Do you do hymenoplasty? Doctors' ethical, cultural and social dilemmas when faced with this question

Hymenoplasty is a procedure to surgically restore the hymen, a thin membrane that partially closes the entrance to the vagina and which may be ruptured due to sexual activity. It is requested by women whose culture demands they prove their virginity by bleeding on their wedding night. As a result, this surgery is filled with ethical and legal controversy surrounding virginity, sexual equality, and women's rights to bodily autonomy and self-determination. This paper is a qualitative analysis of conversations with four Canadian doctors faced with the request for hymenoplasty and their experiences and decision-making process. Results indicate doctors relied on values of self-determination, bodily autonomy, honesty and integrity, and ethical principles of informed consent, competence, privacy, confidentiality, and culture and gender awareness, to inform their decision making. In their dialogues they placed different weight on the biological aspects of the surgery, culture, and personal autonomy resulting in different decisions and actions in response to the request. In addition, compartmentalisation, simplification, distance, differentiation and responsiveness appeared to assist the doctors in engaging with the discomfort and ethical dilemmas inherent in responding to the request for hymenoplasty. Future research is needed to verify these results and to explore the impact of the differing approaches to the women requesting the surgery.