Guidance

Virginity testing and hymenoplasty: multi-agency guidance

Updated 12 April 2024

Purpose of the guidance

The government has made it illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK, as part of the Health and Care Act 2022.

It is also illegal for UK nationals and residents to do these things outside the UK.

Aim and purpose

This non-statutory guidance offers advice for chief executives, directors, senior managers, frontline professionals within agencies and anyone else who may come in to contact with women and girls affected by virginity testing and hymenoplasty. It encourages agencies to cooperate and work together to protect and support those at risk of, or who have undergone, these procedures.

The main aim of this guidance is to:

• provide information and background on virginity testing and hymenoplasty including details of the law in the Health and Care Act 2022
• provide strategic guidance for people leading and working in organisations which come into contact with women and girls, or third parties exercising public protection functions on behalf of those persons or organisations
• provide advice and support to frontline professionals who have responsibilities to safeguard and support women and girls
• help identify when a girl or woman or a member of her family may be at risk of virginity testing and/or hymenoplasty and responding appropriately to safeguard them
• help identify when a girl or woman may have been subjected to a virginity test and/or hymenoplasty and responding appropriately
• help to prevent virginity testing and hymenoplasty, and to act as an aid to frontline professionals and managers to tackle harmful myths that surround virginity and sexuality

This guidance does not replace existing safeguarding guidance. It should be used in conjunction with and to complement existing guidance, including, but not limited to:

• England: Working Together to Safeguard Children (2018) and Keeping children safe in education (2021)
• Scotland: National guidance for child protection in Scotland (2021 - updated 2023)
• Wales: Working together to safeguard people: volume 5 – handling cases to protect children at risk (2018) and Volume 6 – handling cases to protect adults at risk (2018)
• Northern Ireland: Cooperating to safeguard children (2017)

This guidance covers the whole of the UK, but some related areas (for example, health, violence against women and girls, safeguarding etc) are devolved. Where specifics differ between nations this is clearly highlighted.

As well as women and girls, this legislation includes and protects any other person who has female genitalia (meaning vagina or vulva) and is at risk of harm from these practices and procedures, including intersex, non-binary, trans men and women, with or without a gender recognition certificate.

As part of the government response to the expert panel on hymenoplasty recommendation report, we committed to review the legislation and guidance after a set period (to be determined), to ensure it is effectively protecting young women and girls.

Audience

This multi-agency guidance should be read and followed by all persons and organisations across the UK who have a duty and due regard to the safeguarding of children and adults in their care.

Such persons and organisations include:

• local authorities, including district councils
• National Health Service (NHS) bodies and independent health and care service providers
• NHS England, NHS Wales, territorial and national boards in Scotland and Health and Social Care (HSC) bodies in Northern Ireland
• integrated care boards (ICBs)
• pharmacists
• NHS trusts, including NHS ambulance trusts, NHS mental health trusts and NHS foundation trusts
• social care services and social workers
• doctors, GPs, nurses, registered nursing associates, midwives, health visitors and other medical professionals
• police
• Ofsted
• teachers and school nurses
• governing bodies of maintained schools, colleges and universities, including faith schools
• proprietors of independent schools (including academies, free schools and alternative provision academies) and non-maintained special schools, including faith schools and academies
• management committees of pupil referral units (PRUs)
• charities and support organisations
• religious and faith organisations and faith-based groups
• community groups

This list is not exhaustive.

Professionals working in these organisations and/or who have these roles are responsible for ensuring that they fulfil their role and responsibilities in a manner consistent with the statutory duties or requirements of their employer.

The information in this guidance may also be relevant to organisations working with women and girls at risk of all forms of so called ‘honour-based’ abuse.

Definitions

Adult

An adult is an individual who is aged 18 years or older.

Child

For the purposes of this guidance, a child is an individual who is under the age of 18.

Coercive control

Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape, and regulating their everyday behaviour.

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

As set out in the controlling or coercive behaviour: statutory guidance framework, controlling or coercive behaviour in intimate or familial relationships is an offence.

So called ‘honour-based’ abuse

So called ‘honour-based’ abuse includes incidents or crimes involving violence, threats of violence, intimidation coercion or abuse (including psychological, physical, sexual, financial or emotional abuse) which have or may have been committed to protect or defend the honour of an individual, family and/or community for alleged or perceived breaches of the family and/or community’s code of behaviour.

Domestic abuse

Domestic violence is an offence which is defined in the Domestic Abuse Act 2021 and applies in England and to reserved matters in Wales. In the act, domestic violence is defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. Victims are not confined to one gender or ethnic group. Domestic violence can encompass, but is not limited to, the following types of abuse:  

• psychological
• physical
• sexual
• financial
• emotional

In Scotland domestic abuse is defined in the Domestic Abuse (Scotland) Act 2018. In Northern Ireland it is defined in the Domestic Abuse and Civil Proceedings Act (Northern Ireland) 2021.

Understanding virginity testing and hymenoplasty

Virginity

Virgin is a term used to denote that an individual has not had sexual intercourse. Whether an individual is a ‘virgin’ can often depend on what is defined as ‘sexual intercourse’, which is subjective and may vary between person to person. Sexual intercourse may include, for example, vaginal, anal or oral sex. In many cultures, however, the most common interpretation of the term ‘virgin’ is someone who has not had penetrative vaginal intercourse.

Virginity is a concept that, in some cultures, denotes purity of a woman or girl. In some communities it is considered important for a woman to be a virgin before she is married. The concept of virginity can perpetuate harmful attitudes around a women’s sexuality. In some cases, the requirement for a girl to refrain from sexual intercourse before marriage can lead to pressure to undergo virginity testing and hymenoplasty.

Virginity testing

Virginity testing, also referred to as hymen, ‘2-finger’ or vaginal examination, is an inspection of the female genitalia, intended to determine whether a woman or girl has had vaginal sexual intercourse.

For the purposes of the Health and Care Act 2022, virginity testing is any examination (with or without contact) of the female genitalia intended to establish if vaginal intercourse has taken place. This is irrespective of whether consent has been given.

The position of the World Health Organization and the Royal College of Obstetricians and Gynaecologists (RCOG) is that virginity tests have no scientific merit or clinical indication as there is no known examination that can prove whether a woman has had vaginal intercourse.

The hymen

The hymen is a thin membrane that partially covers the entrance to the vagina. During puberty, oestrogen causes the hymen to change in appearance and become very elastic. Normal variations of the post-pubertal hymen range from thin and stretchy to thick and somewhat rigid. A non-intact, or stretched, hymen is not a reliable indication of past sexual activity, nor is it guaranteed that the hymen will break or bleed after first vaginal intercourse. The hymen has relatively few blood vessels, that are unlikely to cause significant bleeding.

The World Health Organization interagency statement on eliminating virginity testing is clear that the appearance of a hymen is not a reliable indication of a woman not having had vaginal intercourse.

Hymenoplasty

Hymenoplasty is a procedure undertaken to reconstruct a hymen. There are a number of different techniques to achieve but it generally involves stitching hymenal remnants together at the vaginal opening, or surgically reconstructing a hymen using vaginal tissue. The aim of the procedure is to ensure that a woman bleeds the next time she has intercourse to give the impression that she has no history of vaginal intercourse. There is no guarantee that this will fully reform the hymen or cause bleeding when penetration is attempted.

Hymenoplasty is not the same as other procedures that could be performed on the hymen for clinical reasons (for example, surgery to treat an imperforate hymen to allow menstrual blood to escape).

Violence against women and girls

Virginity testing and hymenoplasty are forms of violence against women and girls and are part of the cycle of so called ‘honour-based’ abuse. Women and girls are coerced, forced and shamed into undergoing these procedures, often pressurised by family members or their intended husbands’ family in the name of supposedly upholding honour and to fulfil the requirement that a woman remains ‘pure’ before marriage. Some practitioners issue a certificate to prove ‘virginity’ after a virginity test or hymenoplasty, while some will simply tell the family or community members whether a woman or girl has ‘passed’ a virginity test.

Both virginity testing and hymenoplasty can be precursors to child or forced marriage and other forms of family and/or community coercive behaviours, including physical and emotional control. Women who ‘fail’ a virginity test, are found to have undergone a hymen reconstruction, or do not bleed on their wedding night are likely to experience further so called ‘honour-based’ abuse including emotional and physical abuse, family or community disownment and even honour killings.

The practices are degrading and intrusive. They can lead to extreme psychological trauma in the victim, and can provoke conditions including anxiety, depression and post-traumatic stress disorder. The practices have been linked to suicide. They can be physically harmful. For example, virginity testing can result in damage to the hymen, tears and damage to the vaginal wall, bleeding, and infection. The risk of infection is also high in hymenoplasty, which has the added risks of acute bleeding during the procedure, scarring and narrowing of the opening of the vagina and sexual difficulties.

Virginity testing and hymenoplasty are considered to have a similar level of seriousness to assault occasioning actual bodily harm (assault to injury in Scotland). This is in recognition of the physical and psychological harm they can cause to the individual who is subjected to them. This level of seriousness also reflects the controlling attitudes that underpin the practices.

As with other forms of so called ‘honour-based’ abuse, these practices often take place behind closed doors, in highly conservative communities and cultures. Because of this, the numbers of women and girls that are subjected to these practices are not known. Although prevalence is unclear, there is evidence of women and girls being under intense pressure to undergo virginity testing and hymenoplasty.

Victims may also take years to come forward. This could be due to not knowing that the abuse was abnormal or wrong at the time, feeling shame about their sexual experiences or sexual abuse, having been taught that speaking out against family and/or the community is wrong, or being scared about the repercussions of speaking out. As such, the physical signs of abuse may not be present at the time of disclosure, but psychological damage is likely to remain. This should be taken into account when interacting with victims of these practices.

As with all forms of so called ‘honour-based’ abuse, there are many barriers to victims disclosing information and reporting what has happened to them. It is therefore important that, if information regarding either settings or individuals involved in these practices is obtained, this intelligence is shared either with police, or anonymously through Crimestoppers.

Strategies to tackle the prevalence of violence against women and girls, reduce the inequalities in healthcare and tackle the harmful misogynistic views and attitudes towards women and their sexuality are being taken forward across England, Northern Ireland, Scotland and Wales. The banning of these procedures is one part of this important work.

The law

It is illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK. These offences carry extra territorial jurisdiction and carry a maximum sentence of 5 years imprisonment and/or an unlimited fine.

The Health and Care Act 2022

The legislation makes it an offence to carry out, offer or aid and abet virginity testing and hymenoplasty in the United Kingdom. There are separate offences for each UK jurisdiction.

The law defines ‘virginity testing’ as “the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.”

The law defines ‘hymenoplasty’ as “the reconstruction of the hymen (with or without consent).”

Carrying out

It is illegal to carry out virginity testing (with or without physical contact) and/or hymenoplasty in any setting, including medical, community and home environments.

In relation to virginity testing, the purpose, or purported purpose, of the examination must be to determine the virginity of the woman or girl being examined. Because it is not in fact possible to establish from a physical examination whether a woman has had sexual intercourse, this means that the person carrying out the examination must either believe that it is possible to determine virginity from an examination, or they must be pretending to have virginity determination as their purpose. Having this purpose, or purported purpose, for carrying out the examination is the mental element (‘mens rea’) of the criminal offence of carrying out virginity testing.

An examination of a woman’s or girl’s genitalia for the purpose of a medical or forensic examination would not be carried out for the purpose of determining virginity and would not therefore be an offence. This would be the case even where a forensic examination was looking for signs of penetrative trauma, or where a healthcare professional is asked by a teenage girl whether her genital appearance is ‘normal’.

It does not matter if the examination is carried out by someone other than the person who makes the determination. The person doing the examining would be guilty of the offence of carrying out virginity testing, and the person making the determination could be guilty as a secondary participant or as an aider and abetter (see below). It also does not matter if the examination is carried out remotely.

Offering services

The offence of offering virginity testing and/or hymenoplasty has been included as a separate offence, so that people who are offering the service can be prevented from going ahead with the procedures and potential victims can be protected. This would include someone who advertises that they can carry out the procedures. It would not include a person who simply publishes an advert on behalf of another person, such as an internet platform provider. The offence occurs in the place where the offer is made.

Aiding and abetting

It is an offence to aid, abet, counsel, or procure (or incite in Scotland) the carrying out of virginity testing and/or hymenoplasty. This offence (referred to as ‘aiding and abetting’ in this guidance) is aimed at preventing people such as family members from arranging for women or girls to undergo the procedure, or by assisting with it, for example by making the arrangements for the procedures, or by accompanying the woman or girl to the setting where the procedure takes place.

The law already provides for a person to be liable for a criminal offence as a secondary participant, for example by encouraging or assisting a crime. However, the Health and Care Act 2022 includes this specific offence of aiding and abetting mainly to capture scenarios that the existing law would not. These include the making of arrangements (whether from the UK or outside it) for women and girls to have these procedures carried out overseas by people who are not UK nationals. There is some overlap with the existing law of secondary participation, but the new offence makes it clear that the existing law still applies.

Consent

Virginity testing and hymenoplasty are illegal and therefore women and girls are not able to consent to the procedures. Women and girls may request the procedures, but due to the harm they cause and them being precursors to other forms of so called ‘honour-based’ abuse, the procedures have been banned. As such, there are no circumstances under which a woman or girl should be subjected to a virginity test or hymenoplasty.

Extra-territorial jurisdiction

There is a risk that women and girls may be taken abroad and subjected to virginity testing and hymenoplasty (as is often seen with so called ‘honour-based’ abuse offences, such as female genital mutilation or forced marriage). The offences, therefore, carry extra-territorial jurisdiction.

This means that UK nationals and residents who carry out a virginity test or hymenoplasty outside the UK also commit an offence in the UK. Virginity testing and hymenoplasty do not need to be an offence in the country where it takes place (in other words, there is no requirement for dual criminality). UK nationals would commit the offence in each of the jurisdictions of the UK. A person who is not a UK national, but who is a habitual resident of the UK, would commit the offence in the part of the UK where they live. The individual who is subjected to a virginity test or hymenoplasty does not need to be a UK national or habitual resident.

It is an offence for any person in the UK to offer to carry out virginity testing or hymenoplasty in the UK. It is also an offence for any person to make an offer in the UK to carry out those procedures (anywhere) on a UK national or resident. Extra-territoriality means that it is also an offence in the UK for a UK national or habitual resident who is outside the UK to make an offer to carry out virginity testing or hymenoplasty anywhere. The nationality or residence status of the woman or girl who would undergo the procedure is irrelevant.

The Health and Care Act 2022 makes it an offence for anyone in the UK to aid and abet virginity testing or hymenoplasty that is carried out on a woman or girl who is in the UK.

It is also an offence for a UK national or resident to aid and abet virginity testing or hymenoplasty that is carried out on a woman or girl who is outside the UK but who is a UK national or resident. It does not matter where the aiding or abetting occurs; arrangements could be made from within the UK or overseas, for example. The nationality status of the person carrying out the test is also irrelevant.

It is also an offence for a UK national or resident who is outside the UK to aid and abet virginity testing or hymenoplasty that is carried out on a woman or girl who is in the UK. This could include a person who arranges for remote virginity testing to be carried out, or who makes arrangements from overseas for a hymenoplasty to be carried out in the UK, for example.

When we refer to a habitual resident, they can have their usual place of residence in England and Wales, Scotland, or Northern Ireland.

Annex A contains 3 tables which set out when offences are committed, including for extra-territorial jurisdiction.

Penalties

The offence may be tried either summarily or on indictment. In England and Wales and Northern Ireland, this means that it may be tried either in the Magistrates’ Courts or the Crown Court. In Scotland, this means that it may be tried in both the summary and solemn courts.

The offences will each carry a maximum penalty of a 5-year custodial sentence and/or an unlimited fine.

Who is protected by this legislation

Women and girls and any other person who has female genitalia (meaning vagina or vulva) and is at risk of harm from these practices and procedures – intersex, non-binary, trans men and women with or without a gender recognition certificate – are included and protected by this legislation.

The offences, in particular the offence of aiding and abetting, do not apply to victims of virginity testing or hymenoplasty. The offences are aimed at protecting this group of people and they cannot therefore be liable.

Other safeguarding guidance

This document does not attempt to duplicate the content found in other guidance and should be considered alongside other relevant guidance on safeguarding children and vulnerable adults. Specific organisations and individuals (for example, local authorities or healthcare professionals) may have different safeguarding responsibilities and should be familiar with the relevant guidance outlining these obligations. The following list of guidance is not extensive.

The Children Act 1989

The Children Act 1989 allocates duties to local authorities, courts, parents, and other agencies in the UK to ensure children are safeguarded and their welfare is promoted. Local authorities have a duty to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm under section 47 of the Act. The Children Act 1989 introduced the concept of ‘significant harm’ as the threshold that justifies compulsory intervention in family life in the best interests of children and young people. Harm is defined in section 31(9) while section 31(10) provides limited guidance as to what will be considered significant harm.

Keeping children safe in education

Keeping children safe in education (2021) is statutory safeguarding guidance that all schools and colleges in England must have regard to as part of their legal duty to safeguard and promote the welfare of children. This guidance is clear that governing bodies and proprietors must ensure that policies, procedures, and training in their schools are effective and comply with the law at all times. The guidance helps schools and colleges understand what they need to do to respond quickly and effectively when an incident occurs, or they have concerns about a child.

Children (Northern Ireland) Order 1995

The Children (Northern Ireland) Order 1995 is the legislative framework for Northern Ireland’s child protection system. It affects all those who work and care for children, whether parents, paid carers or volunteers. Co-operating to Safeguard Children and Young People in Northern Ireland guidance provides the overarching policy framework for safeguarding children and young people in the statutory, private, independent, community, voluntary and faith sectors.

Working together to safeguard children

Working together to safeguard children (2018) in England and Working together to safeguard people: volume 5 handling individual cases to protect children at risk (2018) in Wales set out the requirements and expectations on individual services and professionals to provide a multi-agency response to safeguard and promote the welfare of children.

These pieces of guidance make clear that in all welfare and safeguarding enquiries, a child-centred approach should be adopted by practitioners to ensure that the best interests of the child are considered at all times.

The Care Act 2014

The Care Act 2014 places a series of duties and responsibilities on local authorities about care and support for adults in England. Section 42 of the act requires local authorities to make enquires, or ask others to make enquiries, when they think an adult with care and support needs may be at risk of abuse or neglect in their area and to find out what, if any, action may be needed.

Adult Support and Protection (Scotland) Act 2007

The Adult Support and Protection (Scotland) Act 2007 is designed to protect adults who are unable to safeguard their own interests and are at risk of harm. Section 4 places a duty on councils to make inquiries about an adult’s well-being, property, or financial affairs in certain circumstances. These circumstances are where the person falls within the definition of an adult at risk, and the council knows or believes it may have to intervene in order to protect the adult’s well-being, property, or financial affairs.

Section 3 defines:

adults at risk as adults (aged 16 or over) who are unable to safeguard their own wellbeing, property, rights or other interests, are at risk of harm, and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.

As such, this act may capture all women who may be vulnerable in respect of virginity testing and hymenoplasty.

Tackling virginity testing and hymenoplasty

Virginity testing and hymenoplasty are illegal. They should be addressed using existing structures, policies and procedures designed to safeguard children and vulnerable adults.

All organisations to which this guidance applies should work together and with other relevant organisations to address the risk of virginity testing and hymenoplasty, while bearing in mind the importance of confidentiality in protecting women and girls from harm.

Identifying those at risk

There is evidence that women and girls from the age of 13 to 30 are most at risk of undergoing a virginity test and/or hymenoplasty, but girls as young as 8 can be affected. Any woman or girl, of any age, ethnicity, race, sexual orientation, religion, disability or socioeconomic status could be subjected to a virginity test or hymenoplasty. Women and girls may take years to discuss their experiences due to the shame associated with these practices, the level of trauma that could be experienced and the fear of further so called ‘honour-based’ abuse.

Professionals may encounter at-risk women and girls in a face-to-face situation, virtually or over the phone, or via a third party such as a concerned friend or a referral from another organisation. These are forms of so called ‘honour-based’ abuse and as such physical signs of the woman or girl having undergone the procedure may be absent. However, the stress, anxiety and other psychological or behavioural signs may be present.

There are several indicators that a woman or girl is at risk of or has been subjected to a virginity test and/or hymenoplasty:

• the woman or girl requests either procedure or asks for help
• family members ask for the procedures or disclose that the woman or girl has already undergone the practices
• there could be pain and discomfort after the procedures, which, for example, could result in the woman or girl having difficulty in walking or sitting for a long period of time which was not a problem previously
• concern from family members that a woman or girl has a boyfriend, or plans for the woman or girl to be married
• a close female relative has been threatened with either procedure or has already been subjected to one
• the woman or girl has already experienced or is at risk of other forms of so called ‘honour-based’ abuse
• the woman or girl is already known to social services in relation to other safeguarding issues
• the woman or girl may disclose other concerns that could be an indication of abuse. For example, they may state that they do not feel safe at home, that family members will not let them out the house and/or that family members are controlling
• the woman or girl may have suffered trauma from being coerced and having to undergo the procedures. This could result in an increase in emotional and psychological needs, for example withdrawal, anxiety or depression, or significant change in behaviour. The trauma could also have long-term implications for the woman or girl and may not manifest for many years after the event
• the woman or girl may appear fearful of their family or a particular family member
• unexplained absence from school, potentially to go abroad
• changes in behaviour – becoming withdrawn, anxious, or depressed; a deterioration in schoolwork, attendance, or attainment

This is not an exhaustive list of indicators. If any of these indicators are identified professionals should follow their organisation’s safeguarding policies.

