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By Daniela Perdomo, AlterNet
June 20, 2010
When most of us think of female genital mutilation, we probably think of faraway places. Well, peel off those blinders. In 1997, our very own Department of Health and Human Services estimated that 168,000 girls and women living in the United States had been or were at risk of being subjected to some form of the abhorrent practice known as female genital mutilation (FGM).
Not only is FGM being practiced relatively widely in the United States, it's happening in the most hallowed halls of American medical science. In fact, the head of the pediatric urology department at Cornell University's New York Presbyterian Hospital -- which is often ranked among the top 10 hospitals in the country -- has been operating on young girls who suffer from what he (and likely the girls' guardians) have decided is "clitorimegaly," or oversized clitorises.
In order to relieve these girls from what seems like little more than a cosmestic issue, Dr. Dix P. Poppas cuts out parts of the clitoris' shaft, saving the glans, or tip, for reattachment. Poppas triumphantly calls the procedure -- rebranded a clitoroplasty -- a "nerve sparing" one unlike the FGMs practiced in other countries.
How does the good doctor know that nerves have been spared? Well, Poppas and his nurse practitioner developed a series of sensory followup tests involving Q-tips, their fingernails and vibrators. But don't worry, a family member was always present in the room. As the resulting journal article notes, management of such situations requires a "compassionate and multidisciplinary approach."
Activists Alice Dreger and Ellen K. Feder, a professor of medical humanities and bioethics and a professor of philosophy, respectively, have been railing against the practice of FGM -- of any kind -- for a decade. They are part of the majority medical view that questions the very basis of clitoroplasties. (The American Academy of Pediatrics disturbingly stated in May that it only had an issue with "all types of female genital cutting that pose risks of physical or psychological harm" -- as if any kind of clitoral mutilation did not necessarily entail such harm. The AAP recanted the shocking affront to women's physical and mental health only a few weeks later.)
"We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm," Dreger and Feder wrote in an article lambasting Poppas' study.
These procedures seem motivated mostly by an obsession with having "normal" genitalia -- and normal kids. The fact that cosmetic genital surgery is on the rise is one sign of this. And given that only one of every 2,000 infants is born with genital ambiguity, parents faced with an "abnormal" clitoris are not likely to have ever seen one before and may react with trepidation. Will my kid be a lesbian? Will my little girl want to become a boy? We know children are all unique, like snowflakes, but when it comes to vaginas, sexual orientation and gender identity, it seems we'd prefer cookie-cutter, please.
So parents go to Dr. Poppas who mirrors their fears and offers a medical procedure that Cornell's Web site recommends "because female patients are able to undergo a more natural psychological and sexual development." What parent would withhold such treatment, recommended by a top-notch pediatrician and hospital?
Poppas cuts off parts of the perfectly healthy, albeit-larger-than-we'd-like clitoris, the only organ in either sex whose only known function is sexual pleasure.
Although Poppas boasts of the "nerve sparing" nature of his procedure, a study in theLancet showed some women who underwent other nerve-sparing surgeries "had the worst possible score for orgasm difficulties." Not to mention the fact that simply preserving the glans may not be enough, given that many women find more pleasure is derived from the shaft than the tip, which can be overly sensitive.
The horrors of clitoroplasties aside, Poppas' particular brand of FGM adds an extra layer of psychological damage. When Dreger told Ken Zucker, a child psychologist about how Poppas used a vibrator to test a little girl's clitoral sensation, he said: "Applying a vibrator to a six-year-old girl's surgically feminized clitoris is developmentally inappropriate."
Dreger and Feder write:
In order to relieve these girls from what seems like little more than a cosmestic issue, Dr. Dix P. Poppas cuts out parts of the clitoris' shaft, saving the glans, or tip, for reattachment. Poppas triumphantly calls the procedure -- rebranded a clitoroplasty -- a "nerve sparing" one unlike the FGMs practiced in other countries.
How does the good doctor know that nerves have been spared? Well, Poppas and his nurse practitioner developed a series of sensory followup tests involving Q-tips, their fingernails and vibrators. But don't worry, a family member was always present in the room. As the resulting journal article notes, management of such situations requires a "compassionate and multidisciplinary approach."
Activists Alice Dreger and Ellen K. Feder, a professor of medical humanities and bioethics and a professor of philosophy, respectively, have been railing against the practice of FGM -- of any kind -- for a decade. They are part of the majority medical view that questions the very basis of clitoroplasties. (The American Academy of Pediatrics disturbingly stated in May that it only had an issue with "all types of female genital cutting that pose risks of physical or psychological harm" -- as if any kind of clitoral mutilation did not necessarily entail such harm. The AAP recanted the shocking affront to women's physical and mental health only a few weeks later.)
"We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm," Dreger and Feder wrote in an article lambasting Poppas' study.
These procedures seem motivated mostly by an obsession with having "normal" genitalia -- and normal kids. The fact that cosmetic genital surgery is on the rise is one sign of this. And given that only one of every 2,000 infants is born with genital ambiguity, parents faced with an "abnormal" clitoris are not likely to have ever seen one before and may react with trepidation. Will my kid be a lesbian? Will my little girl want to become a boy? We know children are all unique, like snowflakes, but when it comes to vaginas, sexual orientation and gender identity, it seems we'd prefer cookie-cutter, please.
So parents go to Dr. Poppas who mirrors their fears and offers a medical procedure that Cornell's Web site recommends "because female patients are able to undergo a more natural psychological and sexual development." What parent would withhold such treatment, recommended by a top-notch pediatrician and hospital?
Poppas cuts off parts of the perfectly healthy, albeit-larger-than-we'd-like clitoris, the only organ in either sex whose only known function is sexual pleasure.
Although Poppas boasts of the "nerve sparing" nature of his procedure, a study in theLancet showed some women who underwent other nerve-sparing surgeries "had the worst possible score for orgasm difficulties." Not to mention the fact that simply preserving the glans may not be enough, given that many women find more pleasure is derived from the shaft than the tip, which can be overly sensitive.
The horrors of clitoroplasties aside, Poppas' particular brand of FGM adds an extra layer of psychological damage. When Dreger told Ken Zucker, a child psychologist about how Poppas used a vibrator to test a little girl's clitoral sensation, he said: "Applying a vibrator to a six-year-old girl's surgically feminized clitoris is developmentally inappropriate."
Dreger and Feder write:
[The study's authors] describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”
Of course it's inappropriate. And lest that is not obvious on its own, transgendered adults have long been vocal about how genital displays in medical exams were among the most traumatic experiences of their entire lives.
In this case, as sex columnist Dan Savage writes, "These post-op visits with the doctor and his vibrator do the girls no good -- what can the doctor do if a girl reports no sensation? reassemble her clit? -- and retaining sensation isn't proof that these girls will grow up to be healthy, sexually functional adults."
The sad irony is that maintaining these girls as healthy, sexually functional, happy adults is the cause of all these problems in the first place. Parents and the doctors who legitimize their fears need to know that reconstructing a clitoris -- or any other ambiguous genitalia -- to meet "normal" standards does nothing to change what may be behind the differences to begin with. You can't "fix" your kid's genetic and hormonal makeup -- you can only cover it up, and such efforts can have tragic psychological and physiological results.
The least we can do is give every kid a chance to figure out who he or she is and what he or she wants when he or she is old enough to do make that call -- and to accept them as they are throughout the entire process.
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