Certificate of virginity: Cultural pressure and ethical dilemmas facing Belgium’s medical practitioners

Monday, 13 May 2019 15:52
Do you remember the first time you had sex? And the time just before that, when your doctor examined your genitalia to determine whether you were still a virgin?
Probably not: if you are a man, the chance that you went through “virginity testing” is virtually zero. But some young women and girls in Belgium and other European countries have to ask their gynaecologist for a certificate of virginity, usually before marriage.

On 16 February 2019, Belgium’s Order of Physicians published an official recommendation to stop the practice of virginity testing and the delivery of certificates, calling it “useless for the health, without scientific pertinence and carrying serious potential consequences for the well-being of the patient.” Indeed, the Order declared, a medical examination cannot determine with certitude whether a person is sexually active or not.

“I am delighted with the recommendation”, Dr Françoise Kruyen, a gynaecologist based in Morlanwelz, told The Brussels Times. “I am against delivering virginity certificates, and have only done it reluctantly in the past, when it seemed to me that the woman would take more risks if I refused the certificate than if I delivered it.” Now, she says, she can “hide away” behind this new legal base. Dr Pascale Jadoul, a gynaecologist from the Saint-Luc hospital at Louvain Catholic University, agrees: “It will make our life easier.”

The Belgian recommendation stems from a report from the World Health Organisation published in October 2018, which concluded that virginity testing “has no scientific merit or clinical indication” and is “medically unnecessary and unreliable”, as well as potentially “painful, humiliating and traumatic” for the patient. “The appearance of a hymen is not a reliable indication of intercourse and there is no known examination that can prove a history of vaginal intercourse,” the report noted, and called for doctors to refuse to conduct a test or deliver a certificate.

It is unclear how many women and girls undergo virginity tests or ask for a certificate in Belgium each year. The latest data is a 2007 study from the French-speaking Group of Belgian Gynaecologists and Obstetricians (GGOLFB), which found 310 requests for virginity certificates during that year in French-speaking Belgium.

The ethics of a virginity certificate

Gynaecologists interviewed for this article could only account for their own experience, and often did not know whether their colleagues had recently been asked. The GGOLFB warned in 2009 about “the difficulties that doctors can face in their practice, due to the diversity of beliefs and traditions.” Some hospitals have a firm policy on the topic, like Hôpital Saint-Pierre in Brussels, which decided to stop the practice in their unit about a decade ago, but most have no set guidance, leaving physicians to reach a decision on an ad-hoc basis.

Requests for certificates is not a very frequent phenomenon in Frédéric Buxant’s gynaecology unit at the Hôpitaux Iris Sud in Brussels. “Personally, it’s been a few years since I have delivered any,” he told The Brussels Times. Jadoul has had one woman asking last year. As a young doctor, she remembers delivering a few, to make a patient happy, but now feels uncomfortable with the idea.

Delivering a virginity certificate can be an ethical dilemma. The GGOLFB notes that where some see such a request as a proof of “submission to degrading practices”, others hope that delivering a certificate can be “a necessary step towards emancipation.” Jadoul finds the concept “quite shocking”: “Why does the woman have to be a virgin, whereas the man does whatever he wants?” Kruyen speaks of an “ethical problem”: to accept, she says, is “to participate in an odious lie, to recognise that the body and the story of a woman as objects subjected to the social and patriarchal order.”

The first reaction for a physician, male or female, is often to refuse, Buxant says. “But we sometimes have patients who are in a distressing situation, so our attitude [at the hospital] has not been to plainly refuse any request,” he adds, stressing that the most important thing is to communicate with the patient. “If my patient has thought about it and made her choice, I could accept delivering a certificate,” Buxant says. “The role of the doctors is to help the patient.” But that should be a last resort, he adds: educating patients about the failed logic behind virginity testing is a priority. Debating the issue with them “opens the door to societal change,” he explains.

Not like a virgin

Virginity testing poses practical problems, too: no test, as the WHO noted, can prove someone’s virginity. It’s a myth that the hymen “breaks” during the first penetration - many women’s membrane is naturally loose. Therefore, about 75% of the time, women do not bleed during the first sexual encounter, but blood is still expected on the sheets as proof of the bride’s virginity. And although medical tests exist to check whether a child has been a victim of sexual abuse, on adult women, gynaecologists can never attest for sure that the vagina is “intact”.

The hymen can loosen over time by the use of tampons, intense sport activity, or masturbation. “It’s not that simple to say if someone is a virgin or not,” Jadoul says, noting that some patients tell her about experimenting with other sexual acts to avoid vaginal penetration and remain a “virgin” until marriage. Buxant agrees: “A certificate means nothing.” Most doctors who deliver them use an intricate style of phrasing, since it’s arduous to describe something that cannot be medically proven. Buxant laughs at the absurdity: “What does it mean to be a virgin, what is she a virgin of? Penetration? By what?”

“Virginity” derives from the Latin virgo, which means “maiden”: a girl or young woman who has not had sexual intercourse, usually implying vaginal penetration. But there is no universal definition; indeed, it is difficult to precisely describe what virginity means, as it greatly varies from one culture to the next. The WHO considers that “the concept of virginity is not a medical or scientific term; rather, it is a social, cultural and religious construct.”

“The disproportionate social expectation that girls and women should remain “virgins” (i.e. without having sexual intercourse) until marriage,” the WHO states, “is rooted in stereotyped notions of female sexuality that have been harmful to women and girls globally.”

In an article she wrote in 2008 about the ethics of virginity testing, Kruyen explains that in Ancient Greece, female virginity was completely dissociated from the hymen, and therefore from the idea of anatomical inspection. “The link between the concept of virginity and the police-like control of the hymen has been denounced throughout time by open-minded spirits,” Kruyen notes, adding that in The Encyclopedia (1751-1772) by Diderot and d’Alembert, the matter of virginity is addressed by the naturalist Buffon, who writes: “Virginity, which is a moral being, a virtue that consists in the purity of the heart, has become a physical object that has fascinated men. They have established opinions, customs, ceremonies, superstitions, and even sanctions.” Buffon concludes that “anatomy itself leaves a complete incertitude as of the existence of this membrane that we call hymen.”

Cultural pressure

Often it’s not the patient who the doctor must convince of the uselessness of the practice, but her family or her fiancé’s. The importance of the bride’s virginity in some cultures can put women in dangerous situations: “Failing” a virginity test is perceived to bring dishonour and shame to the individual’s family and community, and may result in punishment,” the WHO noted in its 2018 report. Faced with a patient who may risk physical or social violence if refused a test, gynaecologists react differently. Buxant says he would be ready to deliver a certificate, while Jadoul would refuse on principle and send her to see another, more willing doctor.

With some of her patients, Kruyen has tried to mitigate a third way: “To one I gave a small scalpel blade for the wedding night, so that she would cut her skin a bit -- obviously, not her genitalia, but somewhere else, to make it bleed a bit”, she explains. She has also advised patients to buy a small ball of red liquid, purchasable online, that is placed into the vagina and melts to released fake blood. “We can’t always convince everyone,” she says, “but I try to help people to find a better way.” 

By Pauline Bock

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