Safeguarding

Virginity testing and hymenoplasty are forms of so called ‘honour-based’ abuse and violence against women and girls. Like forced marriage and female genital mutilation (FGM), the victims of these abuses are at risk of being subjected to further harm, whether that be psychological or physical. Women and girls may themselves present to agencies requesting the procedures in an attempt to protect themselves from further harm and abuse, including shaming, disownment, physical abuse and possible honour-killings. Family and/or community members who are unaware of the change in law may also try to contact agencies seeking the procedures for their daughters and female relatives.

Organisations that work with adults and children should have safeguarding procedures in place, and some individuals such as healthcare professionals will have professional codes of conduct to comply with. These procedures and/or duties should be followed immediately where there are signs that women’s and girls’ safety and welfare is being or may be threatened – they are at risk and assessments of that risk should be made.

It is important to find out if the woman or girl is in immediate danger. In an emergency, the police should be contacted without delay. If it is not an emergency but there is a concern that the individual is at risk, the organisation’s safeguarding procedures and any professional duties should be followed. This may involve a referral to social care services and/or the police should be made.

Anyone who has concerns about a child’s welfare should make a referral to local authority children’s social care and should do so immediately if there is a concern that the child is suffering significant harm or is likely to do so. Safeguarding referrals may be needed for vulnerable adults (including other family members) who could also be at risk of harm. Some women and girls may be reluctant to speak with the police, and a referral to organisations listed in Annex B may be able to provide more tailored support.

Organisations should not involve families and community members in cases involving virginity testing and hymenoplasty, including trying to mediate with family or using a community member as an interpreter. Engaging with families and community members may increase risk of harm to the victim. The victim may be punished for seeking help and arrangements for procedures may be expedited. The risk of the woman or girl having undergone trauma and suffering psychological damage because of these practices is high and mental health services and support should be contacted. Annex B contains existing guidance and resources that professionals can use and/or refer individuals to for further support.

Ultimately, virginity testing and hymenoplasty are crimes and pose serious safeguarding concerns. As such it is important to involve the police as they have the powers, tactics and reach to protect the identified victim and other potentially vulnerable people within the family or broader community.

Talking about virginity testing and hymenoplasty

Good communication is essential when talking to individuals who have undergone or are at risk of virginity testing and/or hymenoplasty, or when talking to friends or family members who might be requesting these procedures for others.

The topic may arise in a variety of settings, including a GP’s surgery or sexual health clinic as part of a medical consultation, or at school. It could take place face to face, virtually or over the phone. Some broad principles on how to approach these conversations are outlined below.

Respond with sensitivity

Acknowledge the disclosure, bearing in mind this is a sensitive topic. Women and girls may feel uncomfortable talking about their sexual experiences or sexual assault fearful of judgement and may be fearful of speaking out against their family and/or community and of an escalation in so called ‘honour-based’ abuse.

Explain to the individual:

• the limits of confidentiality
• what information may have to be shared, with whom and for what purpose.

Immediate safety

If speaking with a woman or girl who has undergone or is at risk of virginity testing or hymenoplasty, ensure she is in a safe place, away from the perpetrator. If speaking over the phone, closed questions should be asked, which would allow them to give ‘yes’ or ‘no’ answers. Code words could also be used to indicate that the victim is on their own and/or able to talk.

The organisation’s safeguarding procedures should be followed. Seek advice from your safeguarding lead or local authority safeguarding professionals if you suspect that a woman or girl is at risk of harm and ensure that appropriate action is taken. In an emergency, contact the police without delay.

Gathering information

It is important to sensitively gather as much information as possible to understand the situation – exactly what procedures have taken place or are being requested, and whether the woman or girl is at risk of other forms of abuse, coercion, and control.

Once it has been ascertained that the woman or girl can speak safely, ask open, non-leading questions. It is important to establish if the woman or girl is in immediate danger. Keep a record of what they said.

Next steps

It is important that the person being spoken with is given advice on the law. It may be helpful to discuss myths and misconceptions around virginity – for example, the myth that virginity can be accurately assessed by a virginity test, or the damaging belief that virginity dictates the worth of women. If the individual is in immediate danger, advise them to contact the police, and if need be, contact the police yourself. Follow the safeguarding procedures of your organisation. Signpost them to the most appropriate support (refer to Annex B for support) and if agreed, make a referral on their behalf. Always follow up on promises to contact the victim.

An accredited interpreter may be required, who should ideally have knowledge of so called ‘honour-based’ abuse. An interpreter should not know the individual and not be someone with influence in the individual’s community. If possible, the woman or girl should be given a choice of the gender of the interpreter, as they may feel more comfortable with a female translator.

Talking about any form of abuse can be difficult and upsetting. Professionals may wish to speak with their supervisor if they are affected by what they have heard.

Multi-agency and victim-centred approach

An effective local response to virginity testing and hymenoplasty should be underpinned by the following principles.

Safeguarding is everyone’s responsibility

Each professional and organisation should play their part. No professional should assume that someone else will pass on information which they think may be critical to keeping a child or vulnerable adult safe.

