From Promise Ring to Stethoscope: Confronting Purity Culture as Patient or Healthcare Provider
by Rebekah Drumsta
Note: This article was written by a woman for women. The author acknowledges that the male experience of purity culture carries different dynamics and should be addressed accordingly.
As a survivor of purity culture and now as a Religious Trauma Advocate, I've come to recognize the profound impact this movement has had on individuals and communities. Purity culture, which gained prominence in the 1990s within evangelical Christian circles, emphasized sexual abstinence before marriage, traditional gender roles, and modesty. While often well-intentioned, this movement has left many grappling with long-lasting effects on their mental and sexual health.
My journey through purity culture began in my youth, surrounded by teachings that stressed the importance of remaining "pure" until marriage. Like many others, I read books about purity, attended seminars, signed a pledge, and was given a purity symbol as evidence of my commitment. At the time, these actions seemed righteous and necessary. And honestly, I was kept so naive and innocent I never fully grasped all the nuances of purity culture. S-e-x was a word I couldn’t say or ask about until after I was married. However, as I grew older and gained more life experience, I began to question the underlying messages and their impact on my identity and relationships.
When, as a young adult, my world began to expand through travel and exposure to other evangelical or fundamentalist spaces outside my own home and church, I started to see that purity culture was a spectrum. Each family, each church, each community had their own rules, expectations and consequences. At that time, I did not have the language or ability to understand yet observed inconsistencies all rooted in the same core philosophy.
What is Purity Culture, Exactly?
Beyond the personal, it's crucial to define exactly what constitutes "purity culture." It's more than just advocating for abstinence. It's a comprehensive system of beliefs and practices built upon:
Abstinence pledges and purity rings: Tangible symbols of commitment.
Strict rules about dating or courtship and relationships: Often dictating permissible interactions.
Emphasis on female modesty: To "protect" men from temptation (placing undue responsibility on women).
Shame-based messaging: Around sexuality, bodies, and even natural attractions.
For women, it’s keeping our “treasure” pure (remaining a virgin mentally, emotionally and physically) until we give it to our husbands otherwise we are a “chewed piece of gum” or there are “no rose petals left.”
Soul-ties or eternal soul connections to any intimate partners.
Specific language which included phrases such as: Shame-faced, stumbling block, eye-trap, guard your heart and avert your eyes.
Promises of an amazing, God-honoring sex life inside of marriage with little or no sexual education.
A Brief History
The movement arose in the 1990s in response to perceived moral decline and the sexual revolution. Key milestones include the 1993 launch of "True Love Waits," the 1997 publication of Joshua Harris's "I Kissed Dating Goodbye," and the emergence of purity balls. While motivations were often sincere, the consequences have proven complex and, for many, deeply damaging.
The effects of purity culture can be far-reaching and complex. Many survivors, myself included, have experienced feelings of shame, guilt, and anxiety surrounding natural sexual feelings and experiences. These emotions can persist long after leaving the movement, affecting intimate relationships and overall well-being. Some individuals report symptoms that mimic PTSD, including vaginismus, pelvic pain, dissociation, and panic attacks. The constant emphasis on virginity as a woman's ultimate value can lead to deep-seated body image issues, fear of sex, and difficulty experiencing pleasure.
As both survivor and professional, I've observed how purity culture can create barriers to proper sexual education and healthcare. Many individuals raised in this environment may feel uncomfortable discussing sexual health with medical providers or may lack basic knowledge about their bodies and reproductive health. This can lead to delayed care and potentially serious health consequences. I've seen firsthand how patients struggle to articulate their concerns or feel judged when seeking help for issues like contraception, STIs, or even basic gynecological care. (Often birth-control has been seen as a form of abortion in fundamentalist religious groups and while traditional medicine is not trusted.)
Approaching this topic with empathy and understanding, both for survivors and for those who promoted purity culture with good intentions, is a vital starting point. Healing from the effects of purity culture is a journey that often requires professional support, education, and patience.
It’s also important to recognize and embrace that a healthy relationship isn’t just about sex, although purity culture leads to that conclusion. Healthy relationships also encourage or embrace wholeness in mental health, emotional connection, spiritual autonomy, independent interests and physical connection outside of the bedroom.
Personal Moment
Purity culture became part of my identity. I was told it was the most important thing in my life, outside of being a Christian and being obedient to authority. My first OBGYN visit came a few weeks before my wedding. I was unprepared for what that experience would be like. Being asked to remove clothing, a doctor who didn’t believe you were a virgin because no one was in their early 20s, having someone invade such a private space, and the pain…it was something I blocked out of my memory for a long time. The female doctor I saw did nothing but get in and get the job done. There was no getting to know my history and background, no sensitivity about my first visit, no measures taken to ensure I felt safe, gave consent or even knew why I was there.
