Promoting women's human rights: A qualitative analysis of midwives' perceptions about virginity control and hymen 'reconstruction'

Immigrant women's perspectives on contraceptive counselling provided by midwives in Sweden - a qualitative study

Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women's health at both individual and societal levels. This study explored immigrant women's perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife's professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.

A Review of Aesthetic Gynecologic Procedures for Women

Aesthetic gynecologic surgery is gaining popularity among women and physicians. Aesthetic genital surgery for women encompasses both minimally invasive and open surgical procedures. Cosmetic genital procedures for women described in this article include perineoplasty, vaginoplasty, vaginal rejuvenation, labiaplasty, G-spot enlargement, Bartholin gland surgery, clitoral hoodoplasty, clitroplasty, hymenoplasty, and mons pubis plastic surgery. Based on a review of the literature for each procedure, the article discusses procedural methods and techniques, indications for implementation, potential consequences and side effects of the procedure, nursing implications, patients' motives for undergoing the procedure, and positions of scientific institutions relative to the procedure.

A Review of Aesthetic Gynecologic Procedures for Women

Aesthetic gynecologic surgery is gaining popularity among women and physicians. Aesthetic genital surgery for women encompasses both minimally invasive and open surgical procedures. Cosmetic genital procedures for women described in this article include perineoplasty, vaginoplasty, vaginal rejuvenation, labiaplasty, G-spot enlargement, Bartholin gland surgery, clitoral hoodoplasty, clitroplasty, hymenoplasty, and mons pubis plastic surgery. Based on a review of the literature for each procedure, the article discusses procedural methods and techniques, indications for implementation, potential consequences and side effects of the procedure, nursing implications, patients' motives for undergoing the procedure, and positions of scientific institutions relative to the procedure.

'Doing hymen reconstruction': an analysis of perceptions and experiences of Flemish gynaecologists

Background

Hymen reconstruction (HR) involves the restoration of the hymeneal membrane’s gross anatomical integrity. Among the medical profession, hymen reconstruction receives particular attention and its necessity is debated because the surgery is not medically indicated, and often reveals conflicting social norms on virginity and marriageability between health professionals and their patients. The focus of this paper is not to address the many open questions that the ethics and politics around HR reveal, but rather aims at contributing to the much-needed empirical evidence. It presents findings of a study conducted in Belgium (Flanders region), among gynaecologists that aimed at assessing their knowledge, views, and experiences on hymen reconstruction.

Methods

A digital self-administered questionnaire-based survey was sent to Flemish gynaecologists and trainees in Flanders registered with the Flemish Society of Obstetrics and Gynaecology (VVOG).

Results

Hundred-and-nine questionnaires were completed. The majority of the respondents (73%) had requests to perform HR. Knowledge and technical skills about HR were considered to be sufficient (69%), even though HR does not seem to be integrated in medical curricula or post-graduate training. Most respondents (72%) would favour the publication of a guideline by their professional organisation. Few respondents discuss alternative options with the patient (19%) and half of the respondents reject to perform HR (49%). The majority of our respondents are against reimbursement of the surgery (70%). Not even half of our respondents believes that a patient is at risk of further violence (47%). 7% of the respondents mentioned complications, but the majority was able to perform a follow up consultation.

Conclusions

The responses of this survey cannot be generalised to the entire population of gynaecologists in Flanders, but do provide insights in how gynaecologists confronted with HR are approaching such requests, and thus contributes to the empirical evidence. Our paper showed that many Flemish gynaecologist are likely to encounter requests for hymenoplasty, but that a majority would not perform the surgery. There seems to be a lack of guidance and debate in Flanders on the social and moral dimensions of HR, and a number of complexities were revealed when gynaecologists address HR that need further research.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0587-z) contains supplementary material, which is available to authorized users.

How variability in hymenoplasty recommendations leads to contrasting rates of surgery in the Netherlands: an ethnographic qualitative analysis

Hymenoplasty is surgery to alter the shape of the hymen membrane in the vaginal canal, commonly performed to minimise the aperture. This medical operation is often requested by women who expect that their virginity will be under scrutiny, particularly during their first sexual encounter on their wedding night. Despite increasing demand for the surgery all over the globe, there is no one standard of practice in performing hymenoplasty. In the Netherlands, the manner in which medical consultations concerning the procedure take place depends heavily on the consulting physician. This paper looks at two different approaches to hymenoplasty consultation in the Netherlands: a pedagogical philosophy adopted in a public hospital and a practical approach employed by a private clinic. Each approach culminates in a contrasting result: patients in one medical establishment are twice as likely to undergo hymenoplasty than those visiting the other.