In Cambodia, where female virginity is prized, women can undergo a number of procedures in order to ‘restore’ it, including hymen repair, elective vaginal tightening and suppository pills. It’s a niche money-making industry without much regulation – in a country with limited sex education Inside a dingy beauty salon just south of Tuol Kork, Phorn* peddles facials and hair treatments. As a sideline, she also serves as a referral agent for various surgical cosmetic procedures: eyelifts, nose jobs, tummy tucks. And on occasion, Phorn refers clients to doctors who say they can stitch women’s hymens back together. The doctors come from both private and public clinics, she explained this week, and could provide consultations at her salon. The procedure – termed a hymenoplasty – takes less than an hour, but can cost up to $300. “In Cambodia, we have a strict culture about having sex before marriage,” Phorn explained. “In the conservative family, when the parents want their daughter to marry with a good man, they need to fix her.” Despite persistent misconceptions, the hymen – a fragile membrane that surrounds or partially covers the vaginal opening and can be torn during penetrative sex – is not recognised as a physical marker of female virginity by the medical community. But its “repair” is a centerpiece in the niche market for virginity restoration in Cambodia. The size and profits of the industry remain unknown because it operates with little documentation and under the pretext of privacy. “I don’t think that we can guesstimate how many clinics or how many gynaecologists do it, and how many women per year, per day,” said Dr Var Chivorn, the executive director of the Reproductive Health Association of Cambodia (RHAC). “It’s difficult, because this kind of thing, people won’t talk [about].” After a hymenoplasty is complete, Phorn collects a small commission from the clinic. But she keeps no record of her clients, nor the doctor. Social (re)construction Ros Sopheap, the executive director of Gender and Development for Cambodia (GD/C), roots the dearth of accurate information in a culture of silence. “I have heard many times that women quietly do this,” she told Post Weekend. “But I cannot count how many. There is no research about this.”

For Sopheap, speaking publicly about misconceptions – in explicit terms – has been met with ire. “People feel that this is not appropriate language,” she said. Sopheap said that Cambodian women were subject to strict cultural expectations surrounding female virginity: in Khmer, the word for virgin, prohmcheari, applies specifically to a woman, and they are expected to bleed the first time they have sex. “Women believe that men are demanding that,” she said.The value placed on female virginity is not unique to Cambodia, nor is the industry that surrounds it. Lisa Wynn, of MacQuarie University in Australia, conducted years of research in Egypt on hymenoplasty – making her one of few anthropologists to focus specifically on this kind of procedure. “The doctors I’ve interviewed say that you can’t actually repair a hymen. It’s just torn fragments of skin that don’t cohere enough to actually be stitched together,” Wynn wrote in an email. Instead, doctors performed procedures that either resulted in bleeding during sex from unhealed stitches or flesh, crafted “new” hymens or made the vagina seem tighter, she said. Both hymenoplasty and vagina-tightening vaginoplasty procedures are available in Cambodia, said Dr Ly Srey Vyna, a family doctor who has two clinics in Phnom Penh and Siem Reap. Vaginoplasty was sometimes medically required, especially after a childbirth resulting in muscle tears or scarring – something that Vyna’s clinic could cater to. But sometimes, these tightening procedures were performed unnecessarily. “I gave birth for the first time in my hometown,” said Yara*, a sex worker who underwent a vaginoplasty. “The doctor asked if I wanted the surgery, and I said yes. With clients, we just worry about doing it too many times.” Yara said she wasn’t sure if other sex workers had undergone similar procedures, including hymenoplasty. “We never talk about this with each other,” she said. Women sometimes returned to clinics seeking a vaginoplasty after multiple births, said Chan Theary, the executive director of the Reproductive and Child Health Alliance. But others wanted to undergo the procedure only to please their male partners. “They say: ‘My husband would like me smaller.’” Private practice Hymen reconstruction operates in a legal grey area.According to Dr Sok Srun, director of the Health Ministry’s Department of Hospital Services, there is no legal regulation on the procedure, meaning that private clinics can’t be licensed to perform it but can’t technically be prohibited either. Public clinics