I was a mother and had experienced several miscarriages before I finally told my new OBGYN, “I grew up in a religious cult and something called purity culture. Can you treat me like you would a rape victim? I don’t know how else to explain it right now. But exams are physically and emotionally very painful for me.” That visit, about a decade after my initial experience, was different.
Steps Towards Healing
If you're a survivor of purity culture, know that healing is possible. Some key steps include:
Recognition: Acknowledge the impact purity culture has had on your life and beliefs.
Education: Seek out accurate information about sexuality, relationships, and consent.
Therapy: Consider working with a therapist specializing in religious trauma and sexuality.
Self-Compassion: Be kind to yourself as you unlearn harmful messages.
Value Autonomy: Define your own values around sex and relationships.
Community: Connect with others who share your experience.
Moving forward, it's essential to promote a more holistic and healthy approach to sexuality and relationships. This includes providing comprehensive, medically accurate sexual education, fostering open communication about sexual health, and emphasizing the importance of consent and mutual respect in relationships.
Purity culture teaches us to disconnect from and distrust our bodies. Those natural ooey-gooey feelings you’re having about that boy? Sin. Those curious thoughts about sexuality? Sin. The desire to hold hands or get your first kiss? Sin. And sin must be dealt with through confession, repentance, prayer, Bible study, accountability…you get the picture.
Know this: You can learn to listen to and trust your body. Reconnecting with that part of yourself takes time and practice. Listening to and trusting your body isn’t just about sexual urges or thoughts, it’s about your physical health, safety, well-being, mental and emotional needs and relationships.
For Purity Culture Survivors
It all starts with consent. It’s a term few people raised in purity culture were ever taught and yes, consent most certainly carries over into marriage.
What is sexual consent? Sexual consent is a voluntary, informed, and enthusiastic agreement to engage in a specific sexual activity. It must be freely given without coercion, pressure, or intoxication, and can be withdrawn at any time. Consent is an ongoing process that requires clear communication between all parties involved. Consent cannot be given by individuals who are underage, incapacitated by drugs or alcohol, asleep, unconscious, or unable to understand the situation. Silence, lack of resistance, or past consent does not imply current or future consent.
Key elements of sexual consent include:
Freely given: Without force, threats, coercion, or manipulation.
Reversible: Can be withdrawn at any time during the activity.
Informed: All parties understand the nature and extent of the activity.
Enthusiastic: Showing clear willingness and desire to participate.
Specific: Agreement to one activity does not imply consent to others.
It’s crucial to recognize the role of power dynamics when discussing consent. An imbalance of power—such as between a pastor and congregant, teacher and student, parent and child, or employer and employee—raises an essential question: Can someone truly give consent freely when one party holds significantly more authority or influence? For consent to be valid, it must be given without coercion or undue pressure, which is difficult to ensure when individuals are not operating as equals. In such situations, the inherent power disparity can undermine the ability to make autonomous decisions, making it vital to carefully examine the context in which consent is sought or given.
At the Doctor’s
For women who have experienced purity culture, survived physical assault, or lack comprehensive sexual education, visiting an OBGYN (especially for the first time) can be an intimidating experience. It's important to remember that you have control over your healthcare journey. You have the right to feel educated, safe, respected, and heard during your appointment.
Before your visit, consider writing down any questions or concerns you have. It's okay to be nervous, and it's perfectly acceptable to communicate your anxiety to your healthcare provider. You can request a female doctor if that makes you more comfortable, and you're entitled to have a support person present during the examination if you wish. Remember, you can ask the doctor to explain each step of the exam before they proceed, and you have the right to pause or stop the examination at any time. It's also helpful to know that you don't have to disclose your entire history if you're not ready - focus on what feels relevant to your current health concerns. Many OBGYNs are trained to work with patients who have experienced trauma or have limited sexual health knowledge, so don't hesitate to ask for additional resources or support if you need them. Your comfort and well-being are paramount, and a good healthcare provider will prioritize creating a safe and supportive environment for you.
Here are some medical conditions you might want to become familiar with as you trek this journey of regaining autonomy and becoming your own advocate:
Vaginismus: A condition where the muscles around the vaginal opening tighten involuntarily, making comfortable physical intimacy difficult. Put simply, the muscles near the vaginal opening may squeeze or tense up on their own, leading to discomfort or pain when something tries to enter.
Dyspareunia: Discomfort or pain experienced during or after intimate physical contact. This just means feeling pain in the genital area around the time of sexual activity.
Pelvic pain disorders: Ongoing discomfort or pain in the lower abdominal area, around the reproductive organs. This refers to persistent pain in the lower torso, where the internal parts of the body responsible for reproduction are located.
