Three months after undergoing a natural birth, which caused widening of the vagina as a result of a surgical procedure called an “episiotomy”, Reham Ali (32 years old) found herself compelled, under pressure from her husband and his constant threats of divorce or of marrying another woman because their relationship had been affected by the after-effects of the operation, to go to the doctor and request another surgical operation to deal with the matter; despite her intense fear of this surgery, she had no choice as the pressure and the threat of breaking up the home mounted.
The operation that Reham resorted to is known among women as the “husband stitch”, because most of these operations are carried out at the husband’s request, without medical or health reasons, while the majority of women fear undergoing it, according to what they told Zawia3.
Scientifically, it is defined as a procedure that is non-medical and professionally condemned, in which one or more stitches are added to narrow the vaginal opening while stitching tears after a natural birth, with the aim of increasing the man’s sexual pleasure, while this practice is classified globally as a form of medical violence and a violation of women’s bodily rights, as it is often carried out without the mother’s consent or knowledge, according to the Sexuality Forum.
Dr Amal Fahmy, executive director of the “Tadwein” foundation, explains to Zawia3 that talk of this practice is linked mainly to a medical procedure known as an “episiotomy”, the surgical incision that may be made during a natural birth to ease the exit of the foetus’s head, noting that some doctors stitch this incision after delivery, and in some cases one or more stitches may be added during the stitching, which is popularly referred to by the term “husband stitch”.
In the absence of official statistics on the number of women who undergo vaginal tightening operations after childbirth in Egypt, women’s groups on social media reveal the growing interest in these surgeries: one of the groups has more than 6,200 members, and some of its posts attract more than 350 comments from women looking for doctors or exchanging their experiences.
Another group has about 27,000 members and sees almost daily discussions about female cosmetic surgery, while a third has nearly 6,600 members, in addition to a closed group with about 11,000 members in which they exchange experiences and recommendations of doctors.
Although these figures do not constitute statistical evidence, they reflect the scale of the growing demand for these surgeries, and the spread among a segment of women of the notion that a natural birth requires surgical intervention to restore the shape and function of the vagina.
Commenting on this, Dr Amal Fahmy says there is a problem in the absence of accurate data and statistics, explaining that there are no official figures showing the number of doctors who add extra stitches during stitching, the number of women who have been subjected to this, or the number who explicitly agreed to it, and noting that the lack of data makes it difficult to assess the scale of the phenomenon in an accurate scientific way, and that there must be a mandatory database in hospitals in order to monitor these phenomena and to protect women from abuses and physical violence.
Women Between the Terror of Surgery and Their Husbands’ Pressure
The testimonies of women who spoke to Zawia3 confirm that the matter is not an exception, but a phenomenon that has become widespread in recent years, amid husbands’ pressure on women to undergo these surgeries.
Mona Abdallah (29 years old) did not think of having any surgery after the birth of her first child, as she considered that recovery needs some time, but her husband’s repeated words about the relationship between them “being different” led her to lose her self-confidence and doubt her body. She tells Zawia3 that she tried to convince him that the doctor had told her that what she was feeling was normal after childbirth, and that most of the changes improve gradually during the first months, but his comments did not stop, and he began comparing her with how she had been before the pregnancy, demanding that she look for a “quick fix”.
She adds that her husband’s pressure was not the only kind: some women close to her advised her to have a vaginal tightening operation, insisting that it had become a common procedure among women after childbirth. As the talk was repeated, she began searching online and in women’s groups on social media for the names of doctors and the experiences of other women, before booking an appointment at a private clinic.
During the consultation, the doctor told her that the operation could be performed, explaining that it would improve the shape of the tissue and might have an effect on the marital relationship, without adequately explaining to her the limits of the results or the possibility that the surgery was not medically necessary. After hesitating for weeks, she agreed to undergo it, not because of a health problem, but to end the state of tension inside her home. She says: “I was not looking for cosmetic improvement so much as I was looking for stability, and I felt that my body had become responsible for the survival of my marriage.”
Likewise, Sara Mahmoud (35 years old), a mother of two, remembers that the idea of having a vaginal tightening operation did not occur to her until years after her last natural birth, and she says that it began with a passing comment from her husband about the marital relationship being affected, before it turned into a repeated complaint that led him to demand that she see a gynaecologist.
She explains that she was not suffering from health problems, urinary incontinence or prolapse of the pelvic organs, but the doctor offered her the surgery as a means of improving the “quality of married life”, and after consulting another doctor, she received almost the same opinion, which reinforced her conviction that the operation had become a usual option.
She adds that the cost of the surgery (which reaches EGP 20,000 in some cases) was high compared with the family’s income, but she had to borrow part of the sum from her sister, considering that preserving the stability of her family life was more important than the financial burden. After the operation, she needed weeks to recover, but she says that the results were not as great as she had expected, and that the tension between them did not disappear completely.
She describes her experience as having revealed to her that the problem was not only physical, but was linked to an absence of dialogue and to unrealistic expectations about the effect of childbirth on a woman’s body, and she adds: “If I could turn back time, I would first look for a specialist consultation or pelvic floor physiotherapy, before thinking about surgery.”
