This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
Two controversies related to women’s virginity have recently generated controversy among physicians and medical ethicists. The first of these is a campaign in Great Britain to ban hymenorrhaphy (often referred to by the broader term hymenoplasty), the surgical repair of the hymen in an effort to convey the appearance of prior sexual abstinence. The second involves legislative efforts in California and New York to criminalize virginity testing. Both efforts are clearly well-intentioned, yet each raises complex ethical concerns.
Women’s virginity has historically been valued in some religious and cultural traditions, and evidence of past sexual intercourse may render women in certain groups unmarriable. This remains true today in some Muslim communities. The issue drew international attention in 2008 when a French court in Lille annulled a marriage (a ruling later overturned) after the husband discovered that his wife had misled him into thinking she was a virgin. The absence of an intact hymen—a mucosal tissue the protects the vaginal opening—is falsely believed to be evidence of unchastity. In reality, a wide range of non-sexual activities in girlhood many lead to the rupture of the membrane, which is often asymptomatic and goes unnoticed. A British study found that the hymen may even remain intact after intercourse.
In an attempt to create the illusion of virginity, Muslim women in Europe and the United States may undergo hymenorrhaphy, a surgical procedure in which the hymen is reconstructed. The procedure began to draw significant public notice after the premiere of Davide Sordella’s 2008 film Women’s Hearts, which tells the story of a women who travels from Italy to Morocco for the procedure. Hymenorrhaphy is increasingly available in both the United States and Great Britain. It takes approximately 30 minutes to one hour and costs between $1,500 and $5,250.
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The purpose of banning this procedure is to protect women from pursuing, often under duress, a medically unnecessary operation and enduring its concomitant risks including infection. This motive is certainly admirable. One might compare such a ban to the similar campaign to stamp out female genital cutting (FGC) or “female circumcision” and its criminalization in the West. Unlike FGC, however, many of the clients pursuing hymenorrhaphy are adults.
Yet banning hymenorrhaphy might have a significant downside. Unable to obtain the procedure, Muslim women may then face severe consequences from limited marital prospects to intrafamilial violence for failing to prove their virginity. Until the state can protect these women from such devastating consequences, which will likely require sustained educational efforts and a fundamental change in community values, women in these communities may be the best judges of whether or not to pursue the surgery. Nobody else can weigh as meaningfully the risks of the procedure against the risks of forgoing it. Rather than FCG, a better analogy might be made to the reporting by physicians of intimate partner violence (IPV), which many jurisdictions do not require and some do not even permit—recognizing that victims of IPV are the individuals who can best determine whether such reporting serves their own interests.
In the United States, activists are not challenging hymenorrhaphy, but rather targeting the virginity tests that make it seem necessary. The effort gained considerable traction in response to a statement by a musician known as T.I. on the podcast Ladies Like Us, in which he said that he takes his 18-year-old daughter on “yearly trips to the gynecologist to check her hymen.” His claim produced widespread public backlash.
California Assemblywoman Lorena Gonzalez of San Diego has introduced legislation to prohibit hymen examinations by physicians; doing so would lead to potential disciplinary action by the state medical board. In New York State, Assemblywoman Michaelle Solages of Elmont has gone one step further; her bill would render such exams a felony. By targeting the tests, the goal is to render hymenorrhaphy both unnecessary and useless. If one cannot test for an intact hymen, having an intact hymen becomes irrelevant. Among those organizations supporting an outright ban are the World Health Organization and the United Nations Human Rights office.
Any effort to prohibit a potential medical intervention, no matter how pernicious or unnecessary, should be approached with considerable care. Entangling the state in the physician-patient relationship is not without its own consequences and may impose serious limits on the meaningful autonomy of patients. One would not be surprised if an underground market arises in professional virginity assessors with no formal clinical training who will fill the void if physicians are excluded from the practice. Alternatively, many families may simply take women abroad for evaluation, potentially exposing them to additional dangers.
Finally, there is an argument to be made that the state should trend very lightly when intervening in the deeply held cultural and religious practices of minority groups, lest one alienate these groups further from mainstream American society. All too short a road runs from proscribing virginity tests to banning certain forms of garb or headwear.
Yet the state does have a meaningful interest in preventing physicians from engaging in procedures that serve no clinical purpose. If virginity tests actually did assess virginity, conducting them would still be an affront to Western values—but the issue of whether to prohibit them by law might prove more challenging. However, virginity tests assess virginity no more effectively than divining rods detect ground water or Ouija boards sense departed spirits. They are pseudoscience. The American College of Obstetricians and Gynecologists stated in 2007 that the procedure does not have any medical indication. Needless to say, preventing the practice of pseudoscience is one of the key reasons the state regulates physicians.
Banning hymenorrhaphy and virginity testing offer two distinct approaches to addressing the same fundamental challenge: how to protect vulnerable women from a cultural practice that most Westerners, and many of these women themselves, view as oppressive. The difference is that the former lets the consequences fall squarely on the potential victims. In contrast, banning virginity tests tackles the problem in a manner least likely to jeopardize their welfare. While in an ideal world, no need would exist for such legislative action, embracing a ban on virginity exams is the best way for the medical community to pass the ethical test it now confronts.