Women in the United Kingdom are being told by healthcare professionals they cannot receive an internal examination because they aren’t sexually active, going against the advice of British medical ultrasound guidelines.
VICE World News has spoken to five women from around the UK who have been denied a transvaginal ultrasound over the past two years because they had been asked – by male and female medical staff – whether they were sexually active or “virgins.”
The exam, which uses a probe that goes two to three inches into the vaginal canal, is a type of pelvic ultrasound that helps doctors examine female reproductive organs to find the cause for conditions such as pelvic pain, unexplained bleeding or cysts.
A 30-year-old woman who was told she couldn’t receive the test because she was a “virgin” at Croydon University Hospital last week, and whose identity is being protected for privacy reasons, told VICE World News, “It’s 2022, for crying out loud. Women have to lie just to get their health checked, because apparently our well-being revolves around men. This is what purity culture has done to us.”
Sophie Hayward, 26, who experienced the same in Leicester last year, said: “I don't want to feel like I am forced to just lose my virginity to a random stranger just to get a test done which is beneficial to me.”
According to the guidance from the British Medical Ultrasound Society, “if a patient has not had penetrative sex, they are still entitled to be offered, and to accept, a TVUS [transvaginal ultrasound] in the same way that cervical screening is offered to all eligible patients.”
“The concept of virginity plays no part in the clinical decision making for a TVUS, and the examination should be offered by the ultrasound practitioner, when clinically indicated. It is, however, acknowledged that health tests such as cervical screening and TVUS may be more uncomfortable for patients who have not had penetrative sex, and therefore the ultrasound practitioner must be extra vigilant if they are to proceed.”
Virginity is a social construct with no biological reality, sometimes erroneously connected in women and those assigned female at birth to the presence of a hymen or their physical anatomy – which has long been debunked by the scientific community and challenged for perpetuating heteronormativity. Questioning around sexual activity often presumes that the female patient is heterosexual and ignores solo sex.
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “Every woman deserves to have control over their own sexual and reproductive health, and no healthcare professional should perpetuate harmful myths regarding virginity.”
Neelam Heera, founder of the Cysters charity that works to remove cultural barriers in BAME communities around women’s health, said that this has also affected several women she has worked with in the Birmingham area where she is based as well as further away, who were all over the age of 18 and were using NHS services.
“It’s definitely happening in the communities. It’s a reoccurring thing from 5 years ago – nothing has changed. When we’ve got the individual to push back, they’re never given a proper answer why,” she said.
The 30-year-old woman who VICE World News spoke to visited Croydon University Hospital last week to receive a scan to try and find out why her periods were heavy and painful.
“‘Are you a virgin?’, the gynaecologist asked me, because it wasn’t on my records that I was sexually active,” she told VICE World News over a video call. When she asked why that would matter, the doctor replied: “I can’t do it because it’s painful for some women and if I penetrate you with this tool, you’ll no longer be a virgin.”
She added that the doctor became irritated and that she eventually lied and said she had once had sex a long time ago. The doctor then performed the ultrasound. “There was slight discomfort,” the woman said, speaking on the condition of anonymity for privacy reasons, “but it was fine. I handled it. A huge fuss over nothing. The person doing the scan was ultimately what gave me a headache.”
“I’ve grown up with this oppressive culture, in a family where unfortunately they still do virginity tests, where they try to label a woman as just her parts,” she continued. “I am slowly unlearning that, and decided I’m going through with this appointment because I need to get to the bottom of what is happening.”
“I couldn’t believe the language she was using.”
Emma Cox, CEO of the charity Endometriosis UK, which supports those affected by endometriosis, said: "In some cases, a transvaginal ultrasound is appropriate for those who have never engaged in penetrative sexual activity. If a doctor thinks that a transvaginal ultrasound is not appropriate for a patient, they should clearly explain the reasons for that decision. In this conversation, it's really important that they keep in mind that gender, sex and sexuality are sensitive topics."
Hayward, the woman from Leicestershire, said that she had a doctor at Diagnostic World, which provides diagnostic services to the NHS, refuse to perform the ultrasound “due to religious beliefs as I am a virgin and her beliefs don't allow her to even risk breaking my hymen.”
“It is absolutely shocking and myself it was upsetting because at the time I was just begging for answers as to why I was in daily pain for over 2 years and felt like I was denied ways to answers because of my choice to not have sex yet,” she said. “I would have literally accepted any test just for an answer to my pain.”
