تبیین درک و تجربه متخصصین زنان و ماماها از معاینه بکارت و پیامدهای آن: یک مطالعه کیفی

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشیار گروه مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 مربی گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه آزاد اسلامی لارستان، فارس، ایران

3 استاد گروه ، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: معاینه بکارت در برخی کشورها از جمله ایران به صورت سنتی و عرفی شناخته شده است. اهداف اصلی برای انجام این معاینه در فرهنگ های گوناگون شامل ارزیابی خویشتن داری، تأخیر در ایجاد رابطه جنسی تا زمان ازدواج، پیشگیری از ایدز و سایر بیماری های مقاربتی و حفظ شرافت خانوادگی با دفاع از بکارت دختران می باشد. به علت وجود دیدگاه‌های متفاوت در رابطه با معاینه بکارت و اقدام به عمل جراحی برای ترمیم آن از جانب گروه پزشکی و ارائه‎دهندگان خدمات بهداشت باروری، بازنگری در نقش و وظایف آنان ضروری به نظر می رسد. مطالعه کیفی حاضر با هدف تبیین درک و تجربه متخصصین زنان و ماماها از معاینه بکارت و پیامدهای آن انجام شد.
روش کار: این مطالعه کیفی با روش تحلیل محتوا انجام شد. مشارکت‌کنندگان در این مطالعه 15 نفر، شامل 7 متخصص زنان و 8 مامای واجد شرایط پژوهش بودند که در ابتدا با روش هدفمند و سپس با روش گلوله برفی انتخاب و مورد مصاحبه عمیق فردی قرار گرفتند. جهت جمع آوری داده ها از راهنمای سؤال اولیه استفاده شد. تمام مصاحبه‌ها ضبط و تایپ شد و با روش تحلیل محتوای قراردادی آنالیز شدند.
یافته ها: تحلیل داده‌های کیفی منجر به ظهور سه طبقه "ماهیت معاینه"، "الزامات معاینه" و "پیشگیری از پیامدهای منفی معاینه" بود که در طبقه "ماهیت معاینه" سه زیر طبقه: "علل معاینه بکارت"، "ارزش تشخیصی معاینه" و "پیامد معاینه"، در طبقه "الزامات معاینه" زیر طبقات: "لزوم برنامه‌ریزی برای نظارت بر انجام معاینه و پیامدهای حاصل از نتایج منفی"، "آموزش، حمایت و امنیت سیستم پزشکی و مامایی" و "اخلاق و حقوق بهداشت باروری" بود و در طبقه سوم یعنی "پیشگیری از پیامدهای منفی معاینه" دو زیر طبقه: "راهکارهای توانمندسازی جامعه" و "راهکارهای پیشگیری از پیامدهای ناشی از اعلام نتیجه" جای گرفتند.
نتیجه‌گیری: معاینه بکارت مرتبط با مداخلات پزشکی مانند پیشگیری، درمان و بازتوانی نیست. این معاینه نمی تواند عدم وجود رابطه جنسی را اثبات کرده و دارای پیامدهای نامطلوب است، چنین ارتقاء سیستم بهداشتی در رابطه با کیفیت انجام این معاینه و توانمندسازی جامعه مبتنی بر آموزش، دو رویکرد اساسی برای حفظ حقوق بهداشت باروری می باشند.

کلیدواژه‌ها


عنوان مقاله [English]

Explaining the experiences and perceptions of gynecologists and midwives about virginity examination and it’s outcomes: A qualitative Study

نویسندگان [English]

  • Masoumeh Simbar 1
  • Fatemeh Rahmanian 2
  • Fahimeh Ramezani Tehrani 3
1 Associate professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Instructor, Department of Midwifery, School of Nursing and Midwifery, Larestan Azad Islamic University, Fars, Iran.
3 Professor, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Introduction: Virginity examination is known as a custom and norm in some countries including Iran. The main aims for virginity examination in different cultures are including assessment of abstinence, delay for sexual relationship until marriage, prevention of AIDS and other sexually transmitted diseases, and keeping honor of family by defending of girls’ virginity. Because of different views in relation to virginity examination and surgery procedures to repair it by medical team and reproductive health service providers, reviewing their role and tasks seems to be necessary. This qualitative study was performed with aim to explain the gynecologists’ and midwives’ perceptions and experiences towards virginity examination and its outcomes.
Methods: This qualitative study was performed using content analysis approach. Fifteen participants including 7 gynecologists and 8 midwives were qualified for the study that were selected at first by purposeful sampling method and then by snowball sampling method. They were interviewed by in-depth individual interview. Primary question guide was used to collect data. All interviews were recorded and typed and were analyzed by content analysis approach.
Results: The analysis of qualitative data led to the presentation of 3 categories "examination’s identity", "examination’s requirements", and "prevention of negative outcomes of examination". The category of “examination identity” had three sub-categories including “the reasons for virginity examination”, “prognostic value of the examination”, and “the outcomes of examination”. The category of “examination’s requirement” had the sub-categories of “the necessity for planning and monitoring of the examination process and the consequences of negative results”, “training, support and safety of medical and midwifery system”, and “reproductive health rights and ethics”. In third category of “prevention of negative outcomes of examination”, there were two subgroups of “the strategies for community empowerment” and “the strategies for prevention from the outcomes of the negative results”.
Conclusion: The virginity examination is not related to medical intervention such as prevention, treatment or rehabilitation. It cannot prove the lack of sexual activity and has undesired consequences. Health system promotion in relation to the quality of this examination and education-based community empowerment are two basic approaches to maintain the reproductive health rights.

کلیدواژه‌ها [English]

  • Gynecologists and midwives
  • Reproductive health
  • Virginity
  1. Leclerc-Madala S. Virginity testing: managing sexuality in a maturing HIV/AIDS epidemic. Med Anthropol Q 2001; 15(4):533-52.
  2. Mourfi DE. A time of testing in virginity. The Los Angeles Times, 15 July 1999. Available at: URL: http://www.aegis.com/news/lt/1999/LT990702.html; 2007.
  3. George E. Like a virgin? Virginity testing as HIV/AIDS prevention: human right universalism and cultural relativism revisited. Int Comparat Law Colloquium 2007; 4:1-58.
  4. Scorgie F. Virginity testing and the politics of sexual responsibility: implications for AIDS intervention. Afr Stud 2002; 61(1):55-75.
  5. Awwad AM. Virginity control and gender-based violence in Turkey: social constructionism of patriarchy, masculinity, and sexual purity. Int J Hum Soc Sci 2011; 1(15):105-10.
  6. Baker N, Gregware P, Cassidy MA. Family killing fields: honor rationales in the murder of women. Violence Against Women 1999; 5(2):164-84.
  7. Helgesson G, Lynöe N. Should physicians fake diagnoses to help their patients? J Med Ethics 2008; 34(3):133–6.
  8. Amy JJ. Certificates of virginity and reconstruction of the hymen. Eur J Contracept Reprod Health Care 2008; 13(2):111–3.
  9. Becker MJ, Rademakers J, Mouthaan I, De Neef M, Huisman WM, Van Zandvoort H, et al. Reconstructing hymens or constructing sexual inequality? Service provision to Islamic young women coping with the demand to be a virgin. J Community Appl Soc Psychol 1996; 6(5):329–34.
  10. Sahinogh SP. Bekaret muayenesi (Virginity examination). State of World Population. Available at: URL: http://www.ucansupurge.org/newhtml/bekaret.php; 2008.
  11. Önal G. Violence towards women. Ucan Supurge. Available at: URL: http://www. ucansupurge.org/newhtm/s¸iddetetik.php; 2002.
  12. Mete S. The effect of nurses’ approach towards the anxiety of women who undergo gynaecological examination. [Master Thesis]. Ankara: Hacettepe Üniversitesi; 1998.
  13. Örs Y. Is it a perineum examination of hymen examination? Bulletin Foren Med 1996; 1(2):54–7.
  14. Impunity for domestic violence, ‘honour killings’ cannot continue–UN official. UN News Center. Available at: URL: http://www.un.org/apps/news/story.asp?NewsID=33971#.VoeH3rZ96M8; 2011.
  15. Earp BD. Hymen ‘restoration’ in cultures of oppression: how can physicians promote individual patient welfare without becoming complicit in the perpetuation of unjust social norms? J Med Ethics 2014; 40(6):431.
  16. Usta I. Hymenorrhaphy: what happens behind the gynecologist's closed door? J Med Ethics 2000; 26(3):217–8.
  17. Hedjazi A, Zarenezhad M, Roshanzamir S, Gholamzadeh S, Valee M, Shaghaghian A, et al. Hymenal findings in women referred to Fars Legal medicine center examination unit, Southwest of Iran. J Gynecol Obstet 2014; 2(2):12-5.
  18. Denzin NK. Interpretive interactionism. Newbury park: CA, Sage; 1989.
  19. Sandelowski M. Focus on research methods whatever happened to qualitative description? Res Nurs Health 2000; 23(4):334-40.
  20. Tesch R. Qualitative research: Analysis types and software. Bristol, PA: Falmer Press; 1990.
  21.  Morse JM, Niehaus L. Mixed methods design. Principles and procedures. Walnut Creek, CA: Left Coast Press; 2009.
  22. Adib Hagbagheri, Parvizi S, Salsali M. Qualitative and quantitative research methods. 3rd ed. Tehran: Boshra publishing; 2007. (Persian).
  23. Juth N, Lynöe N. Do strong values-based influence estimations of future events? J Med Ethics 2010; 36(4):255-6.
  24. Juth N, Tännsjö T, Hansson SO, Lynoe N. Honour-related threats and human rights: a qualitative study of Swedish healthcare providers’ attitudes towards young women requesting virginity certificates or hymen surgery. Eur J Contracept Reprod Health Care 2013; 18(6):451-9.
  25. van Moorst BR, van Lunsen RH, van Dijken DK, Salvatore CM. Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction. Eur J Contracept Reprod Health Care 2012; 17(2):93–105.
  26. Wickstrِm A. Virginity testing as a local public health initiative: a ‘preventive ritual’ more than a ‘diagnostic measure’. J Royal Anthropol Inst 2010; 16(3):532-50.
  27. Curtis E, San Lazaro C. Appearance of the hymen in adolescents is not well documented. BMJ 1999; 318(7183):605.
  28. Ellis H. Clinical anatomy: a revision in applied anatomy for clinical students. 11th ed. Oxford: Blackwell Publishing Ltd; 2006.
  29. Onan MA, Turp AB, Taskiran C, Ozogul C, Himmetoglu O. Spontaneous closure of the hymen during pregnancy. Am J Obstet Gynecol. 2005;193,889- 91.
  30. McCann J, Voris J, Simon M. Genital injuries resulting from sexual abuse: a longitudinal study. Pediatrics 1992; 89(2):307-17.
  31. Eman SJ, Woods ER, Allred EN, Grace E. Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr 1994; 125(1):153-60.
  32. Rogers DJ, Stark M. The hymen is not necessarily torn after sexual intercourse. BMJ 1998; 317(7155):414..
  33. Swartoobi-Xabadiya ZC. Attitudes and perceptions of girls in St John's College about the practice of virginity testing. [Doctoral Dissertation]. Polokwane, South Africa: University of Limpopo; 2010.
  34. Le Roux L. Harmful traditional practices, (male circumcision and virginity testing of girls) and the legal rights of children. [Doctoral Dissertation]. Bellville, South Africa: University of the Western Cape; 2006.
  35. World Health Organization. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Geneva, World Health Organization,2013..
  36. Ndlovu C. Virginity testing raises many questions. Network 2005; 23(4):14.
  37. Myhre AK, Berntzen K, Bratlid D. Genital anatomy in non-abused preschool girls. Acta Paediatr 2003; 92(12):1453-62.
  38. Goodyear-Smith FA, Laidlaw TM. Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature. Forensic Sci Int 1998; 94(1-2):147-53.
  39. Cook RJ, Dickens BM. Hymen reconstruction: ethical and legal issues. Int J Gynaecol Obstet 2009; 107(3):266-9.
  40. Plichta SB. Interactions between victims of intimate partner violence against women and the health care system: policy and practice implications. Trauma Violence Abuse 2007; 8(2):226–39.
  41. Khafagy F. Honour killing in Egypt. In an expert group meeting organised by the UN Division for the Advancement of Women. Cairo, Egypt: UN Division for the Advancement of Women; 2005.
  42. Lemus G, Kenndy M. Strengthening understanding of femicide.Seattle,Program for Appropriate Technology in Health, Washington DC: Intercambios; 2008  Using research to galvanize action and accountability. Washington DC: Intercambios; 2008.
  43. Wells DL. Sexual assault practice: myths and mistakes. J Clin Forensic Med 2006; 13(4):189-93.
  44. Gürsoy E, Vural G. Nurses' and midwives' views on approaches to hymen examination. Nurs Ethics 2003; 10(5):485-96.
  45. Essén B, Blomkvist A, Helström L, Johnsdotter S. The experience and responses of Swedish health professionals to patients requesting virginity restoration (hymen repair). Reprod Health Matters 2010; 18(35):38-46.
  46. Flood M. Men, gender, and development. Develop Bulletin 2004; 64:26-30.
  47. Bersamin MM, Walker S, Waiters ED, Fisher DA, Grube JW. Promising to wait: virginity pledges and adolescent sexual behavior. J Adolesc Health 2005; 36(5):428–36.
  48. Bruckner H, Bearman P. After the promise: the STD consequences of adolescent virginity pledges. J Adolesc Health 2005; 36(4):271–8.
  49. Campbell JC, Glass N, Sharps PW, Laughon K, Bloom T. Intimate partner homicide: review and implications of research and policy. Trauma Violence Abuse 2007; 8(3):246–69.
  50.  Hobday AJ, Haury L, Dayton PK. Function of the human hymen. Med Hypotheses.1997;49:171-3.