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Summary for primary care

Virginity Testing and Hymenoplasty Multi-Agency Guidance

UK Health Security Agency

Overview

This Guidelines summary covers UK Health Security Agency’s guidance on identifying, protecting, and supporting women and girls at risk of, or who have undergone, virginity testing and hymenoplasty.

Virginity Testing

  • Virginity testing, also referred to as hymen, ‘2-finger’ or vaginal examination, is an inspection of the female genitalia intended to determine whether a woman or girl has had vaginal sexual intercourse
  • For the purposes of the Health and Care Act 2022, virginity testing is any examination (with or without contact) of the female genitalia intended to establish if vaginal intercourse has taken place. This is irrespective of whether consent has been given
  • The position of the World Health Organization and the Royal College of Obstetricians and Gynaecologists is that virginity tests have no scientific merit or clinical indication, as there is no known examination that can prove whether a woman has had vaginal intercourse.

Hymenoplasty

  • Hymenoplasty is a procedure undertaken to reconstruct a hymen. There are a number of different techniques to achieve hymenoplasty, but it generally involves stitching hymenal remnants together at the vaginal opening or surgically reconstructing a hymen using vaginal tissue
  • The aim of the procedure is to ensure that a woman bleeds the next time she has intercourse to give the impression that she has no history of vaginal intercourse. There is no guarantee that this will fully reform the hymen or cause bleeding when penetration is attempted
  • Hymenoplasty is not the same as other procedures that could be performed on the hymen for clinical reasons (for example, surgery to treat an imperforate hymen to allow menstrual blood to escape).

Violence Against Women and Girls

  • Virginity testing and hymenoplasty are forms of violence against women and girls and are part of the cycle of so-called ‘honour-based’ abuse. Women and girls are coerced, forced, and shamed into undergoing these procedures, often pressurised by family members or their intended husband's family, in the name of supposedly upholding honour and to fulfil the requirement that a woman remains ‘pure’ before marriage
  • Some practitioners issue a certificate to prove ‘virginity’ after a virginity test or hymenoplasty, whereas some will simply tell the family or community members whether a woman or girl has ‘passed’ a virginity test
  • Both virginity testing and hymenoplasty can be precursors to child or forced marriage and other forms of family and/or community coercive behaviours, including physical and emotional control
  • Women who ‘fail’ a virginity test, are found to have undergone a hymen reconstruction, or do not bleed on their wedding night are likely to experience further so-called ‘honour-based’ abuse including emotional and physical abuse, family or community disownment, and even honour killings
  • The practices are degrading and intrusive. They can lead to extreme psychological trauma in the victim, and can provoke conditions including anxiety, depression, and post-traumatic stress disorder, and have been linked to suicide
  • The practices can be physically harmful. For example, virginity testing can result in damage to the hymen, tears and damage to the vaginal wall, bleeding, and infection. The risk of infection is also high in hymenoplasty, which has the added risks of acute bleeding during the procedure, scarring and narrowing of the opening of the vagina, and sexual difficulties
  • Virginity testing and hymenoplasty are considered to have a similar level of seriousness to assault occasioning actual bodily harm (assault to injury in Scotland). This is in recognition of the physical and psychological harm they can cause to the individual who is subjected to them. This level of seriousness also reflects the controlling attitudes that underpin the practices
  • As with all forms of so-called ‘honour-based’ abuse, there are many barriers to victims disclosing information and reporting what has happened to them. It is therefore important that, if information regarding either settings or individuals involved in these practices is obtained, this intelligence is shared either with police or anonymously through Crimestoppers
  • Virginity testing and hymenoplasty are illegal. They should be addressed using existing structures, policies, and procedures designed to safeguard children and vulnerable adults
  • All organisations to which this guidance applies should work together and with other relevant organisations to address the risk of virginity testing and hymenoplasty, while bearing in mind the importance of confidentiality in protecting women and girls from harm.
For information on the law, refer to the full guidance.