After obtaining a laparoscopy, her endometriosis and polycystic ovary syndrome (PCOS) diagnosis was confirmed – but because she hasn’t had sex she is still being refused transvaginal ultrasounds to monitor further changes in her uterus and ovaries. “I think the worst part is I am still not taken seriously. A lot of it is told it's in my head etc but the ultrasounds still frustrate me as don't want to feel like I am forced to just lose my virginity to a random stranger just to get a test done which is beneficial to me and honestly I have thought about doing it just so it makes it easier. That's how bad it is.”
Another woman in London who would prefer to remain anonymous to protect her privacy visited Middlesex Hospital was also refused a scan despite having had medical procedures before that involved her vaginal canal. “I’ve had a smear test! I’d really like a scan. They’ve suggested a mirena coil [an intrauterine-device] so it just doesn’t make sense how that’s allowed and a scan isn’t.”
A woman who also spoke on condition of anonymity to protect her privacy was denied a transvaginal ultrasound at Nuffield Health, a healthcare charity, in Glasgow: “It’s this idea that no one should be sticking anything up there because it should be broken first by a penis…because I hadn’t had sex, the gynaecologist told me it wouldn’t be an option because it would be too painful for me, so it wouldn’t be something he’d be willing to carry out this stage. He said he could do a surgical investigation. I didn’t want surgery that could be unnecessary.”
“Because I was nervous about all things sex, I took his word for it – but I didn’t like that he decided for me. And where I am now is that my pelvic pain still hasn’t been resolved.”
Dr Hana Patel, a GP with a specialism in women’s health, told VICE World News that patients “should be offered transvaginal ultrasound scans with full information given”.
Dr Amit Shah, gynaecologist and co-founder of Fertility Plus, said “it’s quite a crude approach to say no and decline transvaginal scanning if the patient has agreed to it. As long as there is explicit consent and discussions around pros and cons have taken place, there are no reasons to decline a transvaginal scan.”
Heera, of the Cysters charity, added that she believes women are also being deterred from having the contraceptive coil for similar reasons. “I definitely feel that there needs to be some cultural and LGBT awareness training for GPs practising in community groups because they don’t look at their patients with the level of intersectionality that they need to be doing.”
In late 2020, Deenah Al-Aqsa wrote that “at least six healthcare professionals assumed that I was a virgin because of my hijab and denied me the scan” in a piece for The Femedic. Identifying as a Muslim lesbian, Al-Aqsah wrote that she had wanted to try the scan because “I was in inordinate amounts of pain already each month and a little more wouldn’t make a huge difference.”
“Our patriarchal culture glorifies virginity, and this trickles down into clinical attitudes – allowing an ancient and harmful ideal to be seen as more important than a patient’s bodily autonomy.”
VICE World News contacted the NHS trusts, who act as organisational units for different geographic areas, and Nuffield Health who were mentioned in our interviews for their responses.
A spokesperson from London North West University Healthcare NHS Trust said: “Our clinical teams give patients the option of having a transvaginal ultrasound because it is an invasive procedure that will break the hymen, which can be uncomfortable for some women. It is mainly carried out by sonographers, rather than doctors, and like many procedures does require asking the patient if they are sexually active. Our approach reflects the cultural sensitivity around virginity in some local communities in what is one of the most ethnically diverse communities in the UK.”
They added: “We balance respecting these sensitivities with making sure that our patients know what the procedure involves.”
A spokesperson for Croydon Health Services NHS Trust said: “We follow NICE [National Institute for Health and Care Excellence] guidance relating to transvaginal ultrasounds and hysteroscopy procedures. This includes taking into account the patient’s individual history and preferred method of examination.
“Clinicians will, as part of their discussions with the patient, explain any possible physical implications or side effects of an internal examination and offer a transabdominal pelvic scan as an alternative, should the patient prefer this option.”
A spokesperson at NICE told VICE World News: “Our guideline on heavy menstrual bleeding makes recommendations about what investigations to use to diagnose the cause of HMB.”
“As you’ll see, transvaginal ultrasound is recommended for women with suspected adenomyosis. There is nothing in our guidance to specify that this procedure should not be used in women who are not sexually active.”
A Nuffield Health spokesperson said: “We strictly follow national clinical guidelines and the health, wellbeing and care of our patients is our priority. We are unable to comment further on individual patient cases for confidentiality reasons, however if a patient feels that any clinical care has fallen below expectations we ask them to contact us directly so we can investigate the matter further.”