By Shani Nguyen, Associate Editor at the AMSA Journal of Global Health 2021

Virginity testing is a gynaecological examination that is routinely conducted in at least twenty countries.1However, international organisations such as the United Nations (UN) Human Rights Office and the World Health Organisation (WHO) have emphasised that virginity testing should cease because it is a “medically unnecessary, and… painful, humiliating and traumatic practice”.1 This piece will explore the ethics surrounding this practice and why international organisations consider it to be a violation of women’s rights.

Ethical principles: Autonomy 
In Western countries, there has been increasing requests for virginity testing and accompanying hymenoplasty (virginity repair surgery).2 Often, these women desire the examination and procedure to uphold their traditions and/or preserve their family’s reputation. In these cases, it may be considered ethically justifiable to conduct virginity testing and subsequent virginity repair to respect the patient’s autonomy. Indeed, autonomy is considered upheld as the women usually satisfy the criterion of no internal coercion: alternativism is not possible and patients show intelligibility and authorship.

However, in most situations, women are not acting autonomously when requesting virginity testing. Often, women are unduly forced into undertaking this examination by family members or even local authorities. Indeed, there are reports this examination is performed on female rape victims to corroborate rape claims. 3Thus, the large presence of external coercion from one’s family and authorities and absence of autonomy in requesting virginity testing makes this examination ethically unjustifiable. Concerningly, the lack of consent from women for virginity testing means the examination is sexual assault and violates one’s human rights.   

Maleficence and Beneficence 
With most clinical situations, the ethical pillar of non-maleficence is upheld by ensuring avoidable harm does not befall the patient. However, virginity testing brings a considerable degree of avoidable harm to the patient. As aforementioned, most women do not autonomously request this examination. Thus, the examiner exposes the woman to “fear, humiliation, worthlessness and lack of the right to self-determination”2 by performing virginity testing. The deleterious impact on the female’s mental and psychological wellbeing by both subjectivist and objectivist accounts is harmful, and thus maleficent. Indeed, the examination is further maleficent as it reinforces the oppression and sexual subjugation of women.4 Moreover, virginity testing is not beneficent because the examination itself is inaccurate. Arguably, continuing to allow the continuation of an examination which is medically inaccurate and harmful is maleficent, as it undermines the optimal care of evidence-based clinical practice. 

Justice 
Additionally, virginity testing is ethically unjustifiable from a justice viewpoint. With regards to distributive justice, there is finite medical resources and thus medical interventions should be fairly distributed. However, virginity testing is scientifically lacking and brings little benefit.5 Hence, providing this service is not fulfilling justice because appointments for this harmful and unnecessary examination impedes delivery of other health services. This is especially true if virginity testing is accompanied by hymenoplasty, and the woman suffers post-surgical complications. Moreover, virginity testing undermines justice as it promotes discrimination against women.6

Conclusion
Thus, countries around the world should heed WHO’s call to ban virginity testing as this practice is ethically unjustifiable. Virginity testing is an examination which is traumatising and degrading to the patient and violates humans rights through reinforcing the subjugation and discrimination against women. 

References
 
1.     United Nations. ‘Virginity testing’: a human rights violation, with no scientific basis – UN. Switzerland: United Nations; 2018 [updated 17 Oct 2018; cited 1 Aug 2021]. Available from: https://news.un.org/en/story/2018/10/1023401
2.     Crosby S, Oleng N, Vollpellier M, Mishori R. Virginity testing: recommendations for primary care physicians in Europe and North America. BMJ Global Health [Internet]. 2020 Jan 20 [cited 2021 Aug 21]; 5(1):e002057. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042604/
3.     Olson R, Garcia-Moreno C. Virginity testing: a systematic review. Reprod Health. 2017 May; 14(1):61. 
4.     Moaddab A, McCullough B, Chervenak F, Dildy G, Shamshirsaz A. Virginity testing in professional obstetric and gynaecological ethics. Lancet. 2015 Dec; S0140-6736(15)01275-1.  
5.     World Health Organisation. Eliminating virginity testing an interagenecy statement. Switzerland: World Health Organisation; 2018 [cited 2 Aug 2021]. Available from: https://www.who.int/reproductivehealth/publications/eliminating-virginity-testing-interagency-statement/en/
6.     Behrens K. Why physicians ought not to perform virginity tests. Ethics. 2015;41(8):691–5