The scene
A consultant gynaecologist MDU member called the advice line after a consultation with a 21-year old private patient, who was requesting a hymenoplasty so she would appear to be a virgin on her wedding night.
No date had yet been set for the marriage, but the patient was worried about being subject to a virginity check, and that there might be consequences for her if she 'failed'. In her consultation with the MDU member, she said her father had been violent towards her in the past, as he was very religious and did not approve of some of her life choices now that she was living away from him, at university.
The patient had two younger sisters still living at home, aged eight and 10 years. The patient told the member she didn't feel they were at risk because "they don't challenge him".
Our member told the MDU adviser that she felt the patient had capacity. She had discussed safeguarding with the patient, who'd said she just wanted the operation and didn't want the police involved under any circumstances. The member was not willing to offer this procedure and asked what she should do next.
MDU advice
This type of surgery has been in the media spotlight, with the government saying in October 2021 that they plan to introduce a ban on hymenoplasty and virginity testing. The RCOG has also come out in favour of changing the law. Although female genital mutilation (FGM) is already illegal, that legislation does not cover hymenoplasty due to its current classification as a cosmetic procedure.
The adviser explained that there are existing safeguarding mechanisms in place to protect women who may be at risk of what is sometimes termed 'honour-based violence'. This patient should be viewed as a vulnerable adult, and the member was advised to strongly consider involving her local safeguarding team to protect the patient, if she consented.
There are various charities and support agencies that might offer the patient some help - for example, Karma Nirvana is a dedicated charity providing support and training to help prevent forced marriages and honour-based abuse in the UK and beyond. The member agreed that hopefully, with some time and appropriate support, the patient would change her mind and accept help from the safeguarding team.
The presence of the younger sisters in the home raised concerns about whether they might also be at risk of harm. Although any involvement of the safeguarding team would ideally be with the patient's consent, a risk of harm to the younger sisters may justify disclosure, even against the patient's wishes.
The adviser encouraged the member to discuss this with the local safeguarding lead. In practical terms, it might be difficult to progress any referral to safeguard the sisters without the patient providing key relevant information, such as the address of the family home. It would be important for her to document her discussions with the patient, encouraging her to cooperate with any steps needed to protect her sisters.
This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.
This page was correct at publication on 29/06/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.