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Spanish doctors draw up advice on ethics of virginity certificates

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7344.996 (Published 27 April 2002) Cite this as: BMJ 2002;324:996
  1. Xavier Bosch
  1. Barcelona

    Concerns that requests from Muslim immigrants for medical certificates of virginity could soon become common have led the conservative party Partido Popular to propose a new law in the parliament of Andalucia.

    The party wants Andalucia's health department to warn doctors that virginity certificates are an invasion of a patient's privacy and that “doctors must preserve [such privacy] as guaranteed by the Spanish constitution.”

    Ms Esperanza Oña, the Partido Popular's health coordinator in Andalucia—the Spanish region with the greatest Muslim population—said that the different customs of immigrants to Andalucia might cause problems.

    While it was essential to ensure harmonious and respectful cohabitation, she argued, a respect for different ideas, creeds, and cultures could never justify sex discrimination. Last week the party urged the Andalusian government to make it illegal for doctors in the Andalusian health service to issue virginity certificates. The prohibition should be observed “even when the patient is under age and accompanied by her parents.”

    Ms Oña said she had passed on her party's initiative to the Official Medical College of Malaga and that the Official Medical College of Barcelona was drawing up a consensus report.

    Dr Jaume Padrós, secretary of the Official Medical College of Barcelona, agreed with Ms Oña that virginity certificates invaded the privacy of women and that it was not ethical for a doctor to draw up and sign such a certificate. He argued that the aim of medical certificates was to certify “health states,” and whether a woman was a virgin was not a medical condition.

    “Certifying that a woman has an intact or ruptured hymen isn't a doctor's work and has nothing to do with medical practice, both in public and private sectors,” Dr Padrós said.

    He added that the college's ethical commission would soon release an “official position report” so that Catalan doctors were aware of how to act. He said that the college had been asked twice recently by Catalan gynaecologists what they should do when faced with a request for a virginity certificate.

    These cases, which involved Muslim parents who wanted a certificate so that their daughters could get married without problems, prompted the college to draft its guidelines. Although the phenomenon may be new in Spain, it is a common practice in Muslim countries such as Turkey and Morocco.

    A study published three years ago in JAMA (1999;282:485-90) on virginity examinations in Turkey showed that, although the Turkish Medical Association condemned the practice except in cases of alleged sexual assault, nearly half of Turkish forensic doctors conducted “virginity examinations for social reasons despite beliefs that such examinations are inappropriate, traumatic to the patient, and often performed against the patient's will.”

    The study concluded that doctors' involvement in the practice was inconsistent with bioethical principles and international human rights. It added that such examinations, usually requested by parents, “violate guarantees of freedom from discrimination” found in the International Covenant on Civil and Political Rights and the European Convention on Human Rights.

    Traditional Muslim social norms associate female virginity, defined by an intact hymen, with honour. Yet hymens vary in configuration and elasticity and might be ruptured before sexual intercourse, said Dr Xavier Caparrós, gynaecologist at the Clinical Institute of Gynaecology and Obstetrics in Barcelona.

    Mr Mohammed Halhoul, spokesman for the Islamic Cultural Council of Catalonia, said that the virginity issue was to do with cultural rather than religious reasons and that such certificates were requested by “very traditionalist Muslim families.”

    Dr Xavier Planas, a gynaecologist working in private practice in Barcelona, said: “It's a relatively isolated request so far.” HeeHe recalled being asked to perform the examination twice by Muslim immigrants in the last five years.

    Although requests for virginity certificates might be an emerging phenomenon in Europe, the issue is not new. A study in the BMJ (1998;316:459-60) showed that in 1993 some Dutch gynaecologists were reconstructing the hymen of immigrants to mimic the virginal state.