Genital modification and mutilation

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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.

Body modification[edit]

Main article: Body modification

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.

Contemporary female genital piercings: Clitoral hood piercing and labia piercing

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.[1] 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[edit]

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.[2] Some of the surgical procedures are breast augmentation and vaginoplasty for trans women and mastectomy, metoidioplasty, and phalloplasty for trans men. Trans women may also benefit from hair removal and facial feminization surgery while some trans men may have liposuction to remove fat deposits around their hips and thighs.

Hijra, a third gender found in the Indian subcontinent, may opt to undergo castration.[3]

Involuntary sex assignment[edit]

Main articles: Sex assignment and Intersex surgery

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.[4] For example, in cases involving male children with micropenis, doctors may recommend the child be reassigned as female.[5] 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.[6]

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,[7][8][9][10] 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[edit]

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[edit]

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.

Female genitals[edit]

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.[11][12] Similar concerns have been expressed in Australia.[11]

Female genital mutilation[edit]

Prevalence of FGM by country, according to a 2013 UNICEF report[13]

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."[14] It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. It is practiced in several parts of the world, but the practice is concentrated more heavily in Africa, and parts of the Middle East, and some other parts of Asia. Over 125 million women and girls have experienced FGM in the 29 countries in which it is concentrated.[15] Over eight million have been infibulated, a practice found largely in Djibouti, Eritrea, Somalia and Sudan.[16] Infibulation, the most extreme form of FGM (known as Type III), consists of the removal of the inner and outer labia and closure of the vulva, while a small hole is left for the passage of urine and menstrual blood; afterwards the vagina will be opened after the wedding for sexual intercourse and childbirth. 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.[17]

Hymenorrhaphy[edit]

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.[citation needed] Individuals who are victims of rape, who were virginal at the time of their rape, may elect for hymenorrhaphy.

Labia stretching[edit]

Labia stretching is the act of elongating the labia minora through manual manipulation (pulling) or physical equipment (such as weights).[18][19] It is a familial cultural practice in Rwanda,[18] common in Sub-Saharan Africa,[20] and a body modification practice elsewhere.[19] It is performed for sexual enhancement of both partners, aesthetics, symmetry and gratification.[18][19]

Labiaplasty and vaginoplasty[edit]

Vulva with labia minora surgically removed

Some women undergo vaginoplasty or labiaplasty procedures to alter the shape of their vulvas to meet personal aesthetic standards.[21] The surgery itself is controversial, and critics refer to the procedures as "designer vagina".[22][23][24]

In the article Designer Vaginas by Simone Weil Davis, she talks about the modification of woman’s vagina and the outside influences women are pressured with, which can cause them to feel shame towards their labia minora. She states that the media such as pornography is creating an unhealthy view of what a “good looking vagina” is and how women feel that their privates are inferior and are therefore pressured to act upon that mindset. These insecurities are forced upon women by their partners and other women as well. Davis states, "These days, in part because of the video dissemination and the mainstreaming of pornography, women . . . can see the vaginas of a lot of different other women.” (271). If a woman does wish to change their vagains they’ll have to be economically stable to do so. Davis goes on to include a quote from The Los Angeles Times’ interview with plastic surgeon Dr. David Matlock, of the influence of pornography on his patients seeking labiaplasty. Matlock states, “Women are coming in saying, I want something different, I want to change things. They look at Playboy, the ideal women perse, for the body and the shape and so on. You don’t see women in there with excessively long labia minora” (270). This can relate to the idea of Cycle of Socialization; Which is how our surroundings can define our personalities, and our “norms” as well as our decisions, actions, and the people we turn out to be. What are the outside factors that are influencing women to believe that they should have those kind of vaginas and what are influencing men as well to believe that those are inferior vaginas? The article also mentions the practice of African Female Genital Mutilation. Davis states “Although consent is at the heart of the issue of genital operations on children, a topic both urgent and not to be downplayed, we must also look at the social and cultural means whereby consent is manufactured, regardless of age, in the West as well as in African and other countries engaging in FGOs.” (273). This is an important point, because in both cases women and children are looking to be accepted as normal, to conform to the societal norms.

[25]

Clitoral hood reduction[edit]

Clitoral hood reduction, also termed clitoral hoodectomy,[26] clitoral unhooding,[27] clitoridotomy,[28] or (partial) hoodectomy,[29] is a form of hoodplasty. When performed with the consent of the adult individual, it can be considered 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 thought to improve the sexual functioning of the woman, and the aesthetic appeal of her vulva. 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. When these procedures are performed on individuals without their consent, they are considered a form of female genital mutilation.

Male genitals[edit]

Castration[edit]

Main article: Castration

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.

Circumcision[edit]

Prevalence of male circumcision by country
Main article: Circumcision

Male circumcision is the removal of part or all of the foreskin. It is a procedure usually performed for religious, cultural or medical reasons, and leaves some or all of the glans permanently exposed. The age at which circumcision may be performed varies widely, with Americans and religious groups such as Muslims and Jews typically circumcising in the neonatal period, and Filipinos and African tribes such as the Maasai and Xhosa circumcising in teenage years as an 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 (particularly the bodily integrity of the infant when circumcision is performed in the neonatal period) and the potentially harmful side effects of the procedure.[30][31][32]

The World Health Organization estimates that roughly 30% of the world's men are circumcised, the majority being Muslims.[33]

Foreskin restoration[edit]

Main article: Foreskin restoration

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[edit]

Main article: Infibulation

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[edit]

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.

