Virginity testing in professional obstetric and gynaecological ethics

Introduction Doctors around the world might be asked to provide virginity testing. The ethical framework for the assessment of the physician’s role in virginity testing is based on the professional responsibility model of ethics in obstetrics and gynaecology and its three core ethical principles: benefi cence, respect for autonomy, and justice. Benefi cence-based objections are that virginity testing has no clinical indications and has substantial biopsychosocial risks. Autonomy-based objections are that virginity testing might be the result of social and cultural pressures that result in non-voluntary requests and, by being undertaken mainly for the benefi t of others and not the female patient, impermissibly violates the patient’s human right to privacy. Justice-based objections are that virginity testing discriminates against female patients on the basis of their sex and creates clinically unnecessary confl icts of interest that can undercut the primacy of the health of female patients. Here, we aim to present an ethical framework for the assessment of the physician’s role in virginity testing and its implications for clinical practice. Virginity testing is the performance of a physical examination to establish whether a female patient is a virgin. Typically, such testing involves an inspection of a female patient’s hymen, on the assumption that her hymen can only be torn as a result of sexual intercourse. The practice of virginity testing is prevalent worldwide, according to the varying degrees of the perceived importance of a bride’s or girl’s virginity. Obstetriciangynaecologists and other doctors might be asked to provide virginity testing, either by adult female patients, the parents of minor female patients, or by the state. These requests can happen in countries where the practice has been historically accepted or in countries without such a history but to which women have immigrated. If virginity testing is deemed to perpetuate attitudes that accept violence and sex inequality, then allowing it could also result in increased risk of other kinds of violence against women. Women who fail the test are at greater risk of violence by their own families or their husbands to disclose the name of their partner or their sexual experiences. In 2007, a study by the Swedish National Board of Health and Welfare suggested that 600 to 4500 girls were at risk of violence by their families because of honour or virginity related problems. We provide an ethical framework for the assessment of the doctor’s role in virginity testing and its implications on how obstetrician-gynaecologists and other doctors should respond to such requests in clinical practice. This ethical framework is based on the professional responsibility model of ethics in obstetrics and gynaecology and its three core ethical principles of benefi cence, respect for autonomy, and justice. We show that virginity testing is ethically unacceptable, because it violates benefi cencebased, autonomy-based, and justice-based obligations to female patients. We conclude that doctors should refuse to conduct physical examinations for the purposes of virginity testing because virginity testing is incompatible with professional obstetric and gynaecological ethics.