In contrast to these testimonies, Hasnaa Salem affirms that she asked the doctor to perform vaginal tightening of her own free will, and she says: “After the natural birth I felt that the relationship was no longer what it had been, and I myself was not comfortable. So I began looking for a specialist doctor.” She adds to Zawia3 that she did not feel that anyone had forced the decision on her; rather, she considered it a means of regaining her sense of comfort and confidence.
In a related context, Dr Amal Fahmy draws a precise distinction between the two cases, explaining that the female cosmetic operations that some women resort to of their own free will, especially after repeated births, fall within legitimate cosmetic operations as long as they are performed by a specialist doctor licensed to practise this type of surgery, and as long as the woman is an adult over the age of eighteen and has given her full consent to the procedure; this, from an ethical and professional point of view, is what distinguishes a free decision that a woman takes herself from a procedure that is practised on her or imposed on her under pressure.
Is There a Medical Necessity?
A medical source, an obstetrics and gynaecology specialist who preferred not to be named, explains to Zawia3 that a large number of women experience a tear around the birth canal as the baby’s head descends, and that the aim of the doctor’s intervention in this case is to make a clean cut that prevents laceration of the sphincter muscle or the urinary tract, explaining that after the birth the vagina is stitched again, whether the cut was natural, caused by the foetus’s head, or an interventional cut made by the doctor, and that this procedure fundamentally has nothing to do with the husband or the marital relationship.
He points out that there are other, completely different cases, when some women complain after childbirth of dissatisfaction with the marital relationship, or of the husband’s dissatisfaction, and request tightening as a simple cosmetic procedure, which is carried out at the request of the patient herself.
He explains that the body goes through many changes after childbirth to return to a state close to how it was before pregnancy, and that it is normal for the vagina to narrow a little over time, which may cause pain during sexual intercourse for a period before things gradually return to normal, noting that the problem occurs when some husbands rush this period and have marital relations on a relatively fresh wound, which is by its nature painful.
In his assessment of the practice known as the “husband stitch”, he considers it an unethical medical practice that warrants accountability if it is proven to have occurred in its precise sense, that is, adding a stitch where there is no wound at all, solely for the purpose of tightening. But he pointed to a real difficulty facing the process of assessment and accountability, namely the difficulty of distinguishing in practice between ordinary vaginal stitches after childbirth and the so-called “husband stitch”, explaining that the two procedures are very close technically, and the only difference is the degree of additional tightness.
He says: “What is certain is that if there is no wound, the procedure is unnecessary, but if there is a wound, the stitch is a normal repair of the vagina.” He stresses the importance of raising awareness that any actual wound must be stitched medically, and that the decisive criterion in judging a violation is whether there is a wound in the first place: if there was no wound, and the doctor stitched or tightened anyway, then the problem clearly exists.
For her part, Magda Soliman, director of the health and reproductive rights programme at the Center for Egyptian Women’s Legal Assistance (CEWLA), tells Zawia3 that she had never heard the term “husband stitch” before, but she knows the practice it refers to, explaining that it concerns a procedure carried out after a natural birth by narrowing the vaginal opening with extra stitches, on the claim of achieving greater sexual satisfaction for the husband.
She adds that during a natural birth an incision or tear in the tissue may occur and is stitched medically after delivery, but the idea of adding extra stitches with the aim of tightening the vagina to please the husband is the idea referred to by the term “husband stitch”.
Asked about the rights dimension of this practice, she affirms that the issue cannot be separated from a wider reality relating to the violation of women’s bodily rights in general, saying that from childhood a woman is subjected to multiple forms of guardianship and interference in her body and her personal decisions.
She points out that from her earliest years a girl faces restrictions and interference relating to her appearance, her clothes and the way she sits and moves, up to more private decisions relating to her reproductive health and her medical choices, and she adds that the idea of a woman having full authority over her body still faces great challenges in society.
She also explains that this interference is not limited to practices linked to childbirth or marital relations, but also extends to decisions relating to the use of contraceptives, explaining that it is the woman who bears the potential physical and psychological effects of some methods, such as bleeding or various health complications, yet she is often asked a question about the husband’s consent or knowledge of the matter.
She says that interference in a woman’s health decisions sometimes extends even to the treatments and medicines she takes, as the husband’s opinion is treated as a factor present in decisions that directly concern the woman’s body and health, even though these decisions affect her alone from a health, physical and psychological point of view.
Having looked at the volume of advertisements and centres promoting vaginal tightening services, Magda says that this phenomenon reveals a general trend whereby most of the medical means on offer revolve around achieving the man’s sexual pleasure, while the woman’s needs and desires are ignored. She adds that the prevailing discourse often treats the woman as a means of achieving the man’s comfort and pleasure, and not as a full partner in the marital relationship. She asks: is the same question raised about the woman’s enjoyment or comfort or the effect of these procedures on her? She stresses that women’s needs are often absent from the discussion.