did not carry out the procedure, he said, and the private clinics that did generally didn’t advertise, helping to maintain this uneasy status quo. But one clinic, Victoria International Hospital in Tuol Kork, has not shied away from public discussion of its practice, causing controversy in the process. A year ago the hospital ran television and radio advertisements for “virgin surgery”. They prompted a letter signed by Minister of Information Khieu Kannarith requesting a halt to the advertisements – although not the procedure itself – in order to preserve “the moral and traditional beauty of Cambodian society”. The ads have since stopped, but the hospital has shifted its self-promotion to social media. One sponsored ad on Facebook, posted on January 20, links to a testimonial by “Channa in Phnom Penh”, whose “virgin surgery”, the ad claims, restored her relationship with her husband by making her desirable once again. According to a receptionist at the hospital, a hymenoplasty at Victoria takes 30 minutes, requires only a local anaesthetic and costs about $180. “The price depends on the size of your rupture,” she said, adding that the clinic also offers tightening procedures. Multiple attempts by Post Weekend to reach the owner or doctors for further comment went unreturned. RHAC’s Dr Chivorn insists that clinics offering hymenoplasty are motivated by profit. “As we all know, the hymen is not a matter of virginity,” he said. “Like the people say: money-hungry doctors.” The pill Because the science of virginity and hymen restoration is imprecise, methods aside from surgical procedures have proliferated. Imported suppository pills available on the market allow women to achieve temporary “virginity” by releasing a rush of fake blood, or by producing a tightening response that lasts for up to an hour. Chan Dyna, a team leader with the Cambodian Prostitutes Union, said that the tightening pills were very popular among sex workers, especially those with wealthier customers, and could be bought at cosmetic shops around Olympic Market. She pointed out that surgery was painful, often left a scar and was more expensive. Temporary pills could be used repeatedly, she said, and the unnatural tightness could make for a more profitable exchange. Social media has also furnished new opportunities to distribute the pills, which are not regulated by the Ministry of Health or available in pharmacies. Leakhena*, a 26-year-old in Phnom Penh with a Facebook-based cosmetics business, sells three different virginity-restoration products, ranging in price from $18 to $25. They’re all imported from China or Thailand and bear medical certification from their home countries, she said when contacted by telephone. She delivers to her customers, even those in the provinces. “There are a lot of online shops selling these things,” she said. “It’s not only me.” When contacted for comment, Ministry of Information spokesman Ouk Kimseng acknowledged that the recent proliferation of these types of products on social media is a problem. “We investigate, but we now only have the ability to ask the individual accounts to stop,” he said. Although there was no law forbidding the sale, ads that were deemed “distracting” by the ministry could be removed. What’s next? Doctors familiar with local practices all emphasised the importance of improving knowledge about sex to counter an industry based around virginity restoration. But while sex education has recently been adopted as part of the Ministry of Education’s national curriculum, only the pilot program has yet been completed. ”We still have to train the teachers,” said Education Minister Hang Chuon Naron. It’s also unclear how – and where – the government might regulate the industry. Opposition lawmaker Mu Sochua, a former Minister of Women’s Affairs, said the procedure should be banned by law, including its marketing. “Virginity must be discussed as part of sex education in school, beginning with primary school,” she said.   But the Ministry of Health’s stance remains ambiguous, and while the Ministry of Women’s Affairs is “totally against” hymenoplasty, according to the director of its health department, the government has stopped short of calling for a ban. If even those within the medical community remain tacitly tolerant of what is a small, if medically unnecessary, procedure, change seems unlikely. “We are not objecting to hymen reconstruction,” said Dr Chivorn of RHAC, “because we respect the rights of the individual. If a person wants to change their body, it’s their body.” Dr Ly Srey Vyna, the owner of two family clinics, concurred. “This should not be banned. It is just a cosmetic surgery,” she said. “If you ban this, you have to ban sexual activity before marriage.” *Names have been changed to protect identities.