Hi Alice,

I was wondering if there was any way that a hymen can be replaced by plastic surgery? I am not a virgin and will marry an Arab man who will expect his wife to be a virgin during the wedding. I know this must sound a little odd but I really need your help!

Thank you.

Dear Reader,

Your concern isn't odd or unusual. Many women decide about sharing info regarding their sexual (in)experience and/or virginity status with their partners and/or prospective spouses, risking loss of face, and possibly loss of the relationship. The choice to have surgery to recreate a hymen seems drastic and risky. However, some women decide it is the most appropriate option, given their circumstances.

"Proofs" of virginity are unreliable, inaccurate, or misleading. A torn or absent hymen does not signify that a woman has had vaginal intercourse. A hymen can be stretched or torn by horseback riding, ballet exercises, tampon use, or even a regular gynecological exam. Some women are even born without a hymen. Blood on the sheets, considered necessary in some societies and cultures, also does not indicate virginity or first sexual intercourse. Contrary to popular belief, all women do not bleed during their first sexual experience involving vaginal penetration. A small study published in the British Medical Journal in 1998 backs this up: Sara Paterson-Brown, M.D., a gynecologist, interviewed 41 of her female colleagues at a London hospital, and found that twenty-six of them did not bleed during their first experience, 14 did, and one could not remember. The absence of bleeding is explained by previous stretching of the hymen, or because some women have a naturally more elastic hymen.

Proving virginity involves invested interests and concerns for many parties: the medical profession; families with a desire to preserve cultural traditions (e.g., transfer of property, status of women); men and societies that hold on to beliefs about virginity and female purity; and especially the women who have to take all of these things into consideration.

Women in traditional societies or families may often feel pressured, or even forced, to meet traditional notions of purity for fear of being shamed, humiliated, ostracized, abused, or even killed. Conflicting emotions arise concerning values, a physical "proof" of virginity, and truthfulness, trust, and mutual respect that form cornerstones of healthy relationships. Considering all of these factors adds stress to the decision. Self-preservation and safety also play vital parts in the decision-making process.

Through a surgical procedure called hymenorraphy, health care providers recreate the hymen by piecing together its remnants. Surgery can also include inserting a gelatin capsule filled with a blood-like substance that will burst during intercourse, simulating bleeding. If there is not enough hymen left, or if the woman was born without one, part of the vaginal wall is used to recreate this thin tissue. The procedure, considered relatively simple, is performed on an outpatient basis. In some countries, women will be seen several weeks after the procedure to follow up on any resulting physical effects and emotional issues.

Some health care providers in Western countries will perform hymenorraphy but, not surprisingly, many providers are divided in their opinions about performing the operation. Some consider the procedure a form of plastic surgery and consent to perform it. Others fear that the surgery furthers sexual inequality. Still others consider it unethical to allow surgical intervention in a patient's body solely for cultural or social concerns.

Hymenorraphy is generally illegal in countries where cultural traditions place great emphasis on the bride's virginity before marriage. The procedure, however, is still performed illegally, and at a high cost. When it's done illegally, standards of cleanliness, training, and the reputation of the health care provider are additional things to worry about. Some women may also have to worry about securing up to U.S. $2000.00 for the procedure (though it can often cost much less, even as low as U.S. $100.00, in some parts of the world. To some readers, this may seem an imaginable amount of money.).

The woman might also be concerned about the surgery being included in her medical records. If she has the procedure done in a country where it is illegal, there isn't this worry. Some countries, such as the Netherlands, allow surgeries like hymenorraphy to be deleted from the permanent medical record. Women having the procedure done legally need to ask their provider about whether or not this becomes a part of their permanent medical record.

It is not clear whether you have a current fiancé, or you are concerned about someone you might meet in the future. Just some thoughts: how certain are you that your prospective husband will expect you to be a virgin? Has he verbalized his expectation that his wife be one? And would you really need the surgery even if he does expect his wife to be a virgin? Maybe he already knows that not all women bleed or have pain during their first intercourse.

If you know for sure that he expects you to be a virgin, you have some options to consider. You can decide to proceed with surgery, lying to him in order to avoid his and/or his family's anger, and to save your marriage and possibly yourself. Or, you may want to reconsider your marriage to someone whom you believe will expect his wife to be a virgin. Or, you can tell him the truth (if it's safe to tell him) and see what happens.

You also might want to ask yourself if you know whether your future husband is a virgin. Do you expect him to be one, if you don't already know whether he is or not? If he isn't, or if you don't expect him to be one, how do you feel about his expecting you to be a virgin? If he is not one, would he be tested for sexually transmitted infections (STIs) before marriage? If it's clear that you must be a virgin without any consideration of your fiancé's past experiences, then you might find yourself in an unhealthy relationship with someone who doesn't really respect your equality in the marriage. Of course, in unhealthy relationships, it may not be safe to ask these questions. However, it may be useful to ask yourself these questions, and to consider your choices in view of your future.

It is also possible that you and your future husband have made a conscious commitment to both be virgins before marriage. If that is the case, then you are not being honest with him, and if you have been able or willing to discuss this issue in the past, you need to be willing to be honest with him now. Beginning a marriage with a lie seems to be starting with pretty shaky foundations.

These are complicated and anxiety-provoking decisions, but you will need to soul search to figure out what you want. Since hymenorraphy is taboo and not talked about in most cultures where it's an issue, support resources and networks appear to be nonexistent. Cultural and economic influences also limit the choices a woman truly has.

For more information about hymens and virginity, you can read the related Q&As listed below.


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