Wild Verina, Poulin Hinda, McDougall Christopher W, Stöckl Andrea, Biller-Andorno Nikola
University of Zurich, Switzerland; Ludwig-Maximilians-University, Munich, Germany.
EHESS, Paris, France.
Soc Sci Med. 2015 Dec;147:54-61. doi: 10.1016/j.socscimed.2015.10.051. Epub 2015 Oct 23.
Hymen reconstruction surgery (HR), while ethically controversial, is now available in many countries. Little clinical evidence and hardly any surgical standards support the intervention. Nearly as scarce is social science research exploring women's motivations for the intervention, and health care professionals' justifications for its provision. In order to better understand decision-making processes, we conducted semi-structured interviews in metropolitan Tunis, in 2009, with six women seeking the procedure, four friends who supported such women, four physicians who perform the operation, and one midwife. Health care professionals and patient companions expressed moral ambivalence about HR: although they could comprehend the individual situation of the women, they expressed concern that availability of the procedure might further entrench the patriarchal norms that compel the motivation for seeking HR in the first place. Some women seeking HR shared this concern, but felt it was not outweighed by their personal aims, which were to marry and become mothers, or to overcome past violent sexual experiences. The women felt HR to be uniquely helpful in achieving these aims; all made pragmatic decisions about their bodies in a social environment dominated by patriarchal norms. The link between HR and pervasive gender injustice, including the credible threat of serious social and physical harm to women perceived to have failed to uphold the norm of virginity before marriage, raises questions about health care professionals' responsibility while facing requests for HR. Meaningful regulatory guidance must acknowledge that these genuine harms are at stake; it must do so, however, without resorting to moral double standards. We recommend a reframing of HR as a temporary resource for some women making pragmatic choices in a context of structural gender injustice. We reconfirm the importance of factual sexual and reproductive education, most importantly to counter distorted beliefs that conflate an "intact hymen" with virginity.
处女膜修复手术（HR）尽管在伦理上存在争议，但现在在许多国家都可以进行。几乎没有临床证据和手术标准支持这种干预措施。同样稀缺的是探索女性进行这种干预的动机以及医疗保健专业人员提供该手术理由的社会科学研究。为了更好地理解决策过程，我们于2009年在突尼斯首都对六名寻求该手术的女性、四名支持此类女性的朋友、四名实施该手术的医生以及一名助产士进行了半结构化访谈。医疗保健专业人员和患者同伴对处女膜修复手术表达了道德上的矛盾态度：尽管他们能够理解这些女性的个人情况，但他们担心该手术的可获得性可能会进一步强化父权制规范，而正是这些规范促使她们首先产生寻求处女膜修复手术的动机。一些寻求处女膜修复手术的女性也有这种担忧，但认为这并没有超过她们个人的目标，即结婚生子或克服过去的暴力性经历。这些女性认为处女膜修复手术对实现这些目标特别有帮助；在一个由父权制规范主导的社会环境中，她们都对自己的身体做出了务实的决定。处女膜修复手术与普遍存在的性别不公正之间的联系，包括对那些被认为婚前未能坚守处女膜规范的女性存在严重社会和身体伤害的可信威胁，引发了关于医疗保健专业人员在面对处女膜修复手术请求时责任的问题。有意义的监管指导必须承认这些切实存在的危害；然而，这样做时不能采用道德双重标准。我们建议将处女膜修复手术重新定义为一些女性在结构性性别不公正背景下做出务实选择的临时资源。我们再次确认了进行真实的性与生殖教育的重要性，最重要的是要纠正将“完整处女膜”与贞操混为一谈的错误观念。
