Why Is It So Hard for Unmarried Women in China to Go See a Gynecologist?

The first time Crystal Wang had a gynecological exam was at a large medical center in the central business district of Beijing. When she arrived at the examination area, she was taken aback by a bold red sign that said 处女不能检查, or “virgins may not be examined.”

Crystal, who was 22 at the time, was not a virgin, but she was also unmarried—a combination she didn’t expect would go over well with hospital authorities. “I lied and ticked the married box on the personal information forms,” she said.

Throughout the course of Crystal’s examination, the doctor and nurses were extremely kind. They asked her when she planned to have a baby, and although there was a huge line of women outside waiting to be examined, they answered all of her questions thoroughly.

As she left the exam room, she noticed that another young woman who had been waiting was getting turned away. Unlike Crystal, the woman had indicated on her form that she was not married; after telling the nurse that she was sexually active and requesting an exam, she was begrudgingly given a number and directed to the back of the line.

“They were treating her like trash,” Crystal said. “They were forcing her to make very personal admissions in public and clearly not giving her the same respect or attention they had given me.”

When Crystal got home later that evening, the first thing she did was very carefully hide all the paper traces of her doctor’s visit so that her mother wouldn’t find them. “She would go bonkers,” said Crystal, explaining that for unmarried women in China—especially those who still live with their parents—a visit to the gynecologist is a scarlet letter of sorts. Pap smears and pelvic exams are considered routine for women who are married, but can be a flagrant violation of propriety for everyone else.

As Crystal explained, and several other Chinese women have corroborated, there are two main ways to have a gynecological exam in China. You can go to a large women’s hospital and simply pay for the exam out of pocket (starting at around USD $30, depending on the hospital), or you can have the exam at a smaller facility as part of an annual health check package offered by your employer. These exams take place at checkup centers that are usually staffed by retired doctors or those seeking to make a bit of extra money on the side, and are essentially considered a workplace perk.

26-year-old journalist Xinyuan Yu’s first visit to the gynecologist took place on one of these employer-provided health checks. Unaware that her marital status would determine which examinations she would be entitled to, she filled out the forms truthfully, and checked the box to indicate that she was unmarried. As she hopped onto the examination circuit and began going from exam room to exam room as if on one large production line, she realized that there was one room she hadn’t been assigned to, and approached the nurse at the door to ask why. “Are you married?” asked the nurse. “No,” said Xinyan. She was promptly shooed away without explanation.

Startled, she set off to have the rest of her examinations. A blood test, eye exam, pelvic sonogram, and ear nose and throat probe later, she returned to the room where a cantankerous nurse was still standing guard.

“I realized what was going on, so I got back on line and insisted on having a gynecological exam,” Xinyan said. “I wanted to make sure that I was healthy, and I didn’t think I should be made to feel like I had done anything wrong.”

“You are not a virgin?” asked the nurse, loudly and impatiently. As soon as Xinyan went on the record about being sexually active, the nurse pulled out a waiver. She made Xinyan sign it, essentially freeing the hospital of any liability to the state of her hymen. Xinyan remembers how, as she signed, the nurse continued brusquely dismissing other unmarried women without any explanation.

“It’s barbarian—we’re made to feel like criminals,” said Xinyan. “This is something that our companies pay for and that we have the right to, and yet we are driven away.”

For 29-year-old fashion designer Iris Liu, the experience of visiting a gynecologist for the first time went much more smoothly. “You just have to walk in with a bigger attitude than any of the nurses or the doctors and not let any of their judgment get to you,” she said. Iris doesn’t recall ever having to sign any waivers certifying that she was sexually active despite not being married, “but by the looks of me, I’m sure they just automatically assume I’m not a virgin,” she added, laughing.

