ashleybethard asked: Lena, I've been a fan and follower of your blog for some time now, and in light of sickening news, I'd like to know: what do you think about the "sanctioned genital mutilation at Cornell"? I mean, how could something like this happen? I'm also interested in the backgrounds of the young girls who underwent this procedure — for example, their socio-economic backgrounds, family structure, where they live, etc. Any thoughts on any of this?
I’ve been asked by several readers to address the accusations of female genital mutilation at Cornell University, where a pediatric urologist by the name of Dix Poppas conducted clitoroplasty (removing part of the clitoris) on patients with larger-than-average clitorises. Poppas was dealing with a very young subject group, unlikely mature enough to offer proper consent, especially considering the questionable post-op sensory testing that also took place (and could potentially prove traumatizing). The study, which involved 51 patients from 4 months to 24 years old, was made up of 32 subjects under 2 years old, five subjects 2 to 5 years old, and eleven subjects older than 5. In fairness, Poppas was attempting to perfect a “nerve-sparing” alternative to the sensation-destroying clitoridectomy procedures commonly used to treat these cases. But these operations were not medically necessary in the first place and carried the risk that sensation could be adversely affected, if not altogether eliminated.
Yet after reading Dan Savage’s column and the original article by Alice Dreger and Ellen Feder that inspired his piece, I’m struck by the disproportionate amount of outrage directed at the doctor and the parents of the patients. I say “disproportionate” not because I don’t think this is a serious issue, but because stuff like this happens all the time, on a daily basis, and no one labels it “mutilation”. (I take issue in general with the label of “female genital mutilation”, but hang tight, I’ll address that later.) Savage writes that the doctor is “carving up” “what he judges to be oversized clitorises”, but this makes it seem like what was happening was based on Poppa’s subjective whims. In fact, most of these patients (46 out of the 51) suffered from congenital adrenal hyperplasia, a condition associated with ambiguous genitalia and clitoromeglamy, which can sometimes make clitorises resemble small phalluses. (Look it up on Google for illustrative examples). In other words, this was not some maniacal mad scientist carrying on experiments Human Centipede-style without any reason. Of course, this doesn’t excuse what happened and it doesn’t make it appropriate to operate on minors based on normative ideas of what constitutes proper-looking genitalia. But let’s not sensationalize the situation: in the eyes of the parents, this was presumably alarming enough for them to sign off on their children participating in the study.
Frankly, the least interesting part of the whole thing, in my opinion, is the sensory testing that has captured so much controversy. In follow-up appointments with parents present, researchers applied a vibrating device resembling a Q-tip to patients’ clitorises in attempts to measure the sensations detected. As Lindsay Beyerstein noted on the WAM! list-serve discussion, news reports describing this instrument as a “vibrator” conjure up lurid images of phallic-like objects and Rabbit sex toys a la Sex and the City. Not only is this inaccurate and unnecessarily sensationalistic (similar devices are used post-operation in other medical procedures), but it completely detracts from a meaningful discussion of the situation at hand. It may be “developmentally inappropriate” to subject young patients to this procedure, but it doesn’t make one a pedophile, pervert, or child molester, as Poppas has been called. His behavior is, however, highly ethically problematic and reminiscent of our all-too-recent-medical-past when intersex people were trotted out before teams of med students who sought to treat them for their “abnormal” genitalia.
And that’s what I find most problematic — not “What were the adults thinking?” or “Is the doctor a sex-crazed loon?”— but the idea that there is such a thing as “normalcy”, as in the “normal clitoris” or the “normal female body”, and that any deviation from that is something to be studied and corrected, even if the patient can’t adequately consent and even if it might be traumatizing. It is well-established within medical literature that invasive exams — really, more like inspections — have caused some intersex patients extreme psychological stress. (How an internal review board ever thought this treatment was appropriate, I have no idea.) And though the huge outcry over the study at Cornell seems to indicate that the public will not stand for forced “corrective surgery”, I wonder just how loud the outcry would be if it were made transparent that at least some of the patients exhibited ambiguous genitalia. In fact, there isn’t a single mention of the word “intersex” in either of the above linked articles. I suspect that if this story were publicized differently, if say, instead of describing patients as “little girls” (who were in the minority of the participants) but as “intersex infants”, there would be some critics who would be perfectly okay with putting children through these procedures. I don’t say this to be transphobic, but rather to point out that there are different cultural expectations when the “abnormality” being dealt with has to do with gender identity.
