://www.therai.org.uk/publications/anthropology-today/debate)

In this article, the authors use the example of hymen repair surgeries to discuss the reconfigurations of patriarchal practices in the People's Republic of China. Following a brief overview of concepts of virginity and the importance of the hymen in China, they describe the spread of hymen restorations in the reform era. These surgeries link up traditionalist and ‘patriarchal’ practices and relationships with particular expressions of sexual liberalism in contemporary China.

Wrestling with the hymen: Consultations and practical solutions

Objective To study the consultation and treatment options for young women who desire revirgination surgery, and to offer recommendations. Methods During her initial visit to a Dutch clinic, each of these women discussed with a physician her reasons for consulting and the treatment options. Results One hundred and fifty-four women sought advice for virginity-related issues. They were planning to marry or had experienced some form of sexual violence. Of these, 48 chose hymen reconstruction (HR), 26 a temporary hymen suture (THS), and 27 to resort to some expedient for staining the sheets or to another alternative for surgery. At follow-up, 13 of the 17 women who had THS and six of the 11 who had HR reported blood loss on their wedding night, whereas all six women who inserted a capsule with food colouring stated they had stained the sheets. Conclusions Cost-effective procedures help young women who are no longer virgins to avoid reprisals by their husband or family. Pelvic floor exercises will tighten the vaginal opening. THS seems more effective than HR for producing blood loss. There are alternatives should no blood loss occur during penetration. Chinese 摘要 摘要目的给拟行处女膜修复手术的年轻女性提供咨询、治疗选择和建议。 方法在荷兰门诊的首诊时，每位女性患者均与医生讨论处女膜修复的原因，并以此提供咨询和治疗方案。 结果共154名女性寻求有关贞洁相关问题的建议。她们正打算结婚或者经历过某种形式的性暴力。在这些人中，48人选择了处女膜重建（HR），26人选择临时处女膜缝合（THS），27人求助于能够渲染床单的染色剂或其他替代品以替代手术。在随访中，17名选择THS中的13名女性以及11名选择HR中的6名女性在新婚之夜出现出血，而六名选择放置食物色素胶囊的女性则沾满了床单。 结论成本效益分析可以帮助那些不再是处女的年轻妇女避免被她们的丈夫或家人报复。盆底肌肉练习可以紧缩阴道口。在产生出血方面THS似乎比HR更有效。还有其他的在性交过程中不出血的替代选择。

Are estimations of female patients’ need of hymen restoration and virginity certificate value-impregnated? Empirical study of physicians’ attitudes

Summary Aim The aim of the present study was to examine whether physicians’ estimations of medical needs are influenced by the physicians’ own personal values. Design and method We used a vignette where a young female requests hymen restoration or virginity certificate due to honour-related threats. We asked whether or not the participating physicians would under certain circumstances be prepared to help the young females. We also asked what would happen to their own trust and what they estimated would happen to the general public's trust in healthcare if performing such operations or writing such certificates was generally accepted. Results The majority of those whose own trust would not be influenced [59.7% (95% CI 55.2–64.2)] were found among the respondents who stated that they were prepared to help the young females, as against those [13.5% (95% CI 10–16.5)] stating that they would help under no circumstances. We found an association between those whose own trust would decrease and those stating that they would help under no circumstances [OR 90 (95% CI 12.2–664.3)]. Conclusion The results indicate that factual aspects are influenced by physicians’ own values. If factual aspects such as estimation of the patient's trustworthiness and medical needs are impregnated by physicians’ personal values, there is a risk of arbitrariness when deciding whether to help young females in distress. In order to avoid arbitrariness in decision-making we suggest that consensus in the area is developed.