If a professional has concerns about an individual’s welfare and believes they are suffering or likely to suffer harm, then they should follow their organisation’s safeguarding procedures and professional codes of conduct, and share with the relevant agency, local authority children’s or adult’s social care as necessary – ensuring they meet their wider responsibilities in relation to the handling and sharing of information.

Information should not be shared with family or community members as this may put women and girls at more risk.

Victim-centred approach

A victim-centred approach should be taken that is based on a clear understanding of the needs and views of girls and women at risk of virginity testing, hymenoplasty and other forms of so called ‘honour-based’ abuse.

Scenarios

There are many scenarios in which a woman or girl can be at risk from or can have undergone virginity testing or hymenoplasty. Some example scenarios are included below:

• a woman experiences sexual assault and is concerned that she will fail the virginity tests her family regularly forces her to have. Her family believes that rape is the woman’s fault, so she is scared of them finding out. The woman attends an appointment at a sexual health clinic and requests a hymenoplasty.
• a woman experiences so called ‘honour-based’ abuse and domestic abuse at the hands of her family. The trigger for the violence is that she has a boyfriend and is pregnant. Her family physically assaults her and tries to force her to have an abortion and a procedure to ‘reclaim her virginity’ at a private clinic in the UK. She contacts the police for help.
• a girl travels with her family to a different city and undergoes an examination to check that she is still a virgin. She is afraid that she is going to be sent abroad for a forced marriage and runs away from home. The girl’s friend is concerned and tells a teacher at school. The girl has a younger sister.
• a woman who is due to be married knows that she will have to undergo a virginity test and present a certificate confirming her virginity to her fiancée’s family. As such, she organises a trip abroad and secretly has a hymenoplasty to ensure she passes the virginity test upon her return. She discloses this to a charity supporting women affected by so called ‘honour-based’ abuse years afterwards.
• a girl is made to undergo a virginity test, which she is deemed to have failed. Her father says that she must want to sleep with everyone and invites her male family members to rape her. She is thrown out of the family home and told not to return, or they will kill her. The girl calls a charity helpline to get help.
• a family are concerned about their daughter’s interactions with boys from school. They reach out to a private clinic to try to arrange a virginity test.

Training and education

As with any other form of abuse, training should be appropriate and complement existing safeguarding training and duties. Training on virginity testing and hymenoplasty could include:

• an overview of virginity testing and hymenoplasty, including definitions of and education on the hymen and virginity
• the risks and harms associated with virginity testing and hymenoplasty, including long-term health consequences
• details of the UK law on virginity testing and hymenoplasty
• what to do when someone makes a disclosure and/or is at risk of or has undergone a virginity test or hymenoplasty
• the importance of multi-agency working and sharing information confidentially – never with family or community members
• tools to support sensitive conversations and disclosures

Any training should align with current safeguarding frameworks and guidance, such as the Welsh National Training Framework on violence against women, domestic abuse, and sexual violence.

Working with community organisations and those with personal experience

Community organisations play a vital role in protecting and supporting women and girls at risk of virginity testing and hymenoplasty. This may include:

• supporting woman and girls who have been directly affected. This could include referring to specialist physical or psychological care, offering practical support, or signposting to other advice
• supporting relatives and individuals from communities affected
• disseminating information in schools and community hubs to educate about the harms of these practices and dispel myths
• supporting and supplementing professional training programmes

When developing services and projects, organisations should consider working with appropriate community groups and those with personal experiences to help make sure that they meet the needs of service users and that their staff understand the issues related to virginity testing and hymenoplasty. However, organisations and professionals should also be confident in their own training and expertise to take action to protect women and girls and to uphold the law. Organisations should check that any community groups they work with have robust child protection and general safeguarding policies that cover the sharing of information with statutory agencies.

It is also important to note that some community groups or members may still be in favour of virginity testing and hymenoplasty. Organisations and professionals should never offer to mediate between a victim and family or community members or to disclose information about a specific case. Confidentiality is key to protecting women and girls who are at risk.

Hymenoplasty in the NHS

Hymenoplasty is illegal. There are no justified medical or clinical reasons why a hymenoplasty should take place and under no circumstance should it be performed. Healthcare professionals have been advised that the OPCS-4.9 classification code P15.3 ‘Repair of the hymen’ should not be used and will be removed from the classification listing in OPCS-4.10 on 1 April 2023.

Hymenoplasty is not the same as other procedures that could be performed on the hymen for clinical reasons (for example, surgery to treat an imperforate hymen to allow menstrual blood to escape).

Strategic guidance

Roles and responsibilities

Heads of relevant organisations should ensure that:

• their organisation has a lead person whose role includes responsibility virginity testing and hymenoplasty. This will likely be the safeguarding lead or those responsible for FGM and so called ‘honour-based’ abuse
• there is a member of the organisation who has undertaken additional training and can be approached to discuss and direct difficult cases (this may be the ‘lead person’ mentioned above)
• their staff understand their role in protecting those who have undergone or are at risk of abuse
• their staff know to whom they should refer cases within their organisation and when to refer cases to other agencies
• their staff understand the importance of timely information sharing both internally and with other agencies
• there are policies and procedures in place to protect those who have undergone or are at risk of virginity testing and hymenoplasty

Annex A: extra-territorial jurisdiction tables

Carrying out a virginity test and/or hymenoplasty

	Victim undergoes virginity testing or hymenoplasty in the UK	Victim undergoes virginity testing or hymenoplasty outside the UK
Perpetrator is a UK national or habitual resident	Offence under the Health and Care Act 2022	Offence under the Health and Care Act 2022
Perpetrator is not a UK national or habitual resident	Offence under the Health and Care Act 2022	Not an offence under the Health and Care Act 2022

Offering to carry out virginity test and/or hymenoplasty

	Makes an offer in the UK to carry out virginity testing/hymenoplasty in the UK	Makes an offer in the UK to carry out virginity testing or hymenoplasty outside the UK	Makes an offer outside the UK to carry out virginity testing or hymenoplasty outside the UK
Perpetrator is a UK national or habitual resident	Offence under the Health and Care Act 2022	Offence under the Health and Care Act 2022	Offence under the Health and Care Act 2022
Perpetrator is not a UK national or resident	Offence under the Health and Care Act 2022	Offence under the Health and Care Act 2022, if the person who would be undergoing the test or procedure is a UK national or resident	Not an offence under the Health and Care Act 2022

Aiding and abetting virginity testing and/or hymenoplasty

Person A is doing the aiding or abetting.

Person B is carrying out the virginity testing or hymenoplasty and is being aided or abetted by Person A (this table does not address B’s offences).

Person C is the woman or girl who is being subjected to virginity testing or hymenoplasty.

	Person B carries out the virginity testing or hymenoplasty in the UK	Person B carries out the virginity testing or hymenoplasty outside the UK
Person A aids/abets person B in the UK	Person A commits an offence	Person A commits an offence, but only if person C is either a UK resident or national or present in the UK (for example, remote virginity testing)
Person A is a UK resident or national and aids/abets person B from outside the UK	Person A commits an offence	Person A commits an offence, but only if person C is either a UK resident or national or present in the UK (for example, remote virginity testing)
Person A is a non-UK national or resident and aids/abets person B from outside the UK	No offence under the Health and Care Act 2022	No offence under the Health and Care Act 2022

Annex B: further support

UK wide

Police

If someone is in immediate danger contact the police by calling 999 and asking for the police.

Call 101 for non-emergencies.

Forced Marriage Unit

The Forced Marriage Unit (FMU) is a joint Foreign, Commonwealth and Development Office (FCDO) and Home Office unit which leads on the government’s forced marriage policy, outreach and casework. It operates both inside the UK (where support is provided to any individual) and overseas (where consular assistance is provided to British nationals, including dual nationals).

The FMU operates a public helpline to provide advice and support to:

• victims and potential victims of forced marriage
• professionals dealing with cases

The FMU public helpline can help with:

• safety advice
• providing assistance when an unwanted spouse is due to move to the UK (‘reluctant sponsor’ cases)
• where possible, assistance in repatriation of victims held against their will overseas

Call: 020 7008 0151

Email: fmu@fcdo.gov.uk

Karma Nirvana

In 1993, Karma Nirvana became the first specialist charity for victims and survivors of honour-based abuse in the UK.

Since then, they have led the campaign against honour-based abuse – supporting, empowering and educating those impacted, so they can live a life free of abuse.

They run the national Honour Based Abuse Helpline, train frontline practitioners and professionals, and campaign for change, working with Parliamentarians and policymakers.

Helpline: 0800 599 9247

Middle Eastern Women and Society Organisation

MEWSo is a women’s charity run by and for women from ethnic minority communities. The majority of the communities they serve are from Middle Eastern, North African and Asian backgrounds.

The aim of this charity is to defend and protect women from violence both at home and in the wider community, help them rebuild their lives through tailored advice, guidance and support, and campaign for their equality and human rights.

Call: 07958 145 666

Email: office@mewso.org

IKWRO

IKWRO supports women and girls from the Middle East, North Africa and Afghanistan living in the UK, who are at risk of or are experiencing honour-based violence, forced marriage, child marriage, female genital mutilation and domestic abuse. IKWRO provides culturally specific support, advocacy, training and counselling to women and girls. They offer a free counselling service in Farsi, Kurdish, Arabic and English. They run a specialist refuge for Middle Eastern, North African and Afghan single women at risk of honour-based violence, forced marriage, FGM and domestic abuse.

Call: 020 7920 6460

Email: info@ikwro.org.uk

Freedom Charity

Freedom Charity aims to help, rescue and support those who are victims and potential victims of dishonour abuse, forced marriage, female genital mutilation, virginity testing and hymenoplasty, and to raise awareness of all these issues through education in schools and colleges and through training of front-line professionals who may encounter victims and potential victims in their daily work.

Helpline: 0845 607 0133.

Text the words 4freedom to 88802.

SafeLives

SafeLives is a UK-wide charity dedicated to ending domestic abuse, for everyone and for good. SafeLives provides research, training and support to frontline domestic abuse services and professionals. They are not a domestic abuse service providing direct support to people experiencing abuse.

England and Wales

Victim Support

Victim Support is the independent charity dedicated to supporting victims of crime and traumatic incidents in England and Wales.

Victim Support national 24-hour support line: 0808 1689 111.

England

NHS England Safeguarding

NHS England is dedicated in ensuring that the principles and duties of safeguarding children, young people, and adults at risk are holistically, consistently and conscientiously applied with the wellbeing of all, at the heart of what they do. They are dedicated to ensuring that the principles and duties of safeguarding children and adults are applied every time a citizen accesses the NHS making every contact count.

NHS England Safeguarding

Email: england.safeguarding@nhs.net 

Nursing Directorate
NHS England
5th Floor (5W33), Quarry House
Quarry Hill, Leeds
LS2 7UE

Wales

Welsh Women’s Aid

Welsh Women’s Aid is an organisation supporting Welsh women affected by domestic abuse. Welsh Women’s Aid runs the Live Fear Free helpline below.

Live Fear Free helpline

Live Fear Free helpline is a free, 24/7 service for all victims and survivors of domestic abuse and sexual violence and those close to them, including family, friends and colleagues and concerned others.

Call: 0808 80 10 800

Text: 0786 007 7333

Email: info@livefearfreehelpline.wales

Live chat: gov.wales/livefearfree

Bawso

Bawso is the lead organisation in Wales providing practical and emotional support to black minority ethnic and migrant victims of domestic abuse, sexual violence, human trafficking, FGM and forced marriage. They believe in a future when all people in Wales are free from abuse, violence and exploitation. To achieve this vision, they have been working tirelessly to end all forms of violence against women. They have supported more than a quarter of a million people.

Call the helpline: 0800 731817

Email: helpline@bawso.org.uk

Meic 

MEIC is a free, confidential, anonymous and bilingual helpline service for children and young people up to the age of 25 in Wales providing information, useful advice and support.

Meic are open 8am to midnight, 7 days a week, by telephone, SMS text and instant messaging.

Freephone: 0808 80 23456

Text: 84001

Live chat: www.meiccymru.org

Sexual violence support services

In North Wales (Anglesey, Conwy, Gwynedd, Flintshire, Denbighshire and Wrexham), there are 2 main sexual violence support services:

• Rape and Sexual Abuse Support Centre (RASASC) provides information, specialist support and therapy to anyone who has experienced any kind of sexual abuse and violence. They can be contacted on 01248 670 628 or info@rasacymru.org.uk

• Stepping Stones provides therapeutic services to adults who have been sexually abused as children. They can be contacted on 01978 352 717 or info@steppingstonesnorthwales.co.uk

In Mid, West, East and South Wales, the main sexual violence support service provider is New Pathways. They can be contacted on 01685 379 310 or enquiries@newpathways.org.uk.

Scotland

Shakti Women’s Aid

Shakti Women’s Aid helps Black and minority ethnic women, children, and young people experiencing, or who have experienced, domestic abuse from a partner, ex-partner and/or other members of the household.

Edinburgh: 0131 475 2399

Fife: 01383 732 289

Dundee: 01382 207 095

Forth Valley: 07757 035 794

Amina – The Muslim Women’s Resource Centre

Amina offers a range of tailored support services to enable Muslim women to fully participate in society without fear of discrimination or inequality. This includes a range of one-to-one support (for example, a national ‘listening ear’ helpline which also offers Islamic advice through a scholar, employability guidance and befriending) as well as peer group support (for example, violence against women ‘self-healing’ workshops and refugee work to support the integration of people new to Scotland).

Helpline: 0808 801 0301

Amina web chat: Monday to Friday, 10am to 4pm.

Scottish Women’s Rights Centre

The Scottish Women’s Rights Centre is a unique collaborative project providing free legal information, advice, representation and advocacy support to self-identifying women in Scotland affected by violence and abuse.

Helpline: 08088 010 789

The helpline is open Monday 1pm to 4pm, Tuesday 10am to 1pm, Wednesday 1pm to 4pm and Friday 10am to 1pm.

Victim Support

Victim Support Scotland is the leading charity dedicated to helping people affected by crime across Scotland.

Helpline: 0800 160 1985 (Monday to Friday, 8am to 8pm).

Just Right Scotland

JustRight Scotland use the law to defend and extend people’s rights. JustRight work with Rape Crisis Scotland and the University of Strathclyde Law Clinic as part of the Scottish Women’s Rights Centre (SWRC), which works with women who have been affected by abuse and violence in Scotland with the aim of improving their access to justice and experience of the justice system.

Northern Ireland

NI Direct 24-hour Domestic and Sexual Abuse Helpline

The Domestic and Sexual Abuse helpline is open to women and men affected by domestic abuse or violence. This free telephone service is available 24 hours a day, 365 days a year.

Freephone: 0808 802 1414

Email: help@dsahelpline.org

Victim Support NI

Victim Support NI is an independent charity which helps people affected by crime. It offers a free and confidential service, whether or not a crime has been reported and regardless of how long ago the event took place.

Helpline: Monday to Friday, 9am to 5pm

Belfast Hub Office: 028 9024 3133, belfast@victimsupportni.org.uk

Foyle Hub Office: 028 7137 0086, foyle@victimsupportni.org.uk

Children’s Law Centre

The Children’s Law Centre works to protect the rights of all children living in Northern Ireland, particularly those who are the most disadvantaged – for example, children with disabilities, special educational needs, mental ill health, homeless young people.

Phone: 028 9024 5704

Email: info@childrenslawcentre.org

Northern Ireland Commissioner for Children and Young People (NICCY)

The job of the Northern Ireland Commissioner for Children and Young People is to safeguard and promote the rights and best interests of children and young people. Part of NICCY’s role is to advise government and all its agencies on the policies, legislation, and services it provides for children, young people and their families.

Safeguarding Board for Northern Ireland

The Safeguarding Board for Northern Ireland ensures that there are no barriers to protecting children and young people up to the age of 18 in Northern Ireland. The board provides education on safeguarding, advises the Department of Health and engages with children and young people on the issues that matter to them.