She suspects that other women may find it more difficult to acknowledge their sexuality because of an internal struggle they still face; the shame of having surrendered something they were raised to treat as their most precious tender. For Iris—who described her parents as “open-minded” (they owned a brothel when she was growing up)—the weight of traditional Chinese propriety doesn’t loom quite as heavily as it does for the majority of women, and she is grateful for this. “My most traumatic visit to the doctor was actually related to a stomach problem I was having,” she said. “I was much more embarrassed to admit that I had diarrhea, than I ever was to admit I had sex.”

Like Iris, 36-year-old marketer Lila Song suspects there may be an internal trigger amplifying the sense of unease that unmarried women in China may feel when they visit the gynecologist. But she also believes that hospitals and doctors themselves could take basic measures to make any internal shame easier to bear.

Lila explains that the first time she saw a gynecologist on her employer-sponsored annual health checkup, she knew—other women had told her—to lie about her marital status on the forms. The second year, however, her employer had prepaid for the exams. As a single woman, Lila had been automatically excluded from the package that included a gynecological checkup. “They didn’t even give me the chance to lie!” said Lila. So she went without.

Ingrained in these anecdotes of visits to the gynecologist is an overwhelming indication that China—despite its formidable social and economic transformation—is still reeling from the aftershocks of a culture that has modernized very quickly, but in pockets. On a systematic level, the country continues to be stifled by traditional and often paradoxical mores.

For instance, though gynecological exams remain irregularly available, abortions are much more pedestrian. As Iris recalls, abortion was essentially a method of birth control for some of her high school friends; one girl had three before her 21st birthday. She mentioned that it was common for girls to go to “clinics” that advertised abortion services for the equivalent of around $50 USD.

Iris notes that the ads for these services most often appeared on cards or pamphlets that were distributed on the street, providing little information. “Not all women in China understand how to prevent pregnancy—it’s a subject people don’t like to talk about,” said Iris. “A bit less [abortion] advertising and more education would’ve gone a long way.”

Women in China, in other words, can find themselves with many tools but little knowledge; for another example, birth control is surprisingly easy to obtain. No prescription is needed for the pill or Plan B, and both can be readily acquired, zero questions asked, at just about any Chinese pharmacy. In addition to being easy to find, these drugs are also extremely cheap—a monthly dose of the birth control Diane-35 runs about $12 USD, and a plan B pill (0.75 mg of levongorgestrel) is around $4, compared to between $30-$65 in the US, according to Planned Parenthood.

Much of this is certainly due to China’s one-child policy, which although increasingly relaxed, is still in force—and requires that unwanted (or unlawful) pregnancies be easy to prevent. Easy access to birth control is less a sign that China is facilitating reproductive freedom than evidence of a utilitarian means of enforcing population control policies.

Yet, things are changing. I spoke to Xu Li, a gynecologist at Beijing Obstetrics and Gynecology Hospital, one of the most famous women’s hospitals in China. She has worked there since 1988 and sees over 100 patients a day, three days a week. (Roughly speaking, she’s had her hands in about 450,000 vaginas over the course of her career—a record even the most ardent lothario would have a hard time besting). When I asked her if unmarried women in China can get gynecological exams, she responded, “Your question is very interesting.”

She began by explaining that being unmarried does not necessarily mean a woman has no sex life, but that if a woman is a virgin, she will not be given a pelvic exam because “Chinese traditional culture does not allow it.” Barring heavy bleeding, malignant disease, or similar urgencies, virgins are not to have a vaginal exam, she explained. Instead, they are given pelvic sonograms. (There is also an anal exam for virgins that purportedly tests for gynecological abnormalities. The doctor did not mention this exam, but given the amount of traction it has gotten on Chinese women’s health forums, it appears to be more than an urban legend.)

As we chatted more about her day-to-day responsibilities, Doctor Li made it clear that most women’s hospitals in Beijing are frightfully understaffed. This is part of the reason that egg-freezing—a topic that recently received tremendous attention in both Chinese and foreign media, following the news that 41-year-old celebrity Xu Jinglei had come to the US to undergo the procedure—remains off-limits to most women in China. Though China has the technological capability, these services are only offered under circumstances where fertility is impaired or at risk (i.e., a woman is undergoing chemotherapy). Barring these conditions, according to Chinese regulations, no women—whether single or married—can have their eggs frozen in China.

Essentially, reproductive rights are a challenge for all women in the country. But, as evidenced by their difficulty with gynecological visits, unmarried women in China experience a more onerous set of challenges.

For example, although Item 17 of the Chinese Law on Population and Family Planning states that “civilians enjoy the legal right to give birth,” it is illegal for unmarried women in China to have a baby out of wedlock. If they do, they’re penalized by “social compensation fees” of several thousand dollars, with the final amount based on and representing a generous portion of their yearly income. Until these fees are paid off, the child of an unmarried mother does not have a “hukou” or resident’s permit, which means that he is essentially stateless and without identity; he cannot be enrolled in school or benefit from basic social services or receive a passport. There have been a handful of cases in which unmarried mothers have stood up for their right to obtain a resident’s permit and legitimate benefits for their children, but to date, no policies have changed.

There are loopholes for all of this, as with the pretending-to-be-married OB/GYN workaround. According to Chinese law, unmarried women in China are not prohibited from adopting children—though single adoptive mothers are still very rare. (This allowance may be in place because, as of 2011, unmarried foreign women have been allowed to adopt Chinese babies. Barring unmarried Chinese women from the same privilege would be flagrant discrimination, though it’s hard to get a clear theory about why unmarried women in China can legally adopt but not give birth on their own.) Nevertheless, adopting a child as a single mother in China requires allowing the state to interfere in a way that many would find overly personal. In these cases, the child is granted a resident’s permit and papers, but a call to one of China’s “paichusuo” (public safety bureaus) in Beijing revealed that, in these cases, the local police department that provides these documents essentially serves as the “father” of the adopted child: in China, state benefits are still issued exclusively through the paternal line.

Dr. Li, who spent time at Columbia University as a visiting scholar, is aware that China’s traditions still influence the parameters of her work, but acknowledges that the women’s health landscape is radically different than it was when she started practicing 26 years ago. For one, though still a minority, there are more and more male gynecologists in China, she says, because women are becoming more accepting of the idea. Likewise, 10 years ago, patients were simply asked if they were married, because back then, “not being married meant no sex life.”

Today, the lines have blurred. If a woman is not married, she is asked if she is sexually active. If she is, a note of this is made in her case history. “It’s no longer abnormal to be unmarried and have a sex life,” Dr. Li notes. Indeed, a sexual health survey published directly under the auspices of Qiushi, a Chinese central government periodical, reports that the percentage of citizens who have had premarital sex has dramatically increased. In 1989, only 15 percent of unmarried Chinese had premarital sex, as opposed to over 71 percent today.

Still, as is often the case in China, change is pixelated, and a shift in behavior doesn’t always warrant a revision of attitude or policy. With her next annual company-sponsored medical exam around the corner, Lila Song wonders if she will once again be excluded from receiving the full examination package, which only for married women includes a gynecological exam. Last year she ended up scheduling a separate appointment for this exam, which she had to pay for out of pocket.

She suspects that her company may have signed her up for the less comprehensive of the packages partially because it was an easy way to cut back on costs, though this year, to avoid any confusion, she plans to pay a visit to HR; the department scheduled with arranging the exams. “I think it’s time to remind them that I’m not a virgin anymore,” she says. “I am respectful of my body, conscious about my health, and comfortable with the lifestyle I have chosen. And they should be too.”

Roseann Lake is an American journalist formerly based in Beijing. She is the author of a forthcoming book about Chinese leftover women (剩女), and the creator/director of “The Leftover Monologues”—a stageplay which she recently spoke about at TEDxSuzhouWomen. Her work has appeared in TIME, Foreign Policy, The Atlantic, The Diplomat, Salon, and The South China Morning Post. She currently works for The Economist and lives in New York City.