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Virgins on the cutting-room floor
Excerpt from Chapter Five: The Virgin and the Doctor
For most Western women, health is generally given precedence over any philosophical or moral quibbles about the nature of virginity. We have moved away from an obsessive concentration on the hymen as proof of virginity, too, so a medical intervention in regard to the hymen is somewhat less fraught than it used to be. From both a medical perspective and the standpoint of sexual ethics, we are now capable of viewing a hymenotomy as a legitimate solution for legitimate problems like imperforate hymen.
But this is not the case for all women everywhere. In cultures where there is still a widespread expectation that women will not only remain virgins until they are married, but their bodies will provide proof of this virginity in the form of blood, pain, and a vagina that resists initial penetration, having had a hymenotomy can be a serious liability. Until quite recently, women in cultures that put a high value on the virginal hymen who had to undergo hymenotomy also had to deal with the possibility that they might be seen as no longer being virgins, as being less than optimally marriageable, or that their future spouses might take umbrage at the fact that their brides’ hymens had been surgically opened.
In such a culture, smoothing the path for women who require hymenotomy might be considered a matter for public awareness campaigns, or a service provided by health professionals who understood the issues and were willing to meet with women and their families to counsel them about the salient differences between a medically necessary surgery and premarital sex.
On the other hand, as has in fact recently become the case, the necessity of performing a therapeutic hymenotomy might come to be seen by doctors as a golden opportunity to build the "perfect" hymen. The January 2003 issue of the European Journal of Obstetrics and Gynecology and Reproductive Biology raised eyebrows around the world with the publication of an article under the unassuming title “Treatment of Imperforate Hymen by Application of Foley Catheter.” What it turned out to be was a new twist on an old hymenotomy, developed by a group of practitioners at the medical school of Selçuk University in the metropolitan city of Konya, Turkey.
The Turkish procedure, which its developers tout as preventing “many social problem by preventing destruction of the architecture of hymen and providing annular-intact hymeneal ring,” [sic] works like this. The imperforate hymen is cut and whatever fluid is backed up inside the vagina drains, just as in a normal hymenotomy. At this point a Foley catheter—a type of urinary catheter which uses an inflatable balloon at its tip to hold the end of it in place within the bladder so that it cannot slip out and will provide consistent drainage—is inserted into the middle of the incision and the incision sutured up around the stem of the catheter. The balloon tip of the catheter is then filled with saline to hold it in place, and the tube of the catheter taped to the patient’s inner leg, just as it would be if she were being catheterized normally. This way, should menstruation occur during the two-week healing period, any menstrual fluid can drain out of the vagina through the catheter.
During this time the hymen heals around the stem of the catheter. The catheter is ultimately deflated and removed, leaving the hymen “intact” as a substantial ring of tissue with a small hole in the middle. Catheter stems vary in diameter, but it seems likely that a catheter of fairly average size would be the most probable one pressed into service for this procedure, which would mean that the resulting hymeneal opening would probably be somewhere between 4 and 7 millimeters (approximately 1/4 to 1/3 of an inch) in diameter.
These tiny apertures, while large enough for menstrual fluids to flow through, are nonetheless very small in comparison to the typical size of adult women’s hymeneal openings. While hymens are of course variable in size and elasticity and so forth, hymeneal orifice diameters of between 4 and 8 millimeters are more typical of what one expects to find in children than what is normal for teenagers or adults. Combining the small size of these manufactured hymeneal openings with the typical durability and thickness of imperforate hymens (which would not, after all, pose a problem if they were fragile enough to tear or rupture on their own from the pressure of backed up menstrual fluids), this surgery essentially ensures that the women who have had their hymens opened and rebuilt in this way will endure quite a bit of pain and trauma before the tissue finally tears.
The doctors promoting their technique in this article say that their patients who have gone on to marry have been pleased by the ultimate results, but we should not be lulled into assuming that this is necessarily synonymous with taking pleasure in the experience or even with their not having experienced considerable pain. Being pleased with one’s defloration, after all, may simply mean that a woman is glad that she was able to please her husband or able to provide him with what her culture considers to be a man's rightful due. The entire cultural event of defloration is so typically centered around the male experience of female virginity—what signs of virginity he finds, how her body and her behavior live up to what he has been taught to expect of virgins—that these things, rather than their own comfort or happiness, are what women are most likely to consider when evaluating whether or not their defloration experience was "successful."
One might additionally and legitimately wonder whether, as has sometimes been the case for women for whom penetration was very difficult due to a thick or otherwise recalcitrant hymen, these women's husbands might not possibly have recourse to a quick flick of a penknife or a wedding-night call to a midwife or family doctor who could come in to widen the hymeneal orifice with a scalpel so that the wedding could be consummated. Scar tissue is tough and resistant to tearing, and sometimes, as with some genital mutilations or in the case of the young women discussed earlier in this chapter in whom scar tissue manifests as an “imperforate hymen,” the flesh must be cut in order for it to be possible for sexual penetration to take place. Such wedding-night house calls are not uncommon in some parts of the globe.
This Turkish procedure, so new in the medical literature, has certainly not supplanted the mainstream hymenotomy. In the West at least, it would seem highly unlikely to do so in the future. But still it bears noting that doctors went to the trouble of devising a new and more complicated technique to maintain “the architecture of the hymen” even though a medically adequate solution to the problem of imperforation already existed, an excellent reminder of just how profoundly cultural the practice of medicine can be. It also begs the question of whether it is ethical for any doctor to presume to dictate the "ideal" parameters of the hymen. Normal hymens naturally have many different “architectures," none of them more or less adequate or healthy than the others. The "ideal" hymen here is the one most likely to produce a certain culturally valued range of outwardly obvious signs of defloration. They chose this version of the hymen, a version that is in fact not commonly found in the bodies of grown women, not for medical purposes but in order to fulfill the expectations of a particular cultural ideology of virginity.
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I welcome anyone interested in translating any or all of these excerpts to do so, as long as you put them up on the Web and notify me of where they can be found. I plan to link all translated versions from this page.
Photos by Hanne. Site by Jhames