The Husband’s Stitch … A Crime on the Delivery Table

By: Sarah Gamal

For Marwa, the choice was stark: “either a cesarean section or the ominous Husband’s Stitch.” Threatened with divorce by a husband convinced that natural childbirth would impede his pleasure, Marwa faced a distressing decision, underscoring the unsettling power dynamics surrounding women’s reproductive choices.

“The husband’s stitch”, is the placement of an additional stitch near the vaginal opening, usually after natural birth, ostensibly to enhance a male partner’s sexual satisfaction.

This non-medical and unethical intervention lacks scientific basis, often performed without consent, exposing women to physical and emotional trauma.

Post- “stitch” trauma

Salma, in the throes of childbirth, experienced excruciating pain as the doctor performed an episiotomy—an incision between the vaginal opening and the anus designed to facilitate delivery.

Completing what she thought was the end of her ordeal, Salma was shocked to endure another wave of pain. Witnessing the doctor suturing the wound without administering pain relief, she recoiled. His nonchalant response, “Just a couple of stitches, and you’ll become a bride again,” underscored the callousness of the procedure.

Attempting intimacy with her husband post-trauma proved distressing for Salma. Persistent pain led to a gradual decline in her sexual desire, eventually instilling a sense of dread with each attempt.

Seeking resolution, Salma consulted an obstetrician-gynecologist who disclosed that an additional stitch post-delivery had excessively narrowed her vaginal opening. This revelation linked the “stitch” to her ongoing pain and vaginal infections.

Salma’s case, among others, serves as a poignant illustration of women subjected to various forms of gender-based violence and discrimination. Their exposure to danger not only inflicts harm to their sexual organs but also constitutes a violation of their rights to bodily integrity, denying them informed consent and autonomy.

As the World Health Organization (WHO) defines female genital mutilation as any practice involving the partial or complete removal of external sexual organs or causing other injuries for non-treatment purposes, a pressing question emerges: Should the “husband’s stitch” be classified and criminalized as a form of genital mutilation?

A gynecologist’s opinion: “It’s a common misogynistic practice”

In an exclusive interview with Sharika Wa Laken, we asked Yasmine Abu Al-Azm, an ob-gyn, about the “husband’s stitch” or “daddy’s stitch.” “The vagina consists of a deep muscle layer and an external one, and then the outer layer, which is the skin,” she explained. The latter is the one that is narrowed by what is called the “husband’s stitch”. This leads to, as she put it, “weakness of the internal muscles with the tightness of the external skin, and loss of its elasticity and stretchability.”

She also stressed that “there is no medical need to perform this stitch, and that it is not a medical procedure in the first place. It violates women’s bodies and medical rules, noting that male doctors are more likely to volunteer to do the procedure. It usually happens without the knowledge of women to ‘compliment their husbands’, and in some cases without the husband’s knowledge as well.”

Yasmine Abu al-Azm asserted that the “husband’s stitch” does not achieve its alleged purpose, but rather annoys both parties. “The wife does not feel pleasure and even suffers from severe pain that prompts her to refrain from having sex. As for the husband, he feels the tightness of the vaginal skin with the weakness of its internal muscles, which causes discomfort, and does not achieve sexual satisfaction for either of them.”

“It is customary not to obtain women’s consent for this procedure, and that it is done as a ‘courtesy to men’ at the expense of women’s bodies,” she said.

“It is one of many common misogynistic practices in women’s medical care,” she said.

A threat of divorce… either a cesarean delivery or a “stitch”

Marwa’s prenatal visit took an unexpected turn when she inquired about the feasibility of a natural childbirth. Instead of a straightforward medical discussion, the doctor redirected the conversation towards Marwa’s husband, delving into the alleged detrimental effects of natural childbirth on the “area,” alluding to the vagina.

Emphasizing the supposed risks, the doctor asserted that natural childbirth widens the vagina, potentially leading to sexual problems and, ultimately, divorce, according to Marwa. The discussion extended to the perineal incision, with the doctor’s assertion that, regardless of the method—natural birth or cesarean section—an incision would occur. However, “a cesarean section wound will not affect the condition of the vagina!”

Curiously absent were any mentions of potential complications associated with cesarean delivery, a procedure known to carry its own set of risks for women and newborns. She also did not talk about any possible complications of natural childbirth either.

Marwa confirmed that she “only mentioned the effect of the vaginal opening on sex.” According to this patriarchal perspective, women are reduced to objects of sexual pleasure for their husbands.

The doctor’s approach exhibited a lack of concern for Marwa’s sexual and reproductive well-being, disregarding her agency in the decision-making process. Instead of addressing Marwa directly, the doctor took a shortcut, directing the conversation to her husband. This sidestep is particularly noteworthy considering that the decision to give birth is inherently tied to the woman’s body and should involve her as the primary decision-maker. The doctor further exploited cultural and patriarchal norms by leveraging the perceived authority of Marwa’s husband, who believed that a narrow vagina was crucial for sexual satisfaction, thereby steering Marwa toward a cesarean section.

Medical violence: a favor for a “good man”

The physician’s endorsement of male dominion over women’s bodies is a prevalent aspect of medical violence against women.

This is evident in procedures related to women’s reproductive functions, such as childbirth, abortion, and tubal ligation (i.e., the uterine duct connecting the ovary and uterus). Notably, both public and private hospitals often mandate spousal consent for these procedures.

Marwa, apprehensive about the doctor’s approach, sought clarity on her ability to have a natural childbirth. The doctor assured her that there were no contraindications at that time and, with a veneer of courtesy, suggested a “cosmetic stitch” for vaginal narrowing if Marwa insisted on natural childbirth. The rationale, as articulated by the doctor, was framed as a gesture “for the sake of this good man.”

Despite the gravity of the proposed vaginal tightening and stitches, described as “cosmetic,” the doctor did not engage Marwa in a discussion to obtain informed consent or provide insights into the procedure’s purpose. Instead, the procedure was couched as a sexual gift for the presumed benefit of the “good” man.

Faced with the ultimatum of cesarean section or the “husband stitch” under the looming threat of divorce, Marwa succumbed to the pressure and underwent an unnecessary cesarean section, devoid of any medical necessity.

The societal narrative that shapes men’s self-worth around sexual performance plays a pivotal role in these dynamics. Men, conditioned to perceive their value through sexual prowess, often hesitate to seek medical consultation. This social construct perpetuates the misconception that their partner is solely responsible for any perceived sexual dissatisfaction, contributing to the coercive circumstances faced by women like Marwa.

Women are not sex vessels

Marwa developed complications after her unnecessary cesarean section and gave birth to a baby girl with respiratory problems that required her to be confined to an incubator for ten days.

Marwa and her child suffered health complications, and their physical safety was endangered. Marwa is one of many cases where women have faced obstetric and gender-based violence, just because a man decided that his sexual pleasure was the priority. Furthermore, it underscores how some medical professionals, succumbing to patriarchal notions, exploit these beliefs for financial gain by steering women towards unnecessary procedures like cesarean sections.

Dr. Yasmine Abu Al-Azm, in discussions with “Sharika Wa Laken,” emphasized a crucial distinction – “natural childbirth is not the cause of vaginal widening. She pointed out that pelvic muscle weakness, vaginal muscle issues, and ligament problems stem from various factors, including cesarean sections, improper delivery procedures, chronic constipation, and severe coughing.”

If this is a problem that bothers women themselves, “the solution is not to subject them without permission to the crime of ‘the husband’s stitch’ or direct them to unnecessary cesarean section. Instead, the focus should be on strengthening the pelvic and vaginal muscles by treating the causes of their weakness, eating a healthy diet, and exercising appropriately.”

Dr. Abu al-Azm highlighted an alarming trend: “women experiencing episiotomy during subsequent births, indicating an exaggerated narrowing of the vagina in prior deliveries.” This practice, she asserts, “aligns with the problematic perspective of treating women as mere vessels to be molded for male pleasure.”

The gravity of this issue is acknowledged globally, with the United Nations’ Special Rapporteur on violence against women, Dubravka Šimonović, condemning perineal incisions and routine vaginal dilation during childbirth.

She categorizes such interventions as forms of violence, torture, and inhuman treatment when unnecessary or lacking explicit consent.

The report underscores “the deeply rooted patriarchal stereotypes and unequal power dynamics between men and women, epitomized by the notorious practice known as the husband’s stitch.”

Sexual pleasure is a collaborative experience that transcends the notion of a mere “stitch.”

As Asmaa prepared for her second childbirth, she sought a remedy for her husband’s discontent during sexual intercourse. He attributed this dissatisfaction to the perceived widening of her vagina post-childbirth, a belief deeply ingrained in Asmaa’s mind through repetitive reinforcement.

Asmaa’s husband is not an isolated case; many men subscribe to the toxic masculinity notion that places the burden of achieving sexual pleasure solely on their partners.

This stems from the patriarchal idea that women are primarily responsible for such satisfaction. Additionally, social norms instill a sense of shame in men regarding potential sexual issues, as they are conditioned to tie their value to sexual performance. Consequently, many men hesitate to seek medical advice or consider that their partner might not be the source of their sexual dissatisfaction.

Asmaa is also not the only woman who has been imbued with patriarchal thoughts about the need for vaginal tightness in order to achieve sexual pleasure. Women also grow up with these concepts, thinking that sexual gratification is a woman’s responsibility, mirroring broader expectations related to caregiving and domestic roles.

In her quest for a solution, Asmaa approached her doctor with a request for a stitch, or two, to narrow her vagina during childbirth. Despite her doctor’s refusal, citing the non-medical nature of the procedure, Asmaa persisted in search of a practitioner who would comply.

While acknowledging that sexual pleasure is a shared responsibility, the social narrative tends to disproportionately blame and demand action from women to “fix” perceived issues, often at the expense of their physical and psychological well-being. This narrative largely ignores men’s roles, responsibilities, sexual performance, and even physical attributes in discussions about sexual satisfaction and pleasure.


“Sawt”… Obstacles on the Road to Accountability

In its commitment to champion women’s rights, the “Sawt” initiative has recently launched an impactful awareness campaign focusing on women’s sexual and reproductive rights. The campaign’s primary objective is to heighten awareness among women and medical professionals about the prevalent issue of obstetric violence, with a specific focus on the contentious practice known as the “husband’s stitch.”

Noha Sayed, a distinguished lawyer and the executive director of Sawt, boldly asserts that the “husband’s stitch” amounts to “a crime of female genital mutilation” from a legal standpoint. She expounds on this, framing it as a form of exerting control over others’ bodies, akin to a manifestation of human trafficking. Sawt consistently employs this framing strategy in its awareness campaigns across various social media platforms.

Within the framework of Sawt’s initiatives, Noha actively encourages women who have been victims of obstetric violence, including those subjected to the “husband’s stitch,” to pursue legal action against the perpetrators. Recognizing the critical role of legal recourse in curbing such violations, Sawt also extends its support by providing legal assistance to these women. This approach aligns with the belief that holding individuals accountable and eliminating impunity are vital steps toward ending these egregious practices.

However, Noha sheds light on the formidable challenges women encounter when seeking legal redress. These hurdles encompass insufficient community awareness, the difficulty of substantiating harm, and societal stigmatization of affected women. Additionally, there is a tendency for those responsible for documenting cases to overlook the privacy considerations of women who have suffered from this particular form of violence.

Today, Salma has been receiving treatments for over two years. Her physical condition has improved slightly. Nonetheless, she remains incensed at the medical professional who performed a non-consensual, non-medical procedure involving incision and stitching without anesthesia.

Marwa, grappling with postpartum depression, endeavors to overcome the guilt stemming from succumbing to pressure from her husband and doctor, leading to an unnecessary cesarean section that jeopardized her and her child’s well-being.

Meanwhile, Asmaa, who sought the “stitch” at her request from another doctor, received congratulatory remarks for being “back as a bride” after the procedure, signifying a perceived restoration of vaginal tightness. A year after her procedure, Asmaa continues to suffer every time she has sex, and her husband persistently expresses his dissatisfaction.

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