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: Cultural complexities should not be ignored Elspeth Webb There is no doubt that migrants experience cross cultural stress. Girls living in the West, but belonging to communities that are fiercely patrilineal and patriarchal, are perhaps particularly at risk. These girls do not live within one fixed culture with extrafamilial contact with another fixed culture. They live at the intersections of usually many cultures with widely different cultural norms, all of which change with time and place and influence one another. Members of the white ethnic majority can have little insight into the cultural complexities of their lives. What is clear is that premarital sex places these girls in a predicament which can threaten their chances of a secure future as adults in their own communities. Awareness of multicultural complexities is needed Photo: MURIEL ASITERIBBE/HOLLANDSE HOOGTE The suggestion that hymenal reconstruction is analogous to female genital mutilation is absurd. Whether approached from an absolutist or a culturally pluralist standpoint, female genital mutilation is a practice so dangerous, mutilating, and painful that there is no doubt of the appropriateness of its prohibition. Hymenal reconstruction, on the other hand, theoretically scores low on maleficence and high on beneficence, as it is a safe procedure which may preserve the personal and physical integrity of the woman requesting it. What is more debatable is whether it is needed at all, given that "defloration" and "the blood on the sheet" are largely the stuff of mythology. This is an issue to be approached pragmatically and sensitively. This requires doctors who are trained in multicultural practice, an area largely ignored at undergraduate and postgraduate levels in British medical schools. The multidisciplinary model described in Logmans et al's paper, given appropriate measures to maintain absolute confidentiality, would allow doctors to work with colleagues in other disciplines who do have these skills. In most cases education and counselling will be all that is needed. It is alarming that at least half the young women in this study find themselves in this predicament as a result of sexual abuse. This has implications for protection of other children in the family and community. In Britain, all doctors have, under the Children Act, clear obligations to inform the appropriate authorities if they have information that suggests children are at continuing risk of harm. Department of Child Health, University of Wales College of Medicine, Cardiff CF4 4XN Elspeth Webb, senior lecturer Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline