Hymenoplasty
Hymenoplasty is a procedure undertaken to reconstruct a hymen. This is done by suturing hymenal remnants together at the vaginal opening, or surgically reconstructing the hymen with the purpose of making a woman bleed the next time she has intercourse (but is not guaranteed to do so), in order to give the impression that she has no history of vaginal intercourse. The hymen, once broken, does not disappear but leaves papillary projections. In a hymenoplasty these are trimmed and picked up with a stitch and then tied like a purse string. This will ultimately form some scar tissue. There is no guarantee that this will fully reform the hymen or cause bleeding when penetration is attempted. It can sometimes be advertised as "virginity surgery".
	The hymen is a thin piece of skin that partially covers the vagina. It usually breaks during sex, but not always, and can be broken through using tampons, activities such as horse riding and other sports. This means that having a broken hymen cannot be used as an indication that a woman has had vaginal intercourse. Equally, an intact hymen also does not mean that sexual intercourse has not occurred, as a hymen can stretch to accommodate penile penetration. It is entirely normal for hymenal remnants to remain even after childbirth. The World Health Organisation is clear that the appearance of a hymen is not a reliable indication of absence of intercourse. The hymen also has very few blood vessels and therefore an absence of blood when having sexual intercourse for the first time is also not an indication that a woman has had previous sexual intercourse.
	Following widespread concerns that women and girls were being forced and coerced into undergoing virginity testing and hymenoplasty, in early 2021 the then Secretary of State for Health and Social Care and the Home Secretary commissioned urgent policy work to determine if any government intervention, including legislation, is required, and if so, what the right legislative vehicle might be. The review’s recommendations included the proposal to criminalise virginity testing, but not to legislate to ban hymenoplasty at the same time. The arguments for a ban were at the time not so clear cut, and the government committed to establishing an expert panel to review the procedure in more detail.
	The Panel’s report was published on 23 December 2021 alongside a background paper Expert panel on hymenoplasty - GOV.UK (www.gov.uk) which summarises the evidence gathered during the intensive review and other several other sources of evidence. This evidence includes an extensive literature review, position statements from Royal Colleges, recent campaigns and personal experience case studies. This also includes the conversation and positions put forward by the Moral and Ethical Advisory Group (MEAG) who were consulted prior to the establishment of the panel.
	The Panel found that hymenoplasty is inextricably linked to virginity testing. Hymenoplasty is often undertaken by the same private clinics that offer virginity testing. If a woman or girl "fails" a virginity test, hymen repair surgery might be the logical next step. The continuing availability of hymenoplasty could serve as an incentive for families to seek virginity testing of women and girls. A failure to prohibit hymenoplasty would undermine the Government’s commitment to address the violence against women and girls by criminalising virginity testing. It is a harmful practice that creates and exacerbates social, cultural and political beliefs that a women’s value is based on whether or not she is a virgin before marriage.
	There is no clinical benefit to hymenoplasty, nor any other procedure under a different name that seeks to reconstruct the hymen. The Royal College of Obstetricians and Gynaecologists (RCOG) does not provide any training or clinical guidelines on how to undertake this procedure, and the clinical risks of undertaking it are unknown, with no evidence to prove it has no adverse effects.
	The Panel describes the physical and psychological risks of HP as including:
Infection
Acute bleeding during the procedure
Scarring and narrowing of vaginal opening
Reduced sensation/ increased sensation (pain rather than pleasure)
Sexual difficulties
Depression
Anxiety
Post-Traumatic Stress Disorder
Reduced or no libido
Suicide
	The expert panel have confirmed that there is never a medical or clinical need to repair or reconstruct the hymen. In some very limited circumstances (not least because clinicians have other, non-surgical treatments available), there are procedures that are clinically necessary to remove hymenal remnants caused by external trauma or child birth. This would involve removing any remaining parts of the hymen to prevent bleeding, infection or discomfort to a woman. Such a procedure does not involve any reconstruction of the hymen but rather removes any remaining traces of the skin.
	The government agreed with the panel’s main recommendation and announced its intention to ban hymenoplasty when Parliamentary time allowed in the Women’s Health Strategy Vision Document published on 23rd December 2021. The Health and Care Act 2022 has provided the earliest legislative vehicle to ban hymenoplasty.
	As a cosmetic surgical procedure, hymenoplasty would not have otherwise been an offence if carried out with the patient’s consent. The ban is therefore achieved through the creation of a new criminal offence. No other legislation would serve to prevent hymenoplasty. Sexual offences are not relevant because the surgery is not sexual in nature. The prohibition on female genital mutilation would not cover the surgery, because this only applies to mutilation of certain of the specific external genitalia. Professional regulation was considered by the expert panel, who concluded that this was insufficient to protect women from the risks of hymenoplasty. And in relation to offences against the person, while consent to the surgery may not be in place due to the pressure placed on women to undergo it, this would not necessarily always be the case.
	Provisions in the Health and Care Act 2022 making it illegal to carry out, offer or aid and abet hymenoplasty in any part of the UK came into effect on 1 July 2022.