(Reuters Health) - When doctors are asked to perform virginity testing, they should refuse because it’s not medically necessary and may cause psychological harm, some U.S. ethicists argue.

These pelvic exams are done in many parts of the world to determine suitability for marriage. But doctors shouldn’t agree to these exams because they violate three core ethics of the profession – protecting patient welfare, respecting women’s autonomy, and promoting justice - a group of ethicists wrote recently in an essay the Lancet.

“Virginity testing does not protect and promote the health of female patients; virginity testing is therefore completely incompatible with each of these three principles of professional ethics in obstetrics and gynecology,” said Laurence McCullough, an ethics and health policy researcher at Baylor College of Medicine in Houston and a co-author of the essay.

The exam can be painful or make women feel humiliated or degraded, McCullough added by email.

“There is no net clinical benefit and (a) preventable risk of biopsychosocial harm,” McCullough said.

In the test, which is often called a “two-finger” test, the doctor does an internal vaginal exam to feel the hymen, a thin membrane that some cultures believe remains intact until women have sexual intercourse.

Some women, however, may be born without a hymen, and the membrane can also rupture or stretch from activities like sports or using a tampon.

Many human rights organizations have condemned virginity testing as inhumane and unethical. The World Health Organization has said “there is no place for virginity (or `two-finger’) testing; it has no scientific validity.”

Still, the practice persists in many parts of the world, including India, Turkey, Afghanistan, Egypt, Libya, Jordan, Indonesia and South Africa. It may be done out of a cultural or religious belief that the test can ensure women are virgins until marriage.

Virginity tests have also been done in other situations to ensure, for example, that women are virgins when they enter the military. Tests have also been performed when women are accused of moral crimes or have run away from home.

In South Africa, the tests fell out of use but then became more common again with the rise of the AIDS epidemic, said Louise Vincent, a researcher in virginity testing and other women’s reproductive health issues at Rhodes University in South Africa who wasn’t involved in the study.

In the context of AIDS, in a country where many very young women report that their first sexual experiences aren’t consensual, the specter of virginity tests can potentially serve as a deterrent against unwanted sexual advances, Vincent, who wasn’t involved in the study, said by email.

“It is all very well for high-minded westerners to preach justice and autonomy of the person, but these ethical principles have no efficacy in the context I describe,” Vincent added. “Here for a young girl to say to an insistent man `I can’t, I have to get tested next week by the elder women’ can act as a rare instrument to resist in a context in which such means are often absent.”

Even in these circumstances, though, the tests are unethical for doctors to perform, McCullough said.

“There are no situations in which the female patient can be considered better off by having virginity testing performed,” McCullough said.

SOURCE: bit.ly/1RKPrhc The Lancet, online December 22, 2015.