LOS ANGELES (WOMENSENEWS)--Some doctors perform these specialized surgeries on women late at night when there's no one else in the waiting room.
The patients are most often women of Middle Eastern descent, some with origins from countries such as Iran and Saudi Arabia. They frequently give false names and pay in cash. They arrive alone, faces hidden, under elaborate hats, wigs, scarves and sunglasses, and afraid, say doctors.
They are there for hymenoplasties, or the repair of hymens, which, when intact, are widely recognized as evidence of virginity. The surgeries could save their lives, noted the physicians who perform them, because, according to some interpretations of Islamic law, if a male relative suspects them of having premarital sex, the woman is a criminal. In some countries, such as Saudi Arabia and Nigeria, the penalty could be death.
Although for the most part, many of the women who seek these surgeries live in the U.S. with family members or to attend school, many return to their home countries when it's time to look for a husband.
Doctors say that while there are no official statistics, they have seen an increase in requests for hymen repair surgeries in recent years. In addition, more doctors are receiving threats.
"While we have no concrete numbers, doctors have reported growth in the number of hymenoplasties," Dr. V. Leroy Young, chair of the emerging trends task force of the Arlington Heights, Ill., American Society of Plastic Surgeons, told Women's eNews.
"Yes, there has been a degree of danger to doctors from fundamentalist groups who believe you are violating a law or culture. You can get in a bit of trouble."
Young also said that it's not just women with Middle Eastern backgrounds seeking the surgeries. There has also been an increase in the number of women requesting hymen repair from both the Orthodox Jewish and Christian fundamentalist communities, as well as from women of all nationalities who want the surgery as a sexual enhancement.
"Within the fundamentalist Christian population as well there has been an apparent recent movement towards 'traditional family values' and there is pressure put on women to be virgins," Young said.
The hymen is the thin, fleshy membrane found at the opening to the vagina, long treated as a sign of virginity because it is usually torn by the first experience of sexual intercourse. Hymens can also be torn by athletic activities.
Typical hymen repair surgery involves stitching the remnants of a torn hymen together and inserting a gelatin capsule that contains a blood-mimicking substance. After the hymen has been surgically repaired, a woman will bleed the fake blood the next time she has sexual intercourse. The surgery, which costs from $2,500 to $4,500, is performed on an outpatient basis. Healing can take from a few days to a few weeks.
Doctors Get Death Threats
The women who undergo the procedures are not the only ones who fear for their lives or well-being. A number of U.S. physicians who perform these surgeries have received death threats by some who identify themselves as Muslims.
Young said that some doctors have received e-mails and phone calls threatening them or their staff with physical harm.
The threats to the doctors shadow the greater danger faced by women who undergo the surgery. Many live in fear of violence or honor killing, a practice in which a woman is murdered by her family members for supposedly shaming or tarnishing the family name with "unchaste" behavior. The practice occurs in traditional communities around the world, including the United States and Europe.
A report on honor killings by the Los Angeles-based Muslim Women's League says that while sexual relationships outside of marriage are prohibited, honor killings are not a part of Islam.
"The problem of 'honor killings' is not a problem of morality or of ensuring that women maintain their own personal virtue; rather, it is a problem of domination, power and hatred of women who, in these instances, are viewed as nothing more than servants to the family, both physically and symbolically," the report said.
The Islamic law of chastity before marriage does not distinguish between men and women. But women are often uniformly singled out for punishment of sexual crimes.
Dr. Laila Al-Marayati, communications director for the Muslim Women's League and a gynecologist, says that women seek hymen-repair surgeries to cope with cultural pressures and not to comply with Islamic law, which does not stipulate a need to check a woman's virginity.
"While Islam requires that both men and women be chaste before marriage; it doesn't require women to prove it," she said. "The need for surgery is because of the culture in some countries. Those same cultures do not require a man to prove his chasteness."
"It is sad that doctors are being threatened because proving chastity is not part of Islam," she added.
Fear of Reprisal
Many doctors interviewed who have heard about the threats or have been threatened themselves would only talk off the record to Women's eNews for fear of reprisal. They did not want to advertise the fact that they perform the surgeries and said they like to keep a low profile on their work with hymen repair.
Dr. David Matlock, a Beverly Hills gynecologist, was an exception. Matlock, who pioneered laser vaginal rejuvenation, said he has been performing hymenoplasties on hundreds of women for over 21 years. Most, he said, were of Middle Eastern descent.
He said he recently received death threats in the mail and his office has received numerous calls from men, identifying themselves as Muslims, who threatened to kill him and his office workers if he did not stop performing hymen repair.
"They called my office numerous times and sent letters to my office with pictures of dead and bloodied people," he said. "It was unnerving to say the least. I can now better understand when these women come in and say to me: 'I must do this. I'm going back to Iran and I could be killed.'"
Southern California is home to a large number of people who have emigrated from Iran. Matlock noted that, while many of the patients have lived in the U.S. for much of their lives, they still need to adhere to traditional practices and often undergo the surgery before looking for a husband.
Matlock said last year he contacted the FBI, who told him to keep a low profile and to stop advertising the procedure in local papers such as the L.A. Weekly. He said he was told by the FBI that the notes were real and the people who sent them knew what they were doing.
The local Los Angeles FBI office declined to say whether it had received calls from surgeons reporting death threats for similar reasons.
Dr. John Miklos has been performing hymenoplasties in Atlanta for the past five years on women ranging in age from 19 to 30. "I have had many Middle Eastern women beg me to come in at night and then ask me to destroy the records. They say they could fall into the hands of family members and both of our lives could be in danger."
More Cautious Now
Miklos says colleagues have told him about receiving threats and he has been warned by the women coming in for the procedure. In recent months, he says, he has become more cautious himself. He no longer advertises the procedure in local newspapers and he said most of his business comes from personal referral.
"These kind of threats are no different than doctors getting death threats from performing abortions," said Miklos. "It's insane that the women are so scared but it is shocking and a shame that doctors too have to be nervous."
Dr. Bruce Allan, a prominent Canadian gynecologist, advertises hymen repair prominently on his Web site. When contacted by Women's eNews, however, Allan said he does not do the procedure and refused to discuss his advertising and Web site.
Dr. Ronald Blatt of the Manhattan Center for Vaginal Surgery began doing hymen repair about two years ago and reports a slight increase in the number of hymenoplasties. In the first year, the center performed two of the surgeries. Blatt could not be specific about which countries the women were from, but emphasized that the center works to be discreet about the procedure.
"We've only had about six and they were women who were born somewhere in the Middle East, but we try to keep a low profile. We only do it when asked."
Sandy Kobrin is a writer based in Los Angeles who frequently writes about the plastic surgery industry.