Penectomy[edit]

Main article: Penectomy
Genital area of male after partial penectomy.

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 an expression 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 infamously removed her husband's penis in 1993. In cases of accidental removal, it may be possible to reattach the penis.

Penile subincision[edit]

Main article: Penile subincision
Penile subincision

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 may require a man to sit down while urinating.[34] When 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.

Penile superincision[edit]

Main article: Dorsal slit

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.

See also[edit]

References[edit]

  1. ^ "Penises, Piercings and Pleasure". 
  2. ^ 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
  3. ^ Serena Nanda, "Neither Man nor Woman: The Hijras of India" Published 1999, Wadsworth Publishing
  4. ^ ISNA's Amicus Brief on Intersex Genital Surgery The Intersex Society of North America, Dated February 7, 1998
  5. ^ 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
  6. ^ What's ISNA's position on surgery? - The Intersex Society of North America
  7. ^ 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.
  8. ^ "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004
  9. ^ "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975
  10. ^ Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.
  11. ^ a b Bourke, Emily (2009-11-12). "Designer vagina craze worries doctors". Australian Broadcasting Corporation. Retrieved 2007-05-29. 
  12. ^ 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. 
  13. ^ "Prevalence of FGM/C". UNICEF. Retrieved 18 August 2014. 
  14. ^ Definition of the World Health Organization
  15. ^ UNICEF 2013, p. 22: "More than 125 million girls and women alive today have been cut in the 29 countries in Africa and the Middle East where FGM/C is concentrated.

    UNICEF 2013, p. 121, n. 62: "This estimate [125 million] is derived from weighted averages of FGM/C prevalence among girls aged 0 to 14 and girls and women aged 15 to 49, using the most recently available DHS, MICS and SHHS data (1997–2012) for the 29 countries where FGM/C is concentrated. The number of girls and women who have been cut was calculated using 2011 demographic figures produced by the UN Population Division ... The number of cut women aged 50 and older is based on FGM/C prevalence in women aged 45 to 49."

  16. ^ P. Stanley Yoder, Shane Khan, "Numbers of women circumcised in Africa: The Production of a Total", USAID, DHS Working Papers, No. 39, March 2008, pp. 13–14: "Infibulation is practiced largely in countries located in northeastern Africa: Djibouti, Eritrea, Ethiopia, Somalia, and Sudan. Survey data are available for Sudan, Eritrea, Ethiopia and Djibouti. Sudan alone accounts for about 3.5 million of the women. ... [T]he estimate of the total number of women infibulated in [Djibouti, Somalia, Eritrea, northern Sudan, Ethiopia, Guinea, Mali, Burkina Faso, Senegal, Chad, Nigeria, Cameroon and Tanzania, for women 15–49 years old] comes to 8,245,449, or just over eight million women." Also see Appendix B, Table 2 ("Types of FGC"), p. 19.

    UNICEF 2013, p. 182, identifies "sewn closed" as most common in Djibouti, Eritrea, Somalia for 15–49 age group (survey in 2000 for Sudan was not included), and for daughters, Djibouti, Eritrea, Niger and Somalia. UNICEF statistical profiles on FGM, showing type of FGM: Djibouti (December 2013), Eritrea (July 2014), Somalia (December 2013).

    Gerry Mackie, "Ending Footbinding and Infibulation: A Convention Account", American Sociological Review, 61(6), December 1996 (pp. 999–1017), p. 1002: "Infibulation, the harshest practice, occurs contiguously in Egyptian Nubia, the Sudan, Eritrea, Djibouti and Somalia, also known as Islamic Northeast Africa."

  17. ^ nthWORD Magazine. "nthWORD Magazine Interview with Liz Canner, filmmaker of Orgasm, Inc". Nthword.com. Retrieved 2010-11-07. 
  18. ^ a b c [1], "Rwandan Women View The Elongation Of Their Labia As Positive", retrieved on 2008-06-18
  19. ^ a b c [2], "Enlarging Your Labia", retrieved on 2008-06-22
  20. ^ [3], "Sexual health--a new focus for WHO", page 6, retrieved on 2008-06-19
  21. ^ The Perfect Vagina Documentary Retrieved 13 February 2011.
  22. ^ 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.
  23. ^ Essen, B & Johnsdotter, S: "Female Genital Mutilation in the West: Traditional Circumcision versus Genital Cosmetic Surgery". Acta Obstet Gynecol Scand, (83):611-613, 2004.
  24. ^ Braun, Virginia: "In search of (better) sexual pleasure: female genital ‘cosmetic’ surgery". Sexualities 8(4):407-424, 2005.
  25. ^ Davis, Simone Weil. "Designer Vaginas." Women's Voices, Feminist Visions. Ed. Susan Shaw and Janet Lee. New York: McGraw Hill (2012): 270-77.
  26. ^ 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'."
  27. ^ 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."
  28. ^ 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" 
  29. ^ 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."
  30. ^ Svoboda, J. S. (2013). "Circumