The sparingly practiced the ‘husband stitch’ is a surgical procedure in which a skilled birth attendant adds one or more extra stitches beyond the number needed to repair a woman’s vagina after a vaginal birth to heal episiotomy wound or vaginal tear. While repair of a tear or cut in the perineum is medically necessary, an extra stitch, or “Husband Stitch” has no documented medical benefit to the patient. An extra stitch especially in post-partum period is not justified! Instead, it may cause discomfort or pain. The purported purpose is to tighten the opening of the vagina and thereby enhance the pleasure of the patient's male sex partner during penetrative intercourse. This practice has been often inflicted upon birthing women non-consensually leaving these individuals vulnerable to obstetric violence. Technically tightening should not be done immediately after delivery as vaginal tissue is stretched and the risk of over or under correction will be high. Instead, if needed for medical reasons it must be done after post-partum period of 4-6 weeks. In India it’s mostly urban phenomenon and poses risks of severe pain, tissue trauma, & long-term discomfort, making it a form of obstetric violence rather than a legitimate medical procedure. The husband stitch is one example of the female experience that is usually ignored, rendered invisible, or, if addressed, often denied. 

Materials and Methods: Surprised by an article in print media recently in Bengaluru city, this author interacted with few cases through known contacts, did retrospective epidemiological investigation, to understand the magnitude of the problem. By building the archive on this subject and tracing its available histories, this paper has demonstrated the existence of this practice and its discursive, affective and material destiny under the still-persisting regimes of patriarchal knowledge production and violence to alert the skilled birth attendants across the country, as this practice amounts to inflicting upon birthing women non-consensually, in collusion with male partners, leaving these individuals vulnerable to obstetric violence and getting themselves involved in The Female Genital Mutilation (FGM) Act, though it has a poor record of convictions. 

Despite being in health profession for over 58 years, this author read today this word of “The husband's stitch” and its demand making shocking news in Bengaluru City the home city of this author [1]. Known as the daddy stitch, also, husband's knot and vaginal tuck is a surgical procedure in which one or more additional sutures than necessary are used to repair a woman's perineum after it has been torn or cut in a procedure called episiotomy during childbirth for cosmetic purposes [2]. The purported purpose is to tighten the opening of the vagina and thereby enhance the pleasure of the patient's male sex partner during penetrative intercourse [3]. This practice has at times been inflicted upon birthing women non-consensually leaving these individuals vulnerable to obstetric violence [4,7]. While repair of the perineum is medically necessary, for tears or episiotomy incisions, an extra stitch especially in post-partum period is not! It may cause discomfort or pain [2]. Medical literature mentions this word in Transactions of the Texas State Medical Association in 1885.  Dr. Geo. Cupples reported that when he was stitching up a ruptured perineum, of a married lady, the husband was an anxious and interested observer, and when he had taken all the stitches necessary, the husband peeped over his shoulders and asked to take another stitch, to tighten vaginal opening intended for sexual pleasure of the male partner, therefore, it is called the "Husband Stitch" [2,3]. It poses risks of severe pain, tissue trauma, & long-term discomfort, making it a form of obstetric violence rather than a legitimate medical procedure. Some medical practitioners have asserted that the procedure is mostly an urban legend, and false attribution, while others have claimed to know doctors who perform the procedure [1] The demand is largely driven by male partners raising debated on equality and women’s autonomy over their bodies. Some obstetricians are known to do 1-2 such interventions per month. Medically it is not a routinely warranted procedure but mostly elective, mostly decided by male partner. Technically tightening should not be done immediately after delivery as vaginal tissue is stretched and the risk of over or under correction will be there. Instead, if needed it must be done after post-partum period of 4-6 weeks.  After a normal vaginal delivery some degree of vaginal laxity is natural and takes about a month and half to go back to original tightness. Instead, non-surgical measure like pelvic floor strengthening through Kegels’ exercises restore muscle tone overtime. Perineal massage -self or spouse or doula, starting around 36th week of pregnancy, using lubricants and gentle stretching of the tissues between the vagina and anus which help improve elasticity. Off late if needed laser treatment can be tried though none of them are guaranteed solutions. While repair of the perineum is medically necessary, for tears or episiotomy incisions, an extra stitch especially in post-partum period is not! It may cause discomfort or pain and attract legal action on the performing doctor. This article is an effort to educate and alert the skilled birth attendants (obstetricians, general doctors, Nurses and midwives at maternity homes or practicing in rural area.

Case Reports: 

Case 1: A 32-year-old beautiful Rural Indian woman complained that her former partner a rich obese businessman, after she gave birth to a male baby in a private Hospital in Bengaluru in 2022, her partner jokingly asked the obstetrician to put an extra couple stitches in there for him. She did not understand his remark, but it met with laughter from everyone in the room, including the doctor, who replied, ‘Don’t worry, she’ll be great.’  Now this lady recalls that, after the first birthing, her perineal tissue repeatedly tore during sex, and the stitches were still not healed by the time she was read to deliver her second child. After that second delivery, the doctor told her that her previous suturing ‘wasn’t done right. This lady labouring women for the second time smiled and laughed foolishly when suffering not because she liked being oppressed but because she wished to avoid making her partner uncomfortable or being blamed for being unfriendly. 

Case 2: Husband grateful to The Obstetrician: Partnership between Obstetrician and Husbands: An ayurveda medical student a witness present at a birth, the obstetrician assured the woman’s husband, ‘Don’t worry, I’ll sew her up nice and tight for you.’ The two male students laughed about the comment. The woman, covered in her own blood and that of her baby was so out of it physically, emotionally, and mentally, the doctor told the husband but not the lady herself. In this story, when the doctor ‘informed’ the woman about the husband stitch, he did not do so during the suturing process, when the woman was in an extremely vulnerable and much weaker position. The husband was grateful to the doctor.

Case 3: Eyewitness Medical Student fighting for her Autonomy: It was the same Ayurveda student after graduation and marriage, her obstetrician, after injecting a spinal anaesthetic, dared to ask her husband “How tight do you want her?”’ This case captures not only the patriarchal structure of institutions but also the sense of partnership between men and doctors. She of course objected knowing the consequences and went after the anaesthetic effect waned.  This case is a dose of humiliation in the form of the doctor informing and communicating with her husband or partner about the suturing but not with the woman herself, even though she was a doctor herself. 

Case 4: Case of Failures and Consequences: A woman reported that the stitch was too tight, making her deeply uncomfortable after 2 weeks of parturition with episiotomy. The obstetrician consoled her that everything will fine another month or two. After 6 months she returned with complaints of chronic pain, discomfort while walking, tearing of scar tissue, and severe psychological distress. The woman was in severe pain after giving birth and could not use a tampon. When she went for a pap smear one year after having her first child, the nurse found it difficult to perform the test and told her, ‘It looks like you’ve been stitched too tight. As the doctor did not give any reason or solution, she went to another lead consultant in Bengaluru, she shared what the nurse had told her. This consultant agreed and advised for a plastic surgery to get her problem solved. It was done and she is fine now.

Current medical literature reveals that the nonconsensual “Husband Stitch” has been performed in the United States and Japan, India and other countries. Nonconsensual practice of the “Husband Stitch” is an understudied practice that is medically unnecessary and associated with negative health consequences, including dyspareunia, concern for mental health sequalae, and social isolation. There is a lack of treatment options and accessibility for women experiencing medical consequences from the Husband Stitch [7,1]. The ‘husband’s stitch’ is the practice of placing an extra stitch at the vaginal opening of a patient after birth for cosmetic purposes. This practice has at times been inflicted upon birthing patients non-consensually and leaves these individuals particularly vulnerable to obstetric violence [4]. This invasive practice treats patients as commodities for sexual pleasure and may have significant negative health ramifications, as police often refuse to be involved in medical matters, and significant legal fees are at stake [4]. The Female Genital Mutilation (FGM) Act has a poor record of convictions more generally, as 70-80% of cases brought under the Act, lead to acquittals [8]. The FGM Act represents an attempt to bridge the gap in law, but crucially misses the opportunity to tackle obstetric violence, which precedent demonstrates has often proved beyond the ambit of criminal law. Under the Act, in cases of medical violence, the burden of proving a medical practitioner’s breach of duty is extremely high, limiting options for recourse for victims of obstetric violence. The underreporting of unwarranted medical interferences during pregnancies may be largely attributed to the fact that the systems in place do not recognise this act of sexual violence as a violation. It is also extremely difficult to substantiate the difference between medical error and malicious surgery, as discretion is granted to medical practitioners to avoid any reluctance on their part to perform life-saving surgeries. This gap in the legal system requires a concerted public policy response.  The patriarchal system in place emboldens medical practitioners to take unwarranted decisions against their patient’s consent. How Widespread is it in India? While there are no official, nation-wide statistics tracking the exact prevalence of the husband stitch in India, it is considered a very real, albeit underreported, form of obstetric violence and patriarchy, rather than just an urban legend. Obstetricians in cities like Bengaluru report receiving occasional requests from husbands for this extra, non-medically necessary, stitch. A 2023 survey found over 90% episiotomy rates among nullipara (first-time mothers) in some sites, and more recent data shows a rising trend in episiotomies in western India in cities like Mumbai, Pune, Ahmedabad. This high rate of intervention creates more opportunities for the "extra stitch" to be performed. The procedure is often done without the informed consent of the mother, sometimes in a "wink-and-nudge" manner between the doctor and the husband while the woman is in a vulnerable state after delivery. 

Better Options: After a normal vaginal delivery some degree of vaginal laxity is natural and takes about a month and a half to go back to original tightness. Non-surgical measure like pelvic floor strengthening through Kegels’ exercises restore muscle tone overtime. Perineal massage -self or spouse or doula, starting around 36th week of pregnancy, using lubricants and gentle stretching of the tissues between the vagina and anus will also help improve elasticity. Off late if needed laser treatment can be tried though none of them are guaranteed solutions.

Case Reports of Failures and Consequences

There are few formally documented "case reports" in medical literature due to the unethical nature of the procedure, but anecdotal reports, personal stories, and journalists' accounts show that it is a source of intense physical and mental trauma. 

Case Reports 1: The "failure" of the procedure is, in fact, its typical outcome. It is medically ineffective at tightening the vagina (which is a muscle function, not a surface issue) and causes long-term health problems. Technically tightening should not be done immediately after delivery as vaginal tissue is stretched and the risk of over or under correction will be there as reported in our case number 4. Instead, if needed it must be done after post-partum period of 4-6 weeks. 

Case Reprot 2: Painful Sex (Dyspareunia):  In the context of the "husband stitch," success is defined by the patriarchal, non-medical goal of making the vaginal opening tighter, which is often considered a "success" by the husband or the practitioner performing the abuse, even if it brings pain to the woman as was in our first case. Most Indian women do not complain basically to protect their partners from social bashing.

Legal and Ethical Standing:  The procedure is considered medical malpractice and an unethical, non-approved procedure. It is often performed without the woman's knowledge or consent, with some victims discovering it years later. It is professionally compared to Female Genital Mutilation (FGM) and is considered a violation of a woman's bodily autonomy and dignity. This invasive practice treats women as commodities for sexual pleasure and may have significant negative health ramifications, as police often refuse to be involved in medical matters, and significant legal fees are at stake [4]. However, the Female Genital Mutilation (FGM) Act has a poor record of convictions generally, as 70-80% of cases brought under the Act, lead to acquittals.

Husband’s stitch medicalisation in India:  A particular area of concern is the increasing medicalisation in India, which Equality Now and our partners have documented, including in our new policy brief, Medicalisation of Female Genital Mutilation in South and Southeast Asia. We are working alongside local activists, survivors, & medical associations to challenge this trend. Equality Now calls on the Indian government to address the growing problem of FGM being performed by healthcare professionals. The medicalisation of FGM does not make the practice safe or acceptable it legitimises harm, violates medical ethics, and is condemned under international law. Health authorities must take firm action to prohibit medical practitioners from carrying out FGM and ensure the medical community plays a proactive role in prevention.”  “India has the potential to lead the region in ending FGM by showing that girls’ rights are non-negotiable. With evidence-based policymaking, legal accountability, and strong community collaboration, India can become a model for the global goal of eliminating FGM by 2030.”

The widespread practice called the ‘husband stitch’ is a surgical procedure in which the practitioner adds one or more extra stitches beyond the number needed to repair a woman’s vagina after a vaginal birth. A common perception of childbirth is that it destroys the vagina, while the size of the vagina is considered a form of ‘cultural currency’. This procedure amounts to a direct and harsh form of patriarchal violence that is most visible in cases where the procedure is requested by the husband or partner of the labouring woman without her knowledge or informed consent. The idea behind the husband stitch is that a smaller vagina will increase sexual pleasure for the male partner after the birthing.

Data collection to better study the implication of this procedure is the need of the time in larger countries especially among urban populations. Studies must also assess perception and beliefs of healthcare providers towards the “Husband Stitch.”

It is also extremely difficult to substantiate the difference between medical error and malicious surgery, as discretion is granted to medical practitioners to avoid any reluctance on their part to perform life-saving surgeries. Therefore, framing legislation that both protects birthing people as well as medical practitioners performing essential surgeries is a challenge.