Identifying Those at Risk

  • There is evidence that women and girls from the age of 13–30 years are most at risk of undergoing a virginity test and/or hymenoplasty, but girls as young as 8 years can be affected
  • Any woman or girl, of any age, ethnicity, race, sexual orientation, religion, disability, or socioeconomic status, could be subjected to a virginity test or hymenoplasty
  • There are several indicators that a woman or girl is at risk of or has been subjected to a virginity test and/or hymenoplasty:
    • the woman or girl requests either procedure or asks for help
    • family members ask for the procedures or disclose that the woman or girl has already undergone the practices
    • there could be pain and discomfort after the procedures that, for example, could result in the woman or girl having difficulty in walking or sitting for a long period of time, which was not a problem previously
    • concern from family members that a woman or girl has a boyfriend, or plans for the woman or girl to be married
    • a close female relative has been threatened with either procedure or has already been subjected to one
    • the woman or girl has already experienced, or is at risk of, other forms of so-called ‘honour-based’ abuse
    • the woman or girl is already known to social services in relation to other safeguarding issues
    • the woman or girl may disclose other concerns that could be an indication of abuse. For example, they may state that they do not feel safe at home, that family members will not let them out of the house, and/or that family members are controlling
    • the woman or girl may have suffered trauma from being coerced and having to undergo the procedures. This could result in an increase in emotional and psychological needs—for example, withdrawal, anxiety, or depression, or a significant change in behaviour. The trauma could also have long-term implications for the woman or girl, and may not manifest for many years after the event
    • the woman or girl may appear fearful of their family or a particular family member
    • unexplained absence from school, potentially to go abroad
    • changes in behaviour—becoming withdrawn, anxious, or depressed, or a deterioration in schoolwork, attendance, or attainment
  • This is not an exhaustive list of indicators. If any of these indicators are identified, professionals should follow their organisation’s safeguarding policies.

Safeguarding

  • Healthcare professionals will have professional codes of conduct to comply with. These procedures and/or duties should be followed immediately when there are signs that women’s and girls’ safety and welfare is being or may be threatened—they are at risk and assessments of that risk should be made
  • It is important to find out if the woman or girl is in immediate danger. In an emergency, the police should be contacted without delay. If it is not an emergency but there is a concern that the individual is at risk, the organisation’s safeguarding procedures and any professional duties should be followed. This may involve a referral to social care services and/or the police
  • Anyone who has concerns about a child’s welfare should make a referral to local authority children’s social care, and should do so immediately if there is a concern that the child is suffering significant harm or is likely to do so. Safeguarding referrals may be needed for vulnerable adults (including other family members) who could also be at risk of harm. Some women and girls may be reluctant to speak with the police
  • Organisations should not involve families and community members in cases involving virginity testing and hymenoplasty, including trying to mediate with family or using a community member as an interpreter
  • Engaging with families and community members may increase the risk of harm to the victim. The victim may be punished for seeking help and arrangements for procedures may be expedited. The risk of the woman or girl having undergone trauma and suffering psychological damage because of these practices is high, and mental health services and support should be contacted.

Talking About Virginity Testing and Hymenoplasty

  • Good communication is essential when talking to individuals who have undergone or are at risk of virginity testing and/or hymenoplasty, or when talking to friends or family members who may be requesting these procedures for others
  • The topic may arise in a variety of settings, including a GP’s surgery or sexual health clinic as part of a medical consultation, or at school. It could take place face to face, virtually, or over the phone. Some broad principles on how to approach these conversations are outlined below.

Respond with Sensitivity

  • Acknowledge the disclosure, bearing in mind that this is a sensitive topic. Women and girls may feel uncomfortable talking about their sexual experiences or sexual assault, be fearful of judgement, and may be fearful of speaking out against their family and/or community and of an escalation in so-called ‘honour-based’ abuse
  • Explain to the individual:
    • the limits of confidentiality
    • what information may have to be shared, with whom, and for what purpose.

Immediate Safety

  • If speaking with a woman or girl who has undergone or is at risk of virginity testing or hymenoplasty, ensure that she is in a safe place away from the perpetrator. If speaking over the phone, closed questions should be asked, which would allow them to give ‘yes’ or ‘no’ answers. Code words could also be used to indicate that the victim is on their own and/or able to talk
  • The '5 Rs' of asking about domestic abuse in a virtual setting is a useful resource that is relevant to talking to victims of these practices and other forms of so-called ‘honour-based’ abuse
  • The organisation’s safeguarding procedures should be followed. Seek advice from your safeguarding lead or local authority safeguarding professionals if you suspect that a woman or girl is at risk of harm, and ensure that appropriate action is taken. In an emergency, contact the police without delay.

Gathering Information

  • It is important to sensitively gather as much information as possible to understand the situation—exactly what procedures have taken place or are being requested, and whether the woman or girl is at risk of other forms of abuse, coercion, and control
  • Once it has been ascertained that the woman or girl can speak safely, ask open, non-leading questions. It is important to establish if the woman or girl is in immediate danger. Keep a record of what they have said.