Polycystic Ovary Syndrome (PCOS): A hormonal imbalance affecting the ovaries, which are organs responsible for a woman's reproductive cycle. This can lead to irregular cycles, and small cysts (fluid-filled sacs) forming on the ovaries. In simple terms, the parts of the body that release eggs don't work as smoothly as they should, and small sacs might form.
Primary sexual dysfunction: Difficulties with sexual desire, arousal, or experiencing pleasure, making intimate experiences less enjoyable. In simpler terms, this refers to trouble experiencing enjoyment or satisfaction during intimate times.
Vulvodynia: Chronic pain or discomfort around the outer opening of the vagina. This means ongoing pain in the sensitive area around the outside of the vagina.
Pelvic floor dysfunction: Issues with the muscles that support pelvic organs.
The causes of these conditions are often complex, and may be influenced by a person's past experiences, feelings about their body, and level of understanding about intimacy. It’s important to be able to voice your concerns to a doctor you trust.
Another area to note for women is labor and delivery, especially when it’s your first baby. To my knowledge, there has not been any research done on the connection of embodied purity culture trauma and the length, difficulty or complications during childbirth but from personal experience as well as listening to the stories of other women who were raised inside high-demand religious spaces with purity culture expectations, giving birth can turn into a long, confusing, complicated process instead of the beautiful and joyous occasion we’d been told it would be. One exception would be girls raised around midwife culture and those who have attended multiple births, such as the birth of their siblings. Childbirth and the process involved is yet another space that purity culture has left women uneducated, afraid and ashamed.
To help you start feeling more confident about your personal health, communicating with your doctor about your past rooted in purity culture (and maybe some other stuff too like experiencing pain, fear or anxiety during intimate times, being a sexual abuse survivor, or feeling embarrassed to ask certain questions) I have created this guide, “OBGYN Visits: Four Tips for Purity Culture Survivors.”
Also, keep scrolling to find the, “6 Tips For Doctors of Patients With Purity Culture Experiences,” that you can share with your doctor - email them this link, print out the graphic or use as a resource for conversation!
Or, for PDF format follow these links - 6 Tips for Doctors of Patients with Purity Culture Experiences and OBGYN Visits: 4 Tips for Purity Culture Survivors.
For Healthcare Professionals
If you are a healthcare professional working with patients who have experienced purity culture, it's crucial to understand the potential impacts on mental and physical health. Here are some key points to consider:
Mental Health Implications: Purity culture can contribute to feelings of shame, guilt, anxiety, and depression. Patients may struggle with low self-esteem, negative body image, and difficulties in intimate relationships.
Sexual Health Issues: Many individuals raised in purity culture may experience sexual dysfunction, including vaginismus, pelvic pain, and difficulties with sexual pleasure. These issues can be both psychological and physiological in nature.
Barriers to Care: Patients may feel uncomfortable discussing sexual health topics or seeking gynecological care due to internalized shame and stigma. This can lead to delayed treatment of important health issues.
Limited Sexual Education: Many individuals from purity culture backgrounds may lack comprehensive knowledge about sexual and reproductive health. Healthcare providers should be prepared to offer accurate, non-judgmental information.
Trauma-Informed Approach: Recognize that some patients may exhibit symptoms similar to those of PTSD, religious trauma or a sexual assault survivor. A trauma-informed, compassionate approach is essential.
Pelvic Health Considerations: Be aware of the potential connection between purity culture and pelvic floor dysfunction. Pelvic floor therapy may be beneficial for some patients.
Research and Resources:
As a healthcare provider, it’s important to create safe, non-judgmental spaces for patients to discuss their experiences and concerns. It is imperative that we use inclusive, trauma-informed language and offer comprehensive, medically accurate information. Sometimes, simply validating a patient's feelings and experiences can be profoundly healing. Referrals to mental health professionals specializing in religious trauma and sexuality may be beneficial for some patients.
"Mental Health Implications of Christian Purity Culture" - A study available through MavMatrix, investigating the impact of purity culture on mental health.
The Choosing Therapy website offers an article on "How Purity Culture Harms Mental & Sexual Health" with additional insights for professionals.
For a historical perspective, the Nashville Therapy Co. blog discusses "Purity Culture - What Remains 30 Years Later?".
The Verywell Mind website provides an overview of "Purity Culture and Its Effect on Mental Health".
Rebekah Drumsta is the founder of the Religious Trauma Network.
To read more from Rebekah visit RebekahDrumsta.com.
This article is not intended to treat or diagnose any condition. Rebekah is not a licensed therapist or clinician. Any advice or opinions given on this site are strictly individual observation and insights based on personal experiences and study. It should in no way take the place of professional assistance.