No abstract

BackgroundSo-called virginity testing, also referred to as hymen, two-finger, or per vaginal examination, is the inspection of the female genitalia to assess if the examinee has had or has been habituated to sexual intercourse. This paper is the first systematic review of available evidence on the medical utility of virginity testing by hymen examination and its potential impacts on the examinee.MethodsTen electronic databases and other sources for articles published in English were systematically searched from database inception until January 2017. Studies reporting on the medical utility or impact on the examinee of virginity testing were included. Evidence was summarized and assessed via a predesigned data abstraction form. Meta-analysis was not possible.Main ResultsSeventeen of 1269 identified studies were included. Summary measures could not be computed due to study heterogeneity. Included studies found that hymen examination does not accurately or reliably predict virginity status. In addition, included studies reported that virginity testing could cause physical, psychological, and social harms to the examinee.ConclusionsDespite the lack of evidence of medical utility and the potential harms, health professionals in multiple settings continue to practice virginity testing, including when assessing for sexual assault. health professionals must be better informed and medical and other textbooks updated to reflect current medical knowledge. Countries should review their policies and move towards a banning of virginity testing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0319-0) contains supplementary material, which is available to authorized users.

IntroductionMany low- and middle-income countries have implemented health-system based one stop centres to respond to intimate partner violence (IPV) and sexual violence. Despite its growing popularity in low- and middle-income countries and among donors, no studies have systematically reviewed the one stop centre. Using a thematic synthesis approach, this systematic review aims to identify enablers and barriers to implementation of the one stop centre (OSC) model and to achieving its intended results for women survivors of violence in low- and middle-income countries.MethodsWe searched PubMed, CINAHL and Embase databases and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative and mixed methods studies. Overall, 42 studies were included from 24 low- and middle-income countries. We used a three-stage thematic synthesis methodology to synthesise the qualitative evidence, and we used the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess confidence in the qualitative research. Meta-analysis could not be performed due heterogeneity in results and outcome measures. Quantitative data are presented by individual study characteristics and outcomes, and key findings are incorporated into the qualitative thematic framework.ResultsThe review found 15 barriers with high-confidence evidence and identified seven enablers with moderate-confidence evidence. These include barriers to implementation such as lack of multisectoral staff and private consultation space as well as barriers to achieving the intended result of multisectoral coordination due to fragmented services and unclear responsibilities of implementing partners. There were also differences between enablers and barriers of various OSC models such as the hospital-based OSC, the stand-alone OSC and the NGO-run OSC.ConclusionThis review demonstrates that there are several barriers that have often prevented the OSC model from being implemented as designed and achieving the intended result of providing high quality, accessible, acceptable, multisectoral care. Existing OSCs will likely require strategic investment to address these specific barriers before they can achieve their ultimate goal of reducing survivor retraumatisation when seeking care. More rigorous and systematic evaluation of the OSC model is needed to better understand whether the OSC model of care is improving support for survivors of IPV and sexual violence.The systematic review protocol was registered and is available online (PROSPERO: CRD42018083988).

This article highlights the timely situation that resident physicians, faculty, and staff are facing after the recent highly publicized murders of Black Americans and its impact on our healthcare communities. We discuss our experiences of how the hospital can serve as a meeting place for anti-racism, as well as how anti-racist events at the hospital can raise public consciousness and be catalysts for creating a more inclusive, diverse, and welcoming environment for all members of hospital communities.