This is all a really drawn out way of saying that it would be really easy for me to cry outrage at this incident and condemn all those involved (including the parents — who have been lambasted by some commenters as “sick bitches”), but I think people underestimate what it’s like to be in their position. It is incredibly difficult to be confronted with an “abnormality” in your child, and parents often defer to the advice of doctors and experts, not out of irresponsibility, but out of concern. Usually, these decisions are made with the belief that “normalizing” the body is in the child’s best interest. FGM, for example, is prevalently practiced in some places precisely because it’s, well, prevalent and because girls who aren’t circumcised are in the minority and later viewed as undesirable brides of lower social status. And because these girls grow up in cultures in which women are still beggars and not choosers when it comes to marriage arrangements, then being subjected to FGM could, in a really misguided sense, be considered in their “best interest”. That’s why Western activists confront so many barriers in trying to change FGM abroad; even calling it “mutilation” implies that parents are purposely abusing their children for the heck of it, but there are deep cultural roots to the phenomenon. I’m not saying this is the right thing to do, and I’m certainly not excusing this behavior, but calling the doctors and parents involved “criminals” is really not going to solve anything.
Nor does it make any sense to call this “female genital mutilation” simply because it’s the clitoris that’s being operated on. FGM is not just defined by a bodily organ but by the cultural and religious motivations behind the ritual. The Cornell study, though appalling in its own right, was not meant to purposely inhibit sexual function, and it was certainly not meant to prevent promiscuity or to promote cleanliness (common reasons for FGM in some African societies). Taking your kid to scientists for an experimental procedure because of a perceived abnormality is not the same as slicing off clitorises en masse because it’s what has always been done. If we’re going to draw FGM comparisons, let’s talk about the far more common practice of male circumcision, which affects sensitivity and arousal, yet occurs as a matter of routine in hospitals. Few people would likely call it “mutilation”, though there is no medical necessity for it. The typically cited benefits — hygiene and HIV prevention — are dubious at best, especially in the context of developed nations, where condoms and soap are readily available. I’ve been quite vocal in my criticism of circumcision in the past, but I wouldn’t call its modern practice comparable to FGM, which is very much about controlling sexuality. (Though the original reason circumcision became prevalent is because it was believed to reduce masturbation.) I make these qualifications because I don’t want to minimize the experiences of those who have undergone FGM and because there’s no need to resort to sensationalization to see that these operations are illogical. Now back to the patients at hand.
I would go so far as to argue that any sort of cosmetic surgery done for the sake of an aesthetic preference is questionable since it exposes the patient to all the risks of the procedure without medical necessity. (And this applies as much to breast augmentation and Lasik as it does to clitoroplasty.) In this particular case and in the case of circumcision, most of the patients are not even at an age when they can offer their meaningful consent. When it comes to infants, any altering of sexual organs is completely premature and occurs before said individuals can form a gender identity or anatomical preference. It is also most definitely nonconsensual and decided for individuals under the paternalistic assumption that parents not only know best, but that they essentially own a minor’s body. (The same reasoning applies to age-of-consent laws that restrict everything from abortion to alcohol.)
Having no say in medical decisions is a problem that intersex folks have been grappling with for pretty much all of medical history, and I’m glad this case is drawing some more attention to that. But like I said, I wish these articles could be explicit about the fact that this is about our society’s inhumane and inadequate knee-jerk response to gender ambiguity. It’s not about stifling female sexuality and it’s not about oppressing women. It’s not about “female genital mutilation”, as so many outlets, including Alternet, insist. Those are all problems in the world, but they do not apply to this situation. By mischaracterizing the Cornell case, those who are trying to draw attention to it are willfully ignoring the far more complex and difficult situation facing intersex people.
More burning questions? Ask them here.
