Genital modification and mutilation
The terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs. Some forms of genital alteration are performed at the behest of an adult, with their informed consent. Other forms are performed on people who do not give informed consent, including infants or children. Any of these procedures may be considered modifications or mutilations by different groups of people.
- 1 Body modification
- 2 Voluntary sex reassignment
- 3 Involuntary sex assignment
- 4 In disease or medical necessity
- 5 Self-inflicted genital injury or mutilation
- 6 Female genitals
- 7 Male genitals
- 8 See also
- 9 References
- 10 External links
Many types of genital modification are performed at the behest of the individual, for personal, sexual, aesthetic or cultural reasons. Penile subincision, or splitting of the underside of the penis, is widespread in the traditional cultures of Indigenous Australians. This procedure has taken root in Western body modification culture. Meatotomy is a form that involves splitting of the glans penis alone, while genital bisection is a more extreme form that splits the penis entirely in half.
Genital piercings and genital tattooing may be performed for aesthetic reasons, but piercings have the benefit of increasing sexual pleasure for the pierced individual or their sex partners. Similarly, Pearling involves surgical insertion of small, inert spheres under the skin along the shaft of the penis for the purpose of providing sexual stimulation to the walls of the vagina.
Clitoris enlargement may be achieved temporarily through the use of a clitoral pump, or it may be achieved permanently through application of testosterone cream to the clitoris, or through injectable testosterone. Penis enlargement is a term for various techniques used to attempt to increase the size of the penis, though the safety and efficacy of these techniques are debated.
Voluntary sex reassignment
People who are transgender may undergo sex reassignment surgery in order to modify their bodies to match their gender identity. Not all transgender people elect to have these surgeries, but those who do usually see an improvement in their sexual lives as well as their mental and emotional well-being. Some of the surgical procedures are breast augmentation and vaginoplasty for transwomen and mastectomy, metoidioplasty, and phalloplasty for transmen. Transwomen may also benefit from hair removal and facial feminization surgery while some transmen may have liposuction to remove fat deposits around their hips and thighs.
Involuntary sex assignment
Intersex children and children with ambiguous genitalia may be subjected to genital surgeries to "normalize" the appearance of the genitalia. These surgeries are usually performed for cosmetic benefit rather than for therapeutic benefits. Most surgeries involving children with ambiguous genitalia are sexually damaging and may render them infertile. For example, in cases involving male children with micropenis, doctors may recommend the child be reassigned as female. The Intersex Society of North America (ISNA) objects to elective surgeries performed on people without their informed consent on grounds that such surgeries subject patients to unnecessary harm and risk.
In some cases, a child's gender may be reassigned due to genital injury. There have been at least seven cases of healthy male infants being reassigned as female due to circumcision damaging their penises beyond repair, including the late David Reimer (born Bruce Reimer, later Brenda Reimer), who was the subject of John Money's John/Joan case, an unnamed American child, who was awarded $750,000 by Judge Walter McGovern of the Federal District Court after a military doctor was found guilty of medical malpractice in 1975, and an unnamed child who was circumcised at Northside Hospital, who received an undisclosed amount of money from the hospital.
In disease or medical necessity
If the genitals become diseased, as in the case of cancer, sometimes the diseased areas are surgically removed. Biological females may undergo vaginectomy, while males may undergo penectomy. Reconstructive surgery may be performed to restore what was lost, often with techniques similar to those used in sex reassignment surgery.
Similarly, during childbirth, episiotomy is sometimes performed to increase the amount of space through which the baby may emerge. Advocates of natural childbirth and unassisted birth state that this intervention is often performed without medical necessity, with significant damage to the person giving birth.
Hymenotomy is the surgical perforation of an imperforate hymen. It may be performed to allow menstruation to occur. An adult individual may opt for increasing the size of her hymenal opening, or removal of the hymen altogether, to facilitate sexual penetration of her vagina.
Self-inflicted genital injury or mutilation
A person may engage in self-inflicted genital injury or mutilation such as castration, penectomy, or clitoridectomy. The motivation behind such actions vary widely; it may be done due to skoptic syndrome, personal crisis related to gender identity, mental illness, self-mutilation, body dysmorphia, or social reasons.
Cosmetic surgery of female genitalia, known as elective genitoplasty, has become pejoratively known as designer vagina. In May 2007, an article published in the British Medical Journal strongly criticised the "designer vagina" craze, citing its popularity being rooted in commercial and media influences. Similar concerns have been expressed in Australia.
Female genital mutilation
Female genital mutilation (FGM), also known as female genital cutting (FGC), female circumcision, or female genital mutilation/cutting (FGM/C), refers to "all procedures involving partial or total removal of the external female genitalia or other surgery of the female genital organs whether for cultural, religious or other non-therapeutic reasons." It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. It is practiced throughout the world, but the practice is concentrated more heavily in Africa, Indonesia, and the Middle East. There is much controversy surrounding infibulation procedures, due to concerns regarding the safety and consequences of the procedure. In the past several decades, efforts have been made by global health organizations, such as the WHO, to end the practice. However, because of its importance in traditional life, it continues to be practiced in many societies.
Hymenorrhaphy refers to the practice of thickening the hymen, or, in some cases, implanting a capsule of red liquid within the newly created vaginal tissue. The newly created hymen is created to cause physical resistance, blood, or the appearance of blood, at the time that the individual's new husband inserts his penis into her vagina. This is done in cultures where a high value is placed on female virginity at the time of marriage. In these cultures, a woman may be punished, perhaps violently, if the community leaders deem that she was not virginal at the time of consummation of her marriage. Individuals who are victims of rape, who were virginal at the time of their rape, may elect for hymenorrhaphy.
Labia stretching is the act of elongating the labia minora through manual manipulation (pulling) or physical equipment (such as weights). It is a familial cultural practice in Rwanda, common in Sub-Saharan Africa, and a body modification practice elsewhere. It is performed for sexual enhancement of both partners, aesthetics, symmetry and gratification.
Labiaplasty and Vaginoplasty
Some women undergo vaginoplasty or labiaplasty procedures to alter the shape of their vulvas to meet personal aesthetic standards. The surgery itself is controversial, and critics refer to the procedures as "designer vagina".
Clitoral hood reduction
Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is an elective plastic surgery procedure for reducing the size and the area of the clitoral hood (prepuce) in order to further expose the clitoral glans of the clitoris; the therapeutic goal is to improve the sexual functioning of the woman, and the aesthetic refinement of her vulva. It is a form of hoodplasty. The reduction of the clitoral prepuce tissues usually is a sub-ordinate surgery within a labiaplasty procedure for reducing the labia minora; and occasionally within a vaginoplasty procedure.
Castration in the genital modification and mutilation context involves the amputation of the testicles. Sometimes the term (meaning "cutting") is also used to refer to penis removal, but that is less common. In Greek mythology, Cronus severed Uranus' testicles through castration and threw them into the sea, causing the goddess Aphrodite to rise from the foam.
Male circumcision is the removal of the foreskin, usually for religious, cultural or medical reasons and leaves a circumcision scar. The removal of the frenulum may be performed at the same time. The age at which circumcision may be performed varies widely, with groups such as Americans and Jews typically circumcising in the neonatal period and African tribes such as the Maasai and Xhosa circumcising in teenage years as initiation into adulthood. In modern medicine, circumcision may be used as treatment for severe phimosis or recurrent balanitis. Advocacy is often centered around preventive medicine while opposition is often centered around human rights and the potentially harmful side effects. The World Health Organization estimates that roughly 30% of the world's men are circumcised.
Foreskin restoration is the partial recreation of the foreskin after its removal by circumcision. Surgical restoration involves grafting skin taken from the scrotum onto a portion of the penile shaft. Nonsurgical methods involve tissue expansion by stretching the penile skin forward over the glans penis with the aid of tension. Nonsurgical restoration is the preferred method as it is less costly and typically yields better results than surgical restoration. A foreskin restoration device may be of help to men pursuing nonsurgical foreskin restoration. While restoration cannot recreate the nerves or tissues lost to circumcision, it can recreate the appearance and some of the function of a natural foreskin.
Infibulation of males involves suturing the foreskin together over the head of the penis. In ancient Greece, public performers practiced a nonsurgical form of infibulation by wearing a kynodesme. In modern times, male infibulation may be performed for personal preferences or as part of BDSM.
Pearling or genital beading is a form of body modification, the practice of permanently inserting small beads made of various materials beneath the skin of the genitals—of the labia, or of the shaft or foreskin of the penis. As well as being an aesthetic practice, this is usually intended to enhance the sexual pleasure of partners during vaginal or anal intercourse.
Penis removal involves the amputation of penis. Sometimes, the removal of the entire penis was done in conjunction with castration, or alternatively referred to as castration. Removing the penis was often performed on eunuchs and high ranking men who would frequently be in contact with women, such as those belonging to a harem. The Hijra of India may remove their penis as a part of their gender identity. In the medical field, removal of the penis may be performed for reasons of gangrene or cancer. Penis removal may occur through unintentional genital injury.
Penis removal for purposes of assault or revenge is overwhelmingly a female-on-male crime, particularly in Thailand. Lorena Bobbit famously removed her husband's penis in 1993. In cases of accidental removal, the penis may be able to be reattached.
Penile subincision is a form of genital modification involves a urethrotomy and vertically slitting the underside of the penis from the meatus towards to the base. It is performed by people of many cultures, such as the Indigenous Australians, the Arrente, the Luritja, the Samburu, the Samoans, and the Native Hawaiians. It may also be performed for personal preference. Penile subincision may leave a man with an increased risk of sexually transmitted diseases, issues with fertility (due to lack of control over what direction the sperm goes after ejaculation), and will require a man to sit down while urinating. As the surgery is not performed in a hospital or by a licensed medical professional, complications such as infection, exsanguination, or permanent damage are major concerns.
A dorsal slit (also known as superincision) is an incision made along the upper length of the foreskin with the intention to expose the glans penis without removing skin or tissue. It may be performed as a part of traditional customs, such as those in the Pacific Islands and the Philippines. In the medical field, it may be performed for as an alternative to circumcision when circumcision is undesired or impractical. It remains a rare surgery and practice overall.
- "Penises, Piercings and Pleasure".
- Cuypere, G., T’Sjoen, G., Beerten, R., Selvaggi, G., Sutter, P., Hoebeke, P., Monstrey, S., Vansteenwegen, A., & Rubens, R. (2005). Sexual and physical health after sex reassignment surgery. Archives of Sexual Behavior, 34(6), 679-690. doi:10.1007/s10508-005-7926-5
- Serena Nanda, "Neither Man nor Woman: The Hijras of India" Published 1999, Wadsworth Publishing
- ISNA's Amicus Brief on Intersex Genital Surgery The Intersex Society of North America, Dated February 7, 1998
- Karen S Vogt, MD, Michael J Bourgeois, MD, Arlan L Rosenbloom, MD, Mary L Windle, PharmD, George. P Chrousos, MD, FAAP, MACP, MACE, FRCP, Merrily P M Poth, MD, Stephen Kemp, MD, PhD Microphallus: Epidemiology Medscape, Updated August 3, 2011
- What's ISNA's position on surgery? - The Intersex Society of North America
- Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989;142(3):799-801.
- "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004
- "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975
- Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.
- Bourke, Emily (2009-11-12). "Designer vagina craze worries doctors". Australian Broadcasting Corporation. Retrieved 2007-05-29.
- Liao, Lih Mei; Sarah M Creighton (2007-05-26). "Requests for cosmetic genitoplasty: how should healthcare providers respond?". BMJ (British Medical Journal) 334 (7603): 1090–1092. doi:10.1136/bmj.39206.422269.BE. PMC 1877941. PMID 17525451. Retrieved 2007-05-29.
- Definition of the World Health Organization
- nthWORD Magazine. "nthWORD Magazine Interview with Liz Canner, filmmaker of Orgasm, Inc". Nthword.com. Retrieved 2010-11-07.
- , "Rwandan Women View The Elongation Of Their Labia As Positive", retrieved on 2008-06-18
- , "Enlarging Your Labia", retrieved on 2008-06-22
- , "Sexual health--a new focus for WHO", page 6, retrieved on 2008-06-19
- The Perfect Vagina Documentary Retrieved 13 February 2011.
- Green, Fiona: "From clitoridectomies to 'designer vaginas': The medical construction of heteronormative female bodies and sexuality through female genital cutting." Sexualities, Evolution & Gender 7(2):153-187, 2005.
- Essen, B & Johnsdotter, S: "Female Genital Mutilation in the West: Traditional Circumcision versus Genital Cosmetic Surgery". Acta Obstet Gynecol Scand,(83):611-613, 2004.
- Braun, Virginia: "In search of (better) sexual pleasure: female genital ‘cosmetic’ surgery". Sexualities 8(4):407-424, 2005.
- Gynecological cosmetic surgery: Expert Rev. Obstet. Gynecol. 4(2), 101-104 (2009): "The procedures described under female esthetic genital suergery are reduction labiaplasty, vaginaplasty, liposuction to mons pubis, fat injections to labia majora or mons, clitoral hoodectomy, hymenorrhaphy, 'G-spot amplication', and the use of a surgical laser in 'vaginal rejuvenation'."
- Clitorolabial Reconstruction in Circumcised Females with Clitoral Inclusion Cyst: "It is very clear from the Prophet’s instruction to perform partial hoodectomy. This hoodectomy or clitoral unhooding is currently considered in the aesthetic literature as cosmetic procedure of the female genitalia."
- Obiajulu Nnamuchi (2012). "Circumcision or Mutilation-Voluntary or Forced Excision-Extricating the Ethical and Legal Issues in Female Genital Ritual.". JL & Health (25): 85. "The appropriate medical nomenclature for FC is "clitoridotomy" or hoodectomy"
- New Approach to Clitoral Phimosis: Hoodplasty Giovanni Alei, Cristiano Monarca, Maria I. Rizzo, Piero Letizia, Lavinia Alei, and Nicolò Scuderi. Journal of Gynecologic Surgery. March 2011, 27(1): 25-28. doi:10.1089/gyn.2009.0093. Published in Volume: 27 Issue 1: March 18, 2011: "Clitoral phimosis is seldom reported. It is treated by hoodectomy or dorsal slit."
- "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. Retrieved 2009-03-04.