Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Cultural complexities should not be ignored

How variability in hymenoplasty recommendations leads to contrasting rates of surgery in the Netherlands: an ethnographic qualitative analysis

Hymenoplasty is surgery to alter the shape of the hymen membrane in the vaginal canal, commonly performed to minimise the aperture. This medical operation is often requested by women who expect that their virginity will be under scrutiny, particularly during their first sexual encounter on their wedding night. Despite increasing demand for the surgery all over the globe, there is no one standard of practice in performing hymenoplasty. In the Netherlands, the manner in which medical consultations concerning the procedure take place depends heavily on the consulting physician. This paper looks at two different approaches to hymenoplasty consultation in the Netherlands: a pedagogical philosophy adopted in a public hospital and a practical approach employed by a private clinic. Each approach culminates in a contrasting result: patients in one medical establishment are twice as likely to undergo hymenoplasty than those visiting the other.

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.

An evolutionary interpretation of the significance of physical pain experienced by human females: defloration and childbirth pains

The phenomena surrounding the pains commonly related to both first coitus and delivery have been addressed rather poorly in previous work, as regards their evolutionary aspects, during the investigation of human sexuality and reproductive behavior. In particular, the function of the hymen and the significance of defloration are largely misunderstood. The present paper aims to analyse the meaning of these two female physical pains in an evolutionary context. Accordingly, childbirth and defloration pains are hypothesized to manifest an adaptation designed to increase inclusive fitness in human evolutionary history. Clearly, the significance of pain as a message is essentially emotional. Indeed, the intense sexual emotions that may precede and/or follow the pain, the breaking and bleeding of the hymen during the first complete sexual act may generate distinctive strong feelings on/from each side of the newly formed couple. As to labor pain, both the shared intimacy with the mother and the emotional background during confinement may create mutual solicitude among the protagonists (i.e. midwifes, father, mother). Such feelings or attitudes may subsequently turn out to be beneficial to all of them, and more particularly to the newborn. As a general consequence, it appears that the two physical pains under consideration may have behavioral implications, in the sense that they contribute to increasing the stability of the connection between partners and thus, indirectly, to the welfare or even the survival (especially in former times) of the newborn child.