Intimate surgery in Guatemala

This week’s Lancet reports on a troubling development in Guatemala. Approximately 2% of Guatemalan women undergo reconstructive surgery of the hymen to be able to claim themselves as virgins before marriage. This raises ethical issues at a number of different levels. Given that the surgery involves risks without compensating medical benefits, ‘intimate surgery’ conflicts with the Hippocratic injunction of ‘doing no harm.’ What doctor, in good conscience, ought to participate in this cultural practice? And in the Guatemalan context, the surgical risks are elevated: most of the surgeons performing the interventions are not fully qualified, many clinics operate under the regulatory radar, and the women are typically not informed of the potential side-effects of the surgery, including infections, hemorrhaging, fistulas and extreme pain during sexual intercourse. And this is among the women ‘lucky enough’ to afford the $1000 procedure; one can only imagine the social repercussions for those that cannot. (As usual, there is no corresponding community pressure concerning male virginity.)

As Hannah Roberts, the author of the article points out, intimate surgery and the cult of virginity is only a symptom of a larger biopolitical struggle in Guatemala for women’s reproductive rights. A new law backed by a parliamentary majority on family planning and reproductive health could improve the dismal levels of maternal and infant mortality, and women’s knowledge of and access to contraceptive choice. But the new law is opposed by the Guatemalan president, Oscar Berger, and by his influential supporters within the Catholic Church. The Church is unhappy about the prospect of programs give women the power to control their own pregnancies -- only roughly 40% of women had ever used any conceptive technique at all. Promoting contraception, they claim, is like promoting bullets: it creates a ‘culture of death.’