How much to get that extra stitch? He asks. You offer that, right?

Please, I say to him. But it comes out slurred and twisted and possibly no more than a small moan. Neither man turns his head toward me.

The doctor chuckled. You aren’t the first

An excerpt from Carmen Maria Machado’s “The Husband Stitch,” a short story part of her collection Her Body and Other Parties.

I distinctly remember when I was first exposed to the concept of the “husband stitch.” I was perusing the internet when I came across Machado’s short story. The piece itself was heart-wrenching and emotive; poignant and raw. But it was this scene, where the narrator’s husband asks the physician (who was repairing the narrator’s torn perineum) to add an “extra stitch,” that had me the most gutted. 

I didn’t understand. How could something like that even occur? How could a physician— sworn to heal and treat in the best interest of the patient— even entertain the husband’s request? Why would they need to make the vaginal opening smaller? And, most troubling of all, why did they not listen to or ask the narrator— the individual whose body was being altered? 

Even if it was a work of fiction, every fictitious piece has some truth to it. So, I decided to investigate. 

The “husband stitch,” alternatively known as the “daddy stitch,” is a surgical procedure where an extra suture (or three) is added during the usual reparation made if a woman’s vaginal opening tears when giving birth. It is a form of female genital mutilation; albeit, it is one that occurs behind closed doors and under the guise of a surgical repair. This “extra stitch” is thrown in for only one reason: to increase the “tightness” of a woman’s vagina for male sexual pleasure.

The practice reflects the patriarchal influences within the healthcare system. Even after giving birth, a woman’s body is repaired with the man’s pleasure in mind. The woman’s well-being and pleasure are completely ignored, while simultaneously emphasizing the outdated idea that a woman’s body exists for the fulfillment of a man’s sexual desires. When physicians add the stitch to make the vaginal opening ‘smaller’ to increase the ‘tightness’ of the vagina for ‘better sex,’ they’re only perpetuating harmful stereotypes about sex and the female anatomy. 

Making the vaginal opening smaller does not make a woman’s vagina ‘tighter.’ Nor does that ‘tightness’ equate to more pleasurable sex. In fact, as many resident sex experts and physicians say, the forcible shrinkage of the vaginal opening only translates to painful intercourse for women. Sometimes, as their body struggles to accommodate penetration with the extra stitch, a rupture or tear can occur. 

No matter the outcome, all end in pain and begin with the patriarchy.

The “husband stitch” is nothing more than an outdated and misogynistic practice that continues to violate women within the healthcare system. After giving birth, women are in one of their most vulnerable states, incoherent and barely conscious. They are unable to intervene, with most too caught up in the foggy haze to completely understand what’s going on. It isn’t until they resume sexual activity— which is now accompanied by excruciating pain— do they realize what has happened. But many women go years before understanding why every attempt at sexual intercourse is an agonizing process. And some? Some never realize at all. 

In the past couple of years, various women have come out about the “extra stitch” they too were given. All of them relate the haziness of the incident, the brazen liberty taken by the physician, and the confusion over the pain afterwards. 

Marie Jackson, a 35-year old mother of three, recounts her unfortunately all-too-common experience. 

“When my gynecologist revealed that the physician who had handled by third delivery had made my vaginal opening smaller than it was supposed to be, I was shocked,” Jackson says. “I didn’t even know this… extra stitch… was even a thing.”

“I had no clue he did that… I was horrified.”

She explains how the physician hadn’t bothered to even ask her, nor her husband. “My husband had no clue the doctor did that, I had no clue he did that. We spent months puzzling over why sex was so painful for me. And to think it was because of this stitch that wasn’t supposed to be there… I was horrified.”

And rightfully so. Now, it is important to note that the sole decision about bodily altercations of the woman should remain with the woman. However, the physician choosing not to reveal the extra stitch to McCoy’s husband reveals a frightening reality: it’s commonplace to believe that a woman’s body exists for a woman’s pleasure, thus any alterations to it to increase a man’s pleasure doesn’t even need to be dignified with permission. It’s just done. 

Thankfully, this practice— and belief— is slowly eroding from mainstream healthcare. With fewer episiotomies (surgical repair of vaginal tears) occurring, there are fewer opportunities for physicians to engage in the practice. However, that does not mean the “husband stitch” no longer exists. It’s a horrendous practice based on stereotypes that need to be spoken about, until physicians— and men— understand they do not have the liberty to change a woman’s body for male sexual pleasure. 

Although the practice itself is repulsive, it also reflects the deep and unending influence of patriarchy, misogyny, and sexism within the healthcare field. It illustrates the intersection of healthcare and the objectification of women and reveals (shockingly) how the oppressive systems of patriarchy and sexism are apparent even in the most sacred of places: healthcare. There are still many disparities, stereotypes, and unfounded beliefs that dictate the treatments and practices taken by physicians for women, minorities, and queer individuals.

Physicians need to undergo cultural, gender, and sexual identity training. They need to understand their biases, and work to keep them from their actions. Medical practices need to be evaluated for their effectiveness and analyzed for their intentions. The healthcare system needs to dismantle the influences of patriarchy and misogyny and sexism and queerphobia. It is pertinent this is done— whether through formal interventions and training or informally holding fellow healthcare professionals accountable— in order to make health and treatment more equitable and free of biased and harmful practices.

Otherwise, we’ll have a lot more than the “husband stitch” to contend with. 

And that’s a reality I don’t want to live in.