Next Steps

  • It is important that the person being spoken with is given advice on the law. It may be helpful to discuss myths and misconceptions around virginity—for example, the myth that virginity can be accurately assessed by a virginity test, or the damaging belief that virginity dictates the worth of women
  • If the individual is in immediate danger, advise them to contact the police and, if need be, contact the police yourself. Follow the safeguarding procedures of your organisation. Signpost them to the most appropriate support and, if agreed, make a referral on their behalf. Always follow up on promises to contact the victim
  • An accredited interpreter may be required, who should ideally have knowledge of so-called ‘honour-based’ abuse. An interpreter should not know the individual and not be someone with influence in the individual’s community. If possible, the woman or girl should be given a choice of the gender of the interpreter, as they may feel more comfortable with a female translator
  • Talking about any form of abuse can be difficult and upsetting. Professionals may wish to speak with their supervisor if they are affected by what they have heard.

Scenarios

  • There are many scenarios in which a woman or girl can be at risk from or can have undergone virginity testing or hymenoplasty. Some example scenarios are included below:
    • a woman experiences sexual assault and is concerned that she will fail the virginity tests her family regularly forces her to have. Her family believes that rape is the woman’s fault, so she is scared of them finding out. The woman attends an appointment at a sexual health clinic and requests a hymenoplasty
    • a woman experiences so-called ‘honour-based’ abuse and domestic abuse at the hands of her family. The trigger for the violence is that she has a boyfriend and is pregnant. Her family physically assaults her, tries to force her to have an abortion, and to have a procedure to ‘reclaim her virginity’ at a private clinic in the UK. She contacts the police for help
    • a girl travels with her family to a different city and undergoes an examination to check that she is still a virgin. She is afraid that she is going to be sent abroad for a forced marriage and runs away from home. The girl’s friend is concerned and tells a teacher at school. The girl has a younger sister
    • a woman who is due to be married knows that she will have to undergo a virginity test and present a certificate confirming her virginity to her fiancée’s family. As such, she organises a trip abroad and secretly has a hymenoplasty to ensure she passes the virginity test upon her return. She discloses this to a charity supporting women affected by so-called ‘honour-based’ abuse years afterwards
    • a girl is made to undergo a virginity test, which she is deemed to have failed. Her father says that she must want to sleep with everyone and invites her male family members to rape her. She is thrown out of the family home and told not to return, or they will kill her. The girl calls a charity helpline to get help
    • a family are concerned about their daughter’s interactions with boys from school. They reach out to a private clinic to try to arrange a virginity test.

Hymenoplasty in the NHS

  • There are no justified medical or clinical reasons why a hymenoplasty should take place, and under no circumstance should it be performed. Healthcare professionals have been advised that the OPCS-4.9 classification code P15.3 ‘Repair of the hymen’ should not be used, and was removed from the classification listing in OPCS-4.10 on 1 April 2023.
For strategic guidance, refer to the full guideline.

Further Support

UK-wide

Police

  • If someone is in immediate danger contact the police by calling 999 and asking for the police
  • Call 101 for non-emergencies.

Forced Marriage Unit

  • The Forced Marriage Unit (FMU) operates both inside the UK (where support is provided to any individual) and overseas (where consular assistance is provided to British nationals, including dual nationals)
  • The FMU operates a public helpline to provide advice and support to:
    • victims and potential victims of forced marriage
    • professionals dealing with cases
  • The FMU public helpline can help with:
    • safety advice
    • providing assistance when an unwanted spouse is due to move to the UK (‘reluctant sponsor’ cases)
    • where possible, assistance in repatriation of victims held against their will overseas
  • Call: 020 7008 0151
  • Email: fmu@fcdo.gov.uk.

Karma Nirvana

Middle Eastern Women and Society Organisation (MEWSo)

  • MEWSo is a women’s charity run by and for women from ethnic minority communities. The majority of the communities they serve are from Middle Eastern, North African, and Asian backgrounds
  • Call: 07958 145 666
  • Email: office@mewso.org.

Iranian and Kurdish Women's Rights Organisation (IKWRO)

  • IKWRO supports women and girls from the Middle East, North Africa and Afghanistan living in the UK, and provides culturally specific support, advocacy, training, and counselling. They offer a free counselling service in Farsi, Kurdish, Arabic, and English. They run a specialist refuge for Middle Eastern, North African, and Afghan single women at risk of honour-based violence, forced marriage, female genital mutilation, and domestic abuse
  • Call: 020 7920 6460
  • Email: info@ikwro.org.uk.