She also believes that there is a chain of social and cultural practices that all share in putting the man’s sexual interest first as a priority, starting with some practices linked to controlling a girl’s body, through the pressures linked to marriage and childbirth, and up to procedures such as vaginal tightening or what is known as the “husband stitch”.
She adds that the problem does not stop at these practices alone, but extends to other issues that are still the subject of legal and social controversy, such as the issue of marital rape, noting that this issue has been up for discussion for many years and has seen numerous legal and rights-based interpretations and debates, and that the discussion about criminalising it still faces disagreements and divergent interpretations between legal, religious and social perspectives, which has led to the controversy over it continuing without a final resolution to this day.
For her part, Amal Fahmy, director of the Tadwein foundation, stresses that the basic criterion for any medical intervention must be respect for the ethical and professional rules governing medical practice, explaining that the episiotomy itself should not be performed routinely or automatically during a natural birth, and that modern medical standards set clear controls for performing it, so that it is done only in cases that medically require it.
She affirms that performing an episiotomy without medical necessity, or only to make the delivery easier for the doctor, is a professionally and ethically unsound practice. She also considered that adding extra stitches with the aim of tightening the vagina without the woman’s explicit consent is entirely unacceptable ethically, and that any intervention in a human body (whether a woman’s or a man’s) must take place on the basis of the informed and clear consent of the person themselves, stressing that obtaining consent is a basic right that may not be bypassed.
She added that a woman who undergoes an episiotomy already suffers pain and potential complications linked to the procedure, and therefore adding extra stitches without her consent may have multiple negative effects, including pain during marital relations or the possibility of developing various health complications.
She stresses the importance of distinguishing between individual practices and phenomena proven by figures and studies, affirming the need for accurate research and statistics on episiotomy rates in Egyptian hospitals, the extent of its routine use, and the degree to which doctors adhere to the medical protocols governing it. She said that the existence of clear data on this issue would reveal the scale of the problem and help hold to account any medical practices carried out in violation of professional and ethical standards.
She affirms that doctors specialising in female cosmetic surgery are legally obliged to obtain the consent of the adult woman before carrying out any medical or cosmetic intervention, but this does not negate the need to make women aware of the psychological and social pressures that may push some of them to take decisions that do not necessarily express their free wishes, but rather come as a result of practices of psychological or emotional violence within the marital relationship.
Egypt is witnessing a notable demographic and medical shift in methods of childbirth, as the country has recorded a large jump in caesarean section rates over the past decade. According to the Egypt Family Health Survey and the official data of the Ministry of Health, the proportion of caesarean births rose from 52% in 2014 to reach 72% in 2021, with projections indicating that it would reach about 80% in 2025.
Egypt is currently among the countries with the highest caesarean birth rates in the world, which prompted the Egyptian government to launch initiatives aimed at reducing this proportion to 40–50% by the end of 2026 by encouraging natural birth and raising mothers’ awareness of the risks of unjustified surgery.
It is worth noting that this large rise in caesarean birth rates, according to Dr Amal Fahmy, makes natural births relatively fewer in Egypt, but the episiotomy is still performed in a number of the remaining natural births, whether in Egypt or in other countries, and it is the procedure to which the “husband stitch” remains directly linked.
Pelvic floor disorders (PFDs) are a group of medical conditions that affect a woman’s quality of life after childbearing, while studies indicate that these disorders are common, at rates ranging from 30% to 50% among women who have given birth. In Egypt, research has revealed that the prevalence of these disorders reaches about 41%, and these conditions vary to include overactive bladder and pelvic organ prolapse, conditions that are closely linked to the number of births and the nature of the medical interventions during the procedure.
The female cosmetic sector is witnessing accelerating growth at the global level, and is no longer limited to cosmetic aspects but has extended to include women’s functional and psychological aspects. The size of this market is estimated at about $1.01 billion in 2025, with projected annual growth of up to 16.07%.
Labia cosmetic operations top the list of the most requested female surgeries, having recorded an increase of 45% globally, followed by vaginal tightening and rejuvenation operations, which increasingly rely on non-surgical techniques such as laser and HIFU.
Finally… tracing women’s testimonies and the views of doctors and rights advocates reveals that the controversy over what is known as the “husband stitch” goes beyond being a medical discussion about a surgical procedure, to a wider question relating to a woman’s right to take decisions about her body free from social or marital pressures. While specialists distinguish between cosmetic surgeries carried out on the basis of a woman’s conscious and informed wish and any intervention imposed on her or practised without her consent, the absence of official statistics and of mechanisms for monitoring and accountability remains an obstacle to measuring the scale of the phenomenon and dealing with it.
At a time when demands are growing for stricter adherence to medical protocols and for guaranteeing informed consent before any intervention, the issue remains a mirror of a more complex relationship between medicine and social culture, in which the bodies of many women are still measured by standards that go beyond their health needs to the expectations of others, so that medical decisions that are supposed to be personal turn into a response to social and psychological pressures that may be no less impactful than any surgical intervention.
