NHS Hymen ops on young girls

I think there are some pretty serious questions as to whether invasive cosmetic procedures are ever ethical from a medical standpoint. It's possible to compare things that aren't identical - it's the whole point of comparisons.

Maybe some women want that for their wedding night.

Are you fucking kidding me? That is egregious victim-blaming. It is terrifying for women. There is sometimes a mob outside, waiting to lynch her if she doesn't bleed. Or maybe she's 'lucky' and the family just force poison down her throat, or dowse her with kerosene and set her on fire, in private.

The absolute privilege of equating social pressure to look a certain way with what women in highly patriarchal cultures go through for 'honour'. You have no idea if you think the two are in any way equivalent.

This was my first thought.

Medical coding is a nightmare. It’s all about money. There’s a bit of money for “chest infection” but there’s more money for “left lower lobe pneumococcal pneumonia with bacteraemia”. Which is fine, but there’s an onus on doctors from medical coding people to be accurate for money reasons, when doctors just want to do the job and not sweat on details like this.

It also skews data for research purposes. A doctor in training did an audit on anaphylaxis in children in the local emergency department and found huge numbers, but it turned out everyone had been told to make sure they tried to fit anaphylaxis as the diagnosis any allergic reaction (they had a slight cough? Anaphylaxis!) because it meant more funding.

The cases need reviewing.

And of your argument is a woman who doesn't bleed may be killed, surely a hymen repair could be argued to be lifesaving?

In terms of a consenting adult undergoing an unnecessary surgery I'm not sure it is that different tbh. Maybe some women want that for their wedding night. Societal pressure on women to have surgery that could make or kill them is ridiculous

Ah, so now we're saying that a hymen repair is no different from a nose job, are we?

AFAIK, no woman has ever been murdered in an "honour killing" for having a big nose. Millions of women have been murdered or mistreated for supposedly not being virgins. There are still many cultures which display the bride's wedding night sheets, and in which a young woman is at risk of murder for not bleeding on her wedding night.

Yes, that FGM case was terrible. At the time, there had been no prosecutions of people who actually perform FGM and, instead, the CPS went after a young doctor in an emergency situation, who was trying to repair birth injuries to a woman who had previously undergone FGM and had just given birth.

It was truly bizarre - they accused him of re-doing the FGM but you cannot repair tissue that has already been removed. He could only work with what the people who had originally mutilated his patient had left. What was he supposed to do? Leave her to bleed? The patient totally supported the doctor, and refused to give a statement to the police.

Thank god, the prosecution was not successful, otherwise we would have ended up with UK doctors afraid to treat women who have undergone FGM.

I also recall that case. What I don't understand is how it came to the attention of the police/CPS.
Same with some of the prosecutions that have been going on of women with respect to possible illegal abortion.

Only clinical staff present would surely know about individual cases? Obviously if there are safeguarding issues these need to be raised. But the FGM case was ridiculous.

Is it any more disturbing than the gazillions of unnecessary surgeries that are done privately on consenting adults all the time? That's a very different question to do the nhs do unnecessary hymen repairs on young girls at the behest of their parents, to which I'm very sure the answer is no

That is a very, very different issue. Either parent (provided they have parental responsibility) can consent to a medical procedure. Circumcision is a well-recognised operation with proven clinical benefits for some boys, at least. A cirumcision with consent from a parent is in no way analogous to a hymen repair.

I don't want to get into an argument about the wrongs and rights of religiously- motivated (male) circumcision: can we please stop using analogies about men to trivialise what happens to women and girls? I don't believe that hymen repairs have happened on the NHS but they do happen privately in the UK and elsewhere - and that is disturbing.

Medical coding is actually a very complex role. It is possible some of these are incorrect as others have suggested but the reality is some may be true.

I'm afraid the NHS does have some issues still to address around faith and culture with some doctors just not recognising what is right/wrong/legal etc. a good example was the father who had his baby son on an access visit and took him to be circumcised without any presence of consent from the mother.

I’m going to get flamed for this but as our culture is diversifying we will start to see lots of culture clashes in this regard. Islam particularly praises virginity and operations like this will likely become more common anyway as the islamic population increases im not making a judgement on that just an observation another example recently was that in Islam your not allowed to shake hands with women but obviously western customs say otherwise. It just the price we pay for a diverse culture.

WRT the coding thing - medical coding is not an exact science. It's really common for codes to be a little inexact, or for no one to notice they should be updated, or also for people who are doing the billing to make errors. There are a lot of codes and unusual ones might be less understood by the people doing the billing. Plus there is a speed element.

It's not just an issue in the NHS, it's something that happens in other systems and also private insurance situations.

I would also suspect that hymenoplasty might be used to code for treatment of haematocolpos (imperforate hymen causing build up of the products of menstruation in a distended uterus).

The nhs buy into Snomed that's a worldwide coding system. You can amend to make it more appropriate for your country but I'd guess it's just the code hasn't been removed and someone has used in error. Some of the descriptions put in to notes are very hard to decipher and so coders do their best but aren't infallible.

Sadly, typical of the level of competence of police and CPS, which only continues to get worse.

Don't all genital surgeries and piercings now come under FGM legislation? So, there shouldn't be labiaplasty or genital surgery for trans identified females?

Yes, that FGM case was terrible. At the time, there had been no prosecutions of people who actually perform FGM and, instead, the CPS went after a young doctor in an emergency situation, who was trying to repair birth injuries to a woman who had previously undergone FGM and had just given birth.

It was truly bizarre - they accused him of re-doing the FGM but you cannot repair tissue that has already been removed. He could only work with what the people who had originally mutilated his patient had left. What was he supposed to do? Leave her to bleed? The patient totally supported the doctor, and refused to give a statement to the police.

Thank god, the prosecution was not successful, otherwise we would have ended up with UK doctors afraid to treat women who have undergone FGM.

Equally though, if you are trying to monitor illegal or suspicious activity you have to have a code for that.
I agree with pp that a better range of codes would be helpful, but that assumes that individuals will code procedures correctly and that the NHS tech systems are up to it.

I agree with this.
I think we have to accept that the NHS coding system is far from perfect, not only in its creation but in its application.
There was a thread on here recently about the number of serious errors people found in their own medical records that they were unable to ask to be corrected.
I came across coding errors all the time when I was working.
There has always been a demand for hymen repair in the private sector, I would think that most of what is done in the NHS is mostly repairing injury following assault/intercourse/childbirth where the woman has previously suffered FGM.
I remember some years ago a doctor was facing an enquiry for repairing terrible damage post birth in exactly these circumstances. From what I heard he didn't have much choice if he was to stop the bleeding and preserve continence. He was an easy target though given that there have hardly been any prosecutions for actual FGM.

No problem - and I agree the code should have been removed years ago.

I'm just providing an explanation.

And they haven't put me in charge of NHS surgical coding, as far as I know, so not sure why you're having a go at me?

I can't say for sure, of course, but that would be my suspicion, backed up by the low numbers, which would fit with this relatively rare type of injury (sexual abuse isn't rare, of course, but fortunately most victims don't require surgery).

Thanks for that insight. How awful about the abuse.