Many people might argue that there's a lot of pressure on today's youth to have sex - at least in the Western world. After all, young people are bombarded with suggestive advertising campaigns and tales of young celebrities gone wild every day. But for some girls and young women in countries around the world, the pressure is different: they're to remain virgins until marriage for cultural and religious reasons.

In these cases, the consequences of having premarital sex can include disownment and violence. A special surgery, however, can help women in such situations. Hymenoplasty, or "virginity surgery," as it's sometimes called, gives patients the physical appearance of being virgins.

Christine is 22 years old and lives in France. The young Muslim woman, who doesn't want her real name used, recently had hymenoplasty surgery in a Paris clinic. "I've had this operation because of my family," she says. "They don't know about it, I've done it anonymously."

Christine is just one of an unknown number of women across Europe who have had hymenoplasty - the surgical reconstruction of a woman's hymen membrane. The operation is increasing in popularity in countries like France, Germany and the UK.

"Lots of young women come to see me to get this operation done because they are forced due to their cultural backgrounds to be virgins going into their marriage," says plastic and aesthetic surgeon Dr. Stephan Günther, who performs the operation in the western German city of Düsseldorf.

"They are mostly Muslim women. We do a local anesthesia and we stitch the cuts together."

A secret surgery

Unlike other operations that Günther performs, hymenoplasty is largely cloaked in secrecy. Most women who come to him don't want anyone to ever find out that they've had their virginity artificially restored through an operation that can almost guarantee bleeding the next time they have sexual intercourse.

"It's an ambulatory surgery. They can go home a half hour later and they can do it without anybody knowing about it," says Dr. Günther. "This is very important because lots of these women have to do it secretly. They don't want to tell us their names or addresses."

Knowing how many hymenoplasties are being performed in Germany is difficult. They're usually paid for privately by the patient, which means they don't get recorded through health insurance. Doctors are also under no obligation to report how many they do. In the last five years, however, Günther has gone from performing roughly 10 to 15 a year to between 75 and a hundred. In other European countries, an increase in hymenoplasties is also evident. According to the National Health Service, 30 surgeries were recorded in the UK in 2009 - a 20 percent increase from 2005. The figure for operations that aren't covered and recorded by the healthcare system is expected to be much larger.

The number of hymenoplasty surgeries is also surging in France, where Christine had the operation in an upscale clinic near the Champs-Élysées Avenue. She's getting married this July and says the surgery, which she learned about through a television report, was critical for her.

"It's the tradition and my religion that have pushed me to do this because I know that when I get married, I have to get a virginity certificate and so my hymen has to be intact," she says. "I'd prefer to just simply admit that I'm not a virgin, but if I said that, heads would roll. I'd be disowned."

A life-saving operation?

Dr. Marc Abecassis is the plastic and aesthetic surgeon who operated on Christine. He performs three to five hymenoplasties a week, and largely credits the Internet for spreading the word about the surgery over the past few years. According to Dr. Abecassis, fear like Christine's over what her family might do if they discovered she wasn't a virgin before marriage is what prompts most of his patients to have the operation.

"If we think that this is essential for the patient then we do the surgery, and most of the time it is very important," he explains. "We never suspected that these women are in so much distress and living in such misery. Sometimes they are also in danger. If it's not physical, it's psychological."

While the majority of hymenoplasty patients whom both Abecassis in France and Günther in Germany see are Muslim, both doctors have also performed the surgery on women from a variety of cultural and religious backgrounds, including Christianity. The reasons these women have the surgery however generally mirror those of young women like Christine and are tied to family traditions and religious background.

Not everyone is convinced, however, that hymenoplasty is an appropriate solution to religious and cultural pressure on young women to be virgins. Anke Wolf-Graaf, a representative for the Germany-based women's rights group Terre Des Femmes, says the organization opposes hymenoplasty.

Not the solution, says rights group

"In general, Terre Des Femmes doesn't approve of this operation," she states. "Of course if a woman's mental or physical health is in jeopardy because she's being threatened, then we say that these women can't reject the operation. But in principle, we don't see it as a solution because it leads to young women measuring their worth with virginity." This, she says, completely contradicts the message that Terre Des Femmes and other women's rights organizations are trying to send to young women. "Self-determined sexuality and hymen reconstruction are more or less mutually exclusive," she adds.

Hymenoplasty patient Christine understands this view, and she herself hopes that virginity will be viewed differently within her cultural circle in the future so that these operations become obsolete.

"If I have a daughter one day, I would prefer that she talks to me about sex, even if she's having it. I don't want things to be hidden," she emphasizes. "I would discuss it with her and even talk about protection. I wouldn't want her to ever feel she has to come here and have this surgery."

Author: Laura Schweiger
Editor: Andreas Illmer