Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7129 Volume 316 Education and debate Saturday 7 February 1998 Ethical dilemma Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Commentary: Promiscuity is acceptable only for men Dinesh Bhugra Culture, society, and family are important factors in the way an individual functions. The role of virginity, fertility, and the influence of the family are the main contributors to trends in sexual and marital relationships across cultures.(1) Although promiscuity may carry high prestige for men, promiscuous women are generally scorned. Men prefer chaste women in order to ensure their paternity.(2) Ford and Beach, in their survey of 190 societies worldwide, divided these into three types: restrictive ones, where sexuality outside marriage is discouraged; semirestrictive societies, in which formal prohibitions exist, but are not strictly enforced; and permissive societies.(3) Broude and Greene reported that premarital sexuality in women was approved in 25% of the 141 societies they studied; virginity was valued and premarital sexuality was mildly disapproved of in 26% of societies and strongly disapproved of in 24%.(4) In the last group, virginity had to be proved by tests, and reprisals were severe for those who failed. Although long term psychological follow up of the 20 patients reported by Logmans et al is not available, the procedure highlights some of the problems of younger generations of migrants. When there is a split between two cultures, one prescribing virginity and the other allowing exploration of sexuality before marriage, the stresses on the individual are enormous. The double standards on the part of the groom's family, which may ask for a virginity certificate, further contribute to the stress. In addition, women who are exploring their sexuality may have no confidants and may feel isolated in their dilemmas. Bekker and Rademakers from the Netherlands point out that these women seek help from a number of sources and service providers may deal with them in different ways.(5) The clinicians may view the surgical repair of the hymen as reflecting social injustices and yet more hypocrisy. The hymen, of course, is associated with myths, and men who are expected to succeed in defloration and show the evidence are also likely to feel stressed. The dilemmas in providing this service are many. The loss of virginity may be related to incest and sexual abuse. After vaginoplasty the patient may experience post-traumatic stress disorder. The article of Logmans et al further emphasises the objection to medical intervention in these cases - namely, that it confirms sexual inequality and surgical intervention purely on social grounds.(5) Without longer term follow up it is difficult to say whether surgery will "cure" all the psychological trauma of these young women. Institute of Psychiatry, London SE5 8AF Dinesh Bhugra, senior lecturer in psychiatry email: spjudib@iop.bpmf.ac.uk References 1 Bancroft J. Human sexuality and its problems. Edinburgh: Churchill Livingstone, 1989. 2 Daly M, Wilson M. Sex, evolution and behavior. Belmont, CA: Wadsworth, 1978. 3 Ford C, Beach F. Patterns of sexual behaviour. London: Eyre and Spottiswoode, 1951. 4 Broude G, Greene S. Cross-cultural codes on 20 sexual attitudes and practices. In: Barry H, Schlegel A, eds. Cross-cultural samples and codes. Pittsburgh: University of Pittsburgh Press, 1980. 5 Bekker M H J, Rademakers J. Study examines Islamic virginity issues. Psychol Int 1997;8:1. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline