Trigger Warning: This episode discusses sensitive topics related to cultural practices, sexual health, and trauma that may be triggering for some listeners.

In many cultures, deep-seated traditions shape women's lives in unexpected and profound ways. This episode delves into the intricate world of women's health, sexuality, and the rites of passage that are still practiced today, shedding light on the complex balance between cultural pride and personal empowerment.

This conversation takes you into the lesser-known rituals and beliefs surrounding women's sexual health in North African cultures. Dr. Rahman is joined by Dr. Ons Kaabia, who shares fascinating insights into traditional rites of passage, one practice with roots far beyond modern religion. They discuss the role of matriarchs in maintaining these practices, the dichotomy between preserving cultural heritage and promoting individual empowerment, and the complex experiences of women navigating sexual health in the context of deep cultural expectations. Through empathy and evidence-based knowledge, this episode fosters understanding and builds awareness around sensitive topics often hidden from mainstream discussions.

Highlights

• The role of the matriarch in traditional protective rituals and their impact on young girls.
• The significance of rituals in preserving family and cultural honor.
• The challenges women face when navigating modern health practices alongside deep-rooted cultural beliefs.
• How comprehensive, culturally aware sexual health education can empower future generations.
• The complex emotions and societal pressures surrounding these traditions.

If you found this episode insightful, please like, subscribe, and share it with others. Your comments and thoughts are always welcome—let’s continue this important conversation!

In many cultures, deep-seated traditions shape women's lives in unexpected and profound ways. This episode delves into the intricate world of women's health, sexuality, and the rites of passage that are still practiced today, shedding light on the complex balance between cultural pride and personal empowerment.

This conversation takes you into the lesser-known rituals and beliefs surrounding women's sexual health in North African cultures. Dr. Rahman is joined by Dr. Ons Kaabia, who shares fascinating insights into traditional rites of passage, one practice with roots far beyond modern religion. They discuss the role of matriarchs in maintaining these practices, the dichotomy between preserving cultural heritage and promoting individual empowerment, and the complex experiences of women navigating sexual health in the context of deep cultural expectations. Through empathy and evidence-based knowledge, this episode fosters understanding and builds awareness around sensitive topics often hidden from mainstream discussions.

Highlights

• The role of the matriarch in traditional protective rituals and their impact on young girls.
• The significance of rituals in preserving family and cultural honor.
• The challenges women face when navigating modern health practices alongside deep-rooted cultural beliefs.
• How comprehensive, culturally aware sexual health education can empower future generations.
• The complex emotions and societal pressures surrounding these traditions.

If you found this episode insightful, please like, subscribe, and share it with others. Your comments and thoughts are always welcome—let’s continue this important conversation!

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Dr Sameena Rahman (0:0.288)

remove that statement and that's fine. Hey y'all it's me Dr. Smita Rahman, Gyno Girl. Welcome to another episode of Gyno Girl Presents Sex, Drugs and Hormones. I have a very fabulous guest today that I'm excited for you guys to meet and have a discussion about and so today I have the amazing Dr. Anz Khabia. She and I met

Ons Kaabia, MD (0:3.106)

Okay.

Dr Sameena Rahman (0:23.870)

So interesting, as some of you who follow me may know, I recently was in Brazil for the World Meeting on Sexual Medicine. And this is a meeting I like to attend as many times as I can because you meet so many amazing scholars, researchers, sexual medicine specialists from all over the world. And to find out what different things and different issues, know, women and men are experiencing from around the world and...

I met Ones there. So welcome Ones, thank you for coming.

Ons Kaabia, MD (0:54.502)

Thank you so much, Samina. It's an honor to be part of your broadcast and to have this discussion with you. And I second you, but like I always try to be at the ISSN meetings because that's the platform where you can meet researchers and also like clinicians that will report practices and like, you'll see the trends changing.

Dr Sameena Rahman (1:18.530)

Yay.

Ons Kaabia, MD (1:23.582)

especially in women's health and women's sexual health particularly. So it's always interesting to be part of the ISSM meeting.

Dr Sameena Rahman (1:28.653)

Yeah.

And what's really great is, right? And then what's really great is you see how many commonalities women experience around the world, right? Like some of the same undertones are present in every culture, no matter what. And so it's just when you think that your culture's superior, you realize you're not. Guess what? You guys are all the same. All right.

Ons Kaabia, MD (1:52.990)

I think that everybody is unique, but like we have so many things in common that we need either to cherish and let grow if they can help us empower ourselves or we need to join forces and try to combat the bad and evil stuff so that we are empowered as we are.

Dr Sameena Rahman (1:55.543)

Yeah.

Dr Sameena Rahman (2:7.094)

Yes.

Dr Sameena Rahman (2:16.308)

Absolutely. And Aunts is from Tunisia initially. So we were going to talk about some of the commonalities that we see within the cultures that I see. And I've done some discussion before about hymen surgeries that are done in the United States, in Europe to preserve and.

I oftentimes call it the membrane of honor because we see so much association with virginity and the hymen and everything. But when I was in Brazil, Aung did a wonderful presentation on some of the traditions in Tunisia. And I think they do it in Algeria and some of these other places, which we're going to talk about in some detail. And I think you're going to explain to the listeners and viewers what it is.

So much of sexuality and sex is really just engrossed by culture, by religious beliefs, and this dictates how we sort of even move forward, right? And so I think culturally, we have a lot to overcome when it comes to like patriarchal norms, right? Like when it comes to like tying things up with, you know, a membrane that has very little meaning biologically, I think, right? So I think that...

We talk about the hymen, it's that little slither of tissue, really has very little meaning.

Ons Kaabia, MD (3:41.566)

I like to say that in women's Vinitalia, people focus on the hymen, which has no physiological function, and they forget about the clitoris, that is the only organ for pleasure in women. So for me, it's like this paradigm that is completely...

Dr Sameena Rahman (3:54.544)

Right. Yeah. Which has the most...

Absolutely.

Ons Kaabia, MD (4:7.150)

schizophrenic. So we emphasize something that has no function, but we forget completely about an organ that is its main function is like just having pleasure. like, and another thing, like how much sexuality for women is taboo, but like marriage and we and wedding and virginity are so upfront.

Dr Sameena Rahman (4:8.256)

Yeah.

Dr Sameena Rahman (4:11.992)

Right.

Dr Sameena Rahman (4:20.000)

It's pleasure. Right.

Dr Sameena Rahman (4:28.684)

Yes.

Dr Sameena Rahman (4:33.100)

reproduction, yes, and having the babies and doing all the things that you're physiologically meant to have, you know.

Ons Kaabia, MD (4:38.782)

Yeah. Yeah. And also like, like, like, menses and menstruation is taboo. But like, the wedding night is not. And this the need for bleeding, and like the need for virginity proofs.

Dr Sameena Rahman (4:48.518)

So.

Dr Sameena Rahman (4:52.502)

Yeah, let's see the blood. need to see the blood. Yeah.

Ons Kaabia, MD (5:2.527)

is so like it's something that is shared with all the community and all the family but like just having your wences you don't have to talk about that it's like don't let people know that you are on your period and so on so like we have these double standard

Dr Sameena Rahman (5:11.446)

Right, right, right. Yes. Yes. Let the world know if you bled on your marriage for it, right? Like.

Ons Kaabia, MD (5:22.272)

Yeah, and like these double standards are very difficult to manage, especially when you are a young girl living in this modern world with the new codes, but like also being respectful of your family, being respectful of your culture and wanting to be included.

and accepted by your family, but also wanting to be you and empowering yourself. It's a dilemma for most young women I know, because we are raised to be proud of who we are about our culture, about our family, but also we need to be proud of who we are as women too. And it is difficult. Yeah.

Dr Sameena Rahman (6:11.362)

Yes, yes, our brains and everything else, right? Yeah, yeah. And I think that's so very interesting because, know, really the awareness that we wanna build is one of cultural humility, right? That we have humility towards another culture, that some of these traditions are embedded in and these traditions keep families together, right? And so by explaining some of the stuff that we're gonna talk about, we're not trying to like, you know,

really say that this is something that shouldn't be done or whatever, bring our own values upon it, but have an understanding so that for those of you listening, if you meet someone that's had this procedure or rite of passage done, rite of passage, about someone who's had this rite of passage done, that you're not gonna judge them or look down upon them or even show prejudice toward them.

because so many of these rituals exist in other places. I was just talking in the office and we were talking about people that have done religious sort of, what is it called? Oh, sorry. Sorry, have brain fog. Edit that, We were talking about celibacy contracts. Oh, oh yeah.

I was talking to my nurse practitioner in the office and we were talking about like in some Christian cultures and subdivisions within that they have celibacy contracts, right? So where they like say, I'm gonna be celibate till I'm married and this is for the love of God, right? Like this is kind of the thing that happens. And so in that context, let's talk about the thus be, right? And see, and to explain to our listeners what it is and what it means and what the purpose of it is.

Ons Kaabia, MD (8:4.130)

Thank you so much, Samina, to give me the opportunity to talk about Tasfiq. So Tasfiq is an Arab word and it means ceiling. it means like it is a two parts magical practice exercised by the matriarch on the girls prior to puberty. It is a practice very...

prevalent in North African countries, especially Morocco, Algeria and Tunisia. the aim is to prevent any pre-marital vaginal penetration. And in doing so, it's believed that the hymen will become unreachable. And it is our reality. We did a study like last year, and we know that we have 8 % of

Dr Sameena Rahman (8:35.948)

Mm-hmm.

Ons Kaabia, MD (8:58.868)

all the young population like women between 20 and 40 years old that have gone through that right or that have gone through that practice. And it is something that we need to acknowledge. So what happens is when a young girl is at the age of five or eight, the matriarch of the family, like the grandma,

or the grand grand will call her and they would be and this ritual will take place closer to a loom which is essential for women empowerment in North Africa. like women use the sheep wool and have like we do tapestry and stuff like that and it is a mean of independence for women to be able to have their own resources thanks to the

tapestry and like a carpentry creator. And this loom is essential to the success of this Das Fiehrheit because the loom thread is a powerful symbol of virginity, protection and cultural control. And I think that the loom happens also in Sleeping Beauty, which is a Western story.

Mm-hmm.

Right?

But like we still have these references and still like when she got, she pinched her finger and bled on the loom. So I think that's something that is somewhere embedded through cultures. So this loom thread is really important. the matriarch will call the little girl using a loom thread and she will ask her to...

Yeah.

Mm-hmm.

to sing or to repeat seven times an incantation, hoping that her vagina will be sealed and that if anybody wanted to penetrate her, they would not have any erection and rigidity. So this is the first part of this ride. And then prior to the wedding, usually,

the week before the wedding, the same old lady needs to be available and to do the second part of the ritual, which is de-sealing the vagina or de-sealing the hymen. And for that, there is no genital mutilation in this practice, but there are seven little scars above one of the knees.

Thank

and they will use the blood from these little sterification to open the vagina back.

theoretically open. Yeah, yes. And so, again, it's it and I was thinking it was done right before puberty, but it's even in pre pubescent girls, right? So really ingrained at a young age that nothing should penetrate the hymen.

Yeah.

Yeah, that's the thing. The more protective the moms are, the earlier they do it. And they are doing it in good faith. They are not thinking badly or they are not... They do it because they love their little girls and they don't want anything bad to happen to them. So culturally, it's something that is accepted and it is something that is passed

course.

from generation to generation. And despite like women now going to school, working, being educated, even like when we did our survey, we had like more than 70 % of the women that had this ritual go to university or at least went to university. like, it's not related to your educational level. It's really...

Dr Sameena Rahman (13:6.644)

Right. So they're academic.

true belief embedded within our culture.

Right. Do you know how far it dates back? Like is it from tribal times?

So, yeah, so the thing about North Africa, it's a very very like country or land. So before even Arabs and Muslims came, this tradition was there. So it's not related to Islam only, but Islam reinforced that idea of virginity. So it is something that happens even

Yeah.

So it predates this bomb too. Right. Right.

Right.

happened prior to the first Islam installment in North Africa. because North Africa is like the home of several tribes and the tribes had very important territories for the pasturing and stuff like that. if the honor

the honor of the family or of the tribe was somewhat, sorry, somehow hurt. It's all the tribe that is penalized because of that. And this is happening before having the religious portion about virginity and no sex before.

So it's really embedded in the culture.

Good luck.

Right, and similar, think, not, I mean, obviously this is a magical theoretical proceed, rite of passage. It's not anything physically done to the woman or little girl, different than some people are, you know, I'll confuse it with female genital cutting, which is actually a procedure, a surgical thing done by the matriarch. And that also is, I think, more in the Sub-Saharan Africa and areas as well.

Yeah, it's African too. We have that in North Africa, like it's mainly Egypt and Sudan. It's not sub-Saharan, it happens also in sub-Saharan Africa, but it's mainly the eastern part of North Africa. And it is something that we need to also acknowledge. But, and there is a lot of cultural resistance, even through name.

Yeah.

Not just

Mm-hmm.

Yes.

correctly what is done to the young girls. Like, it's really hard to say it is genital mutilation. Like, if you use those wording, like, people will get a little bit offended, but like, this is what it is.

Right, female petal cutting.

Yeah.

Dr Sameena Rahman (16:2.434)

Right. Yeah.

Right, and I think most standard discussions are around FGC now. We don't call it FGM anymore. And I think that it's important to recognize that is part of the embedded culture, again, pre-date and probably more in the tribal times as well. there are, and I've done research on this as well. Some women have really amazing sexual lives even after having any of the clitoral area incised.

Whereas others have a lot of nerve compromise or infections or other problems, depending on the type, right? We know there's like four different types. And so depending on the type, know, some women might experience it differently and their sex lives might be different. And I think from based on my research, and please correct me if I'm wrong, that in the past, you know, women who become embedded in or acculturated to a new culture like Western culture, they're the ones that kind of have more

orgasmic dysfunction and other kinds of sexual dysfunction versus those that are still, you know, maintain their culture from previous, like if they were migrants or immigrants into different countries.

Like norm is very subjective in sexuality. And I think that if everybody's like you within your community, you don't feel that you are a part and you can share like your experience with your peers and discuss about what's happening. And you can cope with that if everybody's like you, because you are the normal, like you are within normality.

Mm-hmm.

Right.

But if you go outside of this culture and you are the... And it's usually partners that will stress this thing out. Because if you are within a culture that does those practices, you are like all other girls, all other women. But when you go outside, you are the outsider.

Dr Sameena Rahman (18:6.860)

Mm-hmm. Yeah, you're too long.

and you need to adapt and this is very different because there is the cultural shock and there is also the work towards intimacy and what is sexuality and re-appropriating the norms that are foreign to you.

Yes, absolutely. And I think it's very interesting that, you know, whether or not it's the female general cutting or it's just the magical, you know, rite of passage, thus be that, you know, it's all done by the matriarchs of the family, right? These are like the women that you trust the most.

who've probably had it done with themselves or even had, like they have a true belief that this is the right thing for their child that they love more than anything on the planet, that it's not like they're actively trying to do it, right? So this is, and the status of that woman in the family, right? The matriarch has so much power in these communities. And so I think that's very important to remember.

Yeah, they are the ones you look for advice and you look for help if you need anything. if they would, they encourage you to do some stuff or prohibit you from doing some stuff, they are the ones that are educating you. So you follow their steps. That's why I think if we need to work on something, it's comprehensive sexuality education.

Right.

for the younger generation and this needs to be culturally appropriate. But it will also make people question some stuff and see if they feel comfortable with people like messing with their bodies or their minds and maybe they can have their own ideas and criticize or discuss what is happening.

Right.

No. No.

Ons Kaabia, MD (20:7.892)

and see if that works for them or not. Because like these women, these matriarchs, they are reproducing what happens and this is how they learned about sexuality. They learned from other older women and wiser women because that's their belief. And if you don't have an evidence-based data set that you can go to and get information from,

you will follow your elders and they know better, so and they know best, so like that's the way to do stuff. That's why I think that in our countries and in our cultures it's really important to have programs for comprehensive sexuality education that are culturally appropriate but evidence-based.

Yes.

Dr Sameena Rahman (21:4.829)

And what do you think in terms of like the rates of sort of when you talk about sexual dysfunction and mainly when I look at like at least some predominantly you know Muslim countries and I've done the research on it we see that you know roughly like 40 % of women might experience you know sexual pain or vaginismus right and so some of that we know I've done many podcasts about vaginismus even my own experiences with it and how this involuntary contraction of the pelvic floor

when you've been so ingrained not to want to or not. Like it's kind of like I never had this magical right of passage done on me, but I'm Pakistani. And so you know, we have our own like, okay, you didn't, I didn't have a magical right of passage done, but I was actually like, you know, ingrained so much about the idea of, you know, premarital relationships that

when it became time to do anything, it was almost impossible, right? Because it's like your whole life, no, no, no, no, nothing in the vagina. And then, hey, go, go for it. How does that work?

Ons Kaabia, MD (22:8.012)

And everybody is pushing, and you have to perform. So you have this anxiety to perform, something you were not educated about, something you never talked about just a week prior to the wedding. You got all this info and you have to do well. It's stressful for both partners. It's stressful for the lady, but it's also stressful for the guy. Because I'm going to give you some data from Tunisia.

Right.

Yeah. Yeah.

So like the prevalence of sexual dysfunction among our population is higher than other countries. in one of the studies we had like 60%, which is absolutely high. And we have also high rates of unconsumated marriages. And when we break down the unconsumated marriages, we will find this mirror.

Yes.

Ons Kaabia, MD (23:5.888)

dysfunctions, like we would have vaginismus with patients with vaginismus, but their husbands will also have erectile dysfunction, mainly associated to this stress to perform and anxiety to perform. like, it becomes a couple issue. It's not only the women's issue, but like it's mainly a couple issue. like regarding women,

for just watching,

I like we don't have actual trends, but like virgin is still is the second cause of consultation in Tunisia. The first one is lack of desire. But these things go like if you have always been educated that having sexual desire is bad and it's loose morals and it shows that you are not a good girl.

Sure, it's across the world, I think.

Ons Kaabia, MD (24:3.570)

So it's hard to have desire just like that for your sexual partner or your husband. the brain cannot switch on and off without it. So like we have lack of desire and we have vaginismus. So like it's not only vaginismus and the inability to have vaginal penetrative sex. It's also like spreading to the other

Dr Sameena Rahman (24:8.364)

No. Yeah. Right.

I know. Yeah.

is still lacking design.

sexual function.

Right, right. And I think that it's interesting, like, what happens to those, you know, maybe women who are out there who have had, know, maybe they've been, you know, because we know that spiritual abuse and sexual assault are still very common in many communities. And so what happens to some of those patients, those women that have had that? they, you know, if they're like forced, their thus fees broken, that kind of thing?

Have you looked at the video?

Ons Kaabia, MD (25:5.554)

So like, yeah, so like women have different reactions to this. So some women, they they tend to accept that and they try to cope with it as well as they can. And they kind of accept the idea that sex is just a marital duty and it is an aim, like it is just reproductive.

Thank

productive.

and it's not like a source of pleasure, but like we have a good proportion of women that adapt because resilience is something that is within us. some of them adapt and they and it is really interesting for sex therapists to see women with vaginismus that have developed a great

Yes.

Ons Kaabia, MD (26:2.174)

variety of sexual practices that do not involve vaginal penetration but that give them pleasure and that help them have a satisfying sexual life even without penetrative sex. And this is something also we need to acknowledge as sex therapists and not always push the patient to have penetrative sex.

And as OBG is, sometimes they come to the consultation just for normality because they need to have a baby.

Right. Yeah, no, that's true. And that's oftentimes what I see here is I'll see couples who have been married for a while. And what pushes them actually to get help is that they're like ready to have children. Right. They've been unconsummated for years. And then now like we're actually thinking about a family. So we got to get serious about this, but they've been doing other stuff as couples, like being happy and whatever, know, pleasurable.

Yeah.

Ons Kaabia, MD (27:0.704)

And usually we have better results for treating patients with vaginismus that have a great or like a more diverse sexual activities than women that had nothing prior to the marital night. like even like masturbation is something that is forbidden.

section.

Yes, I agree.

And so if you don't know what is pleasure, what is orgasm, what is like your excitement level, it's really hard to start from scratch with those patients. So they have like, it takes longer time and more effort for them to reach where they want to be.

Yeah.

No, and I think that's true for what we do here too, when I'm treating my own patients with the therapists that I work with. What do you see culturally when it comes to these women who have had premarital things happening or whatever, and they're caught? we see in Pakistan, and we've seen some of the immigrants here also be victims of honor killings, right? Because that hymen and that virginity is really a matter of your family honor in these cultures, right?

And so when there is something beyond that and and I guess I should have made a trigger warning about this because it is very traumatic for so many people that all of a sudden they'll You know be you know these victims of these horrible, you know

assaults or killings that happen within the family. Sometimes a brother, sometimes a father, sometimes another family member. And even if some people are raped or other things, this is still on that victim, unfortunately.

Ons Kaabia, MD (29:1.654)

I cannot talk about honor killing per se, but what I want to report is first incest happens everywhere and the closest member of the family will be the ones that will perpetrate that. And the only person that will be blamed will be the girl. it can be very...

Mm-hmm.

the world.

little girls, like can be children. And what we see is that we have this suicides, like child suicide in the rural area. And when we do the autopsies, most of the time we find like signs for sexual abuse, either for boys or for girls. And I think that's how we are coping with that. We don't have

Oh, that's fine.

Like in Tunisia, like it's really rare to have like honor killing but these kind of silence deaths that are not in the media and stuff like that, but the coroners know about them and this is what is happening. We have a whole generation that is living that and we are trying actively

Dr Sameena Rahman (30:8.088)

you

Yeah.

to reinforce laws. We had a law against violence against women and children in 2017, and it was a very progressive law. The only thing is we need the means to achieve the objectives of this law. But we are conscious that this is happening, that these little children and these little girls and boys who commit suicides, it's not fun.

Great.

That's awful. think for Carrie when you edit this, please put a trigger warning there for anyone listening that this is gonna be Something that might be triggering to people and maybe you can we can grab a clip of you know that what you showed at the meeting maybe we can send us Yeah, okay awesome and Well, I mean I think this is a very amazing that you're doing all this great research and really, you know

Ons Kaabia, MD (31:3.350)

Yeah, absolutely.

Yeah, I can share with you.

Just getting the word out, the awareness building, I think that's very important. I think education is, like you said, I think it would make a world of difference for all, I mean, it's not like in the United States where you get all that much education either when it comes to a lot of the sexual issues, because we see it all across the board. People don't even know the names of their genitals and all these things. tell us what's on the horizon for you. What other stuff are you looking into?

For me, we started this research on what was culturally happening and what was culturally related within sexual health because we wanted to craft and to adapt our comprehensive sexuality education program to that. So if we don't know what is happening in our society and we don't address it and we don't measure it,

Dr Sameena Rahman (32:3.574)

Yeah. Yeah.

we cannot give information and like valid information to young boys and girls about what is happening and what they have to be cautious about. So that's the first thing. And like now I'm also focusing my research about on co-sexology because like

cancer patients and we are in October. I don't know when this podcast will be aired, but it's pink October, we are raising awareness against breast cancer and lots of women that suffer from cancer, either breast cancer, organecological cancer, they are also suffering and hurting regarding their sexual health. And this is...

mainly my current focus now, but it goes hand in hand with the comprehensive sexuality education program because if we understand that sexual health is actually part of health and we need to take that into account when we are treating patients regardless of their illnesses, it's really important.

Yes.

I think it can make a change. Like just asking the question to the patient, sometimes it's a relief for them. And I will always remember my first patient that survived cervical cancer. She had like a stage three cervical cancer and she had the treatment and she was cured. She was only 34 at the time and she was cured.

Dr Sameena Rahman (34:3.467)

Mm-hmm.

Ons Kaabia, MD (34:5.354)

And I was so happy because everything was good and the MRI was normal and everything was good. But she was crying all the time. And her partner at the end told me, we tried to have sexual penetration, but because of the radiation, we couldn't. And nobody talked about that with them. Some people talked about the fertility issues.

but no bad he talks about any negative consequences on the vagina or sexual health and stuff like that. So I think that's the next step.

Right, no, that's wonderful. I mean, I think it's great what you're doing. I hope that you can come to Ishwish. We'll talk offline about that so that we can figure it out. But I want to be cognizant of your time as well. And I appreciate you coming on today to really help us understand. I guess the one other thing that some people ask is really when it comes to this whole rite of passage and then needing to see blood at the wedding day when.

See you next time.

There is a woman, know, I've had an, you know, every so often, maybe twice a year, I'll get someone that will ask me about their hymen and ask me if I should, if there's a way to put the hymen back together and.

We all know that the hymen can break very readily. Some people aren't born with really firm hymen. Some people will never bleed. Some people bleed all the time. It's variable. And so there has been a rise in these hymenoplasty procedures in the United States. And basically in Europe, I've seen much more. And I think we talked about this at some point. But have you seen this at all in the medical community?

Yeah, like nobody does that. We cannot have statistics about that because every doctor that does that, will not code it as like they would code it as another procedure. Like they would code it as, I don't know, assist or like whatever, but like you cannot have actual statistics because nobody's coding it correctly.

Mm-hmm.

this right.

And the other thing, I think that the ladies are smart. They discovered that they can go through marriage without having hymenoplastia and they get these tools from the internet that mimic bleeding and so on. So I think that women are adapting and we need to help them. when I started, my mentors always told me,

like not to do feminoclasts. It is something that encourages young girls to do whatever they want and stuff like that. But for me, think first, if you are in a couple and you are able to discuss with your partner and to share with them prior to the wedding, it would be great that you get on the same foot.

If it is like a marriage of convenience or if it is something you're not comfortable talking about or you don't want to raise a fuss, it's always like it's a conversation you need to have with your patient and they know best what works for them. But like my idea is the risks never should be higher than the consequence for the girl.

So like, for instance, if they are facing the risk of like honor killing or something like that, I don't think that saying yes to the procedure would be something that is hurtful or shameful for the doctor.

Dr Sameena Rahman (38:1.240)

I And I think the American College of OB-GYN put out a statement a few years ago, kind of against this type of cosmetic procedure. it is just like all that we do in medicine. should be.

Just to say something about the cosmetic procedures, I'm seeing more and more literature about this vaginal rejuvenation and like the nymphoplastia and stuff like that. And so much pressure and negative press is put on heminoplastia. So like, how can you empower girls to have new vaginas and new labias that you will say, hey,

Yes.

Yeah.

For us, it's cool that you have that. But if you ask about heminoplastia, it's bad. think it's double standards. If you discuss with the patients, they know best.

Yeah, yeah.

Right, right, exactly. And that's what we always talk about precision medicine, really talking to a patient as a unique individual, understanding all their nuances, which include their cultural nuances, whether or not religious nuances play into it, who they are, socioeconomically, all of that. So I think that's very important for us to remember. But I did want to bring that little topic up that comes up. Like I said, frequently I get.

Thank you so much, Tamina.

I get some patients come to ask me and I use it as time to educate them like this is your hymen, it's still intact, you can see or it's not intact and it's still okay. Just to kind of educate them, I show them their vulvas, I show them with the mirror, I show them their labias, their vestibule, everything.

Like summer season is wedding season in Tunisia, like it's from May until August. And I hate to be in the ER or on call during those nights because at 3 a.m. you will have the whole tribe coming for an exam, for virginity exam, because during the wedding night there was no bleeding. And why is it happening?

Yeah.

Right. Yes.

and tell us what is going on and stuff like that. yes, this is a concern. they drag the couple like at three or four a.m. just like to bring them to the hospital and like shame them. And we are having a special course for OBG specialists to learn how to deal with that.

And yeah, crazy.

Because when you are a young resident and you have more than 40 people in the ER just asking for an exam and you have other emergencies, it's hard to manage that. And young doctors are not always educated for that. we are also working on, we have this program for the residents.

in the ER.

I

Thank you.

Dr Sameena Rahman (41:4.652)

Yeah.

that includes how to manage these emergencies.

Oh, that's wonderful. Yeah, so I think that is a very important factor as well. And it's because really when it comes to sex and sexuality in so many cultures, it's really a family thing too, right? Most medical decisions are made among like a family unit. I think those are important nuances to remember when we think about different cultures and cultural humility. But we appreciate all your insight on this. This has been very fun. I'm going to have you come back again.

I know that you're all busy, but we'll talk offline about Ishwesh, but thank you for coming. Thanks for the, thanks you guys for listening to my podcast today. Remember I'm Dr. Samina from Gyno Girl. Thanks for joining me on Gyno Girl Presents Sex, Drugs and Hormones. Remember I'm here to educate so you can advocate for yourself. So please join me next week for another episode.