Like a virgin... again

They're usually in their early 20s and most are in the final year of their studies.

"The girls don't come alone (for the consultation and surgery). They come with their boyfriends or a trusted girlfriend," says a consultant plastic surgeon with a notable private hospital in Kuala Lumpur.

A lot can happen when youths leave home to study abroad and sexual exploration is invariably on the top of the list.

"And when these girls come here - either with their boyfriends or they befriend local guys - some of them engage in penetrative sexual acts," says the surgeon.

But despite the freedom they enjoy here, the day eventually comes when they have to go home to their parents, get married and settle down.

And some of these girls come from communities that for various cultural and religious reasons, still require a girl to be a virgin.

"To them, having the hymen intact is not just an important marriage commodity - their very lives depend on it," says the surgeon.

Never mind that over the past few decades we've achieved and advanced so much - like putting a few men on the moon, doing organ transplants and creating babies in test tubes.

There are still reports of women being killed or brutalised by their family members in certain African and Middle-eastern countries if they are found not to be virgins on their wedding night.

Last Sunday, it was reported that a young Muslim couple's marriage was annulled in 2006 because the bride, a student nurse in her 20s, was not a virgin.

The wedding night party was still under way at the family's home in Roubaix, France, when the groom, an engineer in his 30s, came down from the bedroom complaining that his bride was not a virgin.

He could not display the blood-stained sheet that is traditionally exhibited as proof of the bride's purity.

Elisabeth Badinter, a philosopher and pioneer of women's legal rights, said the annulment would only serve to send young Muslim girls running to hospitals to have their hymens restored.

In France, although it is officially discouraged, the operation is seeing increasing demand from Muslim women who fear the consequences of being unable to prove their virginity on their wedding night.

It takes only about 30 minutes and voila, the girl is a "virgin" again. The operation is not only attracting foreign students, but some local university students have also started to request for their hymen to be repaired.

A 22-year-old varsity student told the New Sunday Times that she went to see a plastic surgeon to have her hymen restored after she learnt about the procedure on the Internet.

"I buat salah (made a mistake) and had pre-marital sex with my former boyfriend once. I don't want my future husband to think that I'm a slut just because of that one night," says the business administration student who agreed to speak on the condition of anonymity.

She forked out RM2,500 for the procedure last December. It was money she saved from giving part-time tuition.

"The hymen is fragile and can be easily torn, not necessarily through penetrative sex, but also rigorous physical activities like cycling or running, or even after a fall," says consultant plastic surgeon Dr V. Surendranathan.

Restoration of the hymen is done on an outpatient basis, under local anesthesia or sedation.

Simple repair consists of piecing together the remnants of the hymen by closing the tear and it's a simple procedure that is done by pulling the tissue together.

However, the result of this particular procedure is not meant to last and some experts say "it must be done three to seven days before the wedding".

When the hymenal remnants are not sufficient, a small incision can be cut into the outer flaps of the vagina and a suture put across it.

"After about three to four weeks - during which time the patient is advised against any form of penetrative sex -- the sutures, which are usually fine black threads, will come off on their own," says Dr Surendranathan.

Another option is inserting a tear-through nylon-like biomaterial. "When sexual intercourse takes place, the biomaterial would be torn and the tearing would cause some bleeding - just like what a broken hymen would."

Hymen reconstruction is quite the in-thing among sex workers, says another plastic surgeon who declines to be named.

"They come here for vaginoplasty (tightening and reshaping of the vagina) and usually request hymenoplasty as part of the package," he reveals.

He says simple vagina tightening surgery costs about RM3,000 to RM8,000 - although the procedure can go up to RM16,000 in some hospitals. Hymenoplasty is more affordable - it's usually about RM1,500 to RM3,000.

"They tell me having a new hymen is worth it because some customers are willing to fork out about RM10,000 just to spend one night with a 'virgin'."

Procedures like hymen reconstruction are relatively rare and confined to a minority of women who need to conform to religious or ethnic rules on virginity, says Dr Surendranathan.

A greater number of patients complain of stretched vaginal muscles or inner labia that are too big, uneven or unsightly.

Vaginoplasty involves the removing of excess vaginal lining and the tightening of surrounding soft tissues and muscles to return a vagina to its normal anatomical shape and diameter.

Most women who opt for vaginoplasty are those who've had children and are in their late 30s and above.

"They complain about a feeling of looseness. This can decrease the sensation during sexual intercourse, resulting in lower levels of satisfaction for her and her partner," says consultant obstetrician and gynaecologist Dr Lee Say Fatt.

After three children and 14 years of marriage, Kristy (not her real name), 42, went for vaginoplasty recently after her husband hinted that he "could not really feel her" any more.

So when she suggested about going for surgery to "tighten things up down there", he was all for it.

"He paid for everything of course. Our sex life has definitely improved," says Kristy.

But she can't help harbouring a little resentment towards her husband after the surgery.

"In a way, him wanting me to do it made me feel like he didn't really love me anymore -- not if I can't satisfy him sexually."

The erosion of sexual pleasure aside, a woman would also experience stress incontinence, and the weakening of the wall between the vagina and bladder or the vagina and that with the rectum.

Some hospitals combine vaginoplasty together with labiaplasty and advertise them collectively as vaginal rejuvenation surgery.

Labiaplasty is a cosmetic genital surgical procedure that will reduce the size or change the shape of the small lips on the outside of the vagina.

What are the risks involved in such surgeries?

"As with any surgery, there can be complications, both surgical and anaesthetic. But complications are rare and they may include bleeding, infection and scarring," says Dr Lee.

Proper surgical techniques and the use of laser will significantly reduce these risks, he says, adding that "laser minimises pain, blood loss and swelling".

It also promotes excellent wound healing, resulting in minimal or no scarring at all.

"The procedures are generally done as day cases and patients are usually put under general anaesthesia.

"After surgery, the patient will be under observation for a few hours before they are allowed to go home -- on the same day."

Women usually report mild to moderate discomfort for a few days after the operation, says Dr Lee. "This can be easily relieved by oral painkillers and cold packs.

"Many women can return to their usual daily activities after resting for a few days."

After surgery, patients would have to abstain from sexual activities for at least six weeks.

This story was first published in the New Straits Times on June 9, 2008.