Freedom Charity

  • Freedom Charity aims to help, rescue and support those who are victims and potential victims of dishonour abuse, forced marriage, female genital mutilation, virginity testing, and hymenoplasty
  • Helpline: 0845 607 0133.
  • Text the words 4freedom to 88802.

SafeLives

  • SafeLives is a UK-wide charity providing research, training, and support to frontline domestic abuse services and professionals. They are not a domestic abuse service providing direct support to people experiencing abuse.

England and Wales

Victim Support

  • Victim Support is the independent charity dedicated to supporting victims of crime and traumatic incidents in England and Wales
  • Victim Support national 24-hour support line: 0808 1689 111.

England

NHS England Safeguarding

Wales

Welsh Women’s Aid

  • Welsh Women’s Aid is an organisation supporting Welsh women affected by domestic abuse. Welsh Women’s Aid runs the Live Fear Free helpline below.

Live Fear Free Helpline

Bawso

  • Bawso is the lead organisation in Wales providing practical and emotional support to black minority ethnic and migrant victims of domestic abuse, sexual violence, human trafficking, FGM and forced marriage
  • Call the helpline: 0800 731817
  • Email: helpline@bawso.org.uk.

Meic 

  • MEIC is a free, confidential, anonymous, and bilingual helpline service for children and young people up to the age of 25 in Wales providing information, useful advice, and support
  • Meic are open 8 a.m. to midnight, 7 days a week, by telephone, SMS text and instant messaging
  • Freephone: 0808 80 23456
  • Text: 84001
  • Live chat: www.meiccymru.org.

Sexual Violence Support Services

  • In North Wales (Anglesey, Conwy, Gwynedd, Flintshire, Denbighshire, and Wrexham), there are two main sexual violence support services:
    • Rape and Sexual Abuse Support Centre (RASASC) provides information, specialist support and therapy to anyone who has experienced any kind of sexual abuse and violence. They can be contacted on 01248 670 628 or info@rasacymru.org.uk
    • Stepping Stones provides therapeutic services to adults who have been sexually abused as children. They can be contacted on 01978 352 717 or info@steppingstonesnorthwales.co.uk
    • In Mid, West, East and South Wales, the main sexual violence support service provider is New Pathways. They can be contacted on 01685 379 310 or enquiries@newpathways.org.uk.

Scotland

Shakti Women’s Aid

  • Shakti Women’s Aid helps Black and minority ethnic women, children, and young people experiencing, or who have experienced, domestic abuse from a partner, ex-partner, and/or other members of the household
    • Edinburgh: 0131 475 2399
    • Fife: 01383 732 289
    • Dundee: 01382 207 095
    • Forth Valley: 07757 035 794.

Amina—The Muslim Women’s Resource Centre

  • Amina offers a range of tailored support services to enable Muslim women to fully participate in society without fear of discrimination or inequality. This includes a range of one-to-one support (for example, a national ‘listening ear’ helpline which also offers Islamic advice through a scholar, employability guidance, and befriending) as well as peer group support (for example, violence against women ‘self-healing’ workshops and refugee work to support the integration of people new to Scotland)
  • Helpline: 0808 801 0301
  • Amina web chat: Monday to Friday, 10 a.m. to 4 p.m.

Scottish Women’s Rights Centre

  • The Scottish Women’s Rights Centre is a unique collaborative project providing free legal information, advice, representation and advocacy support to self-identifying women in Scotland affected by violence and abuse
  • Helpline: 08088 010 789
  • The helpline is open Monday 1 p.m. to 4 p.m., Tuesday 10 a.m. to 1 p.m., Wednesday 1 p.m. to 4 p.m., and Friday 10 a.m. to 1 p.m.

Victim Support

  • Victim Support Scotland is the leading charity dedicated to helping people affected by crime across Scotland
  • Helpline: 0800 160 1985 (Monday to Friday, 8 a.m. to 8 p.m.).

Just Right Scotland

  • JustRight Scotland use the law to defend and extend people’s rights. JustRight work with Rape Crisis Scotland and the University of Strathclyde Law Clinic as part of the Scottish Women’s Rights Centre (SWRC), which works with women who have been affected by abuse and violence in Scotland with the aim of improving their access to justice and experience of the justice system.

For further support sources in Northern Ireland, refer to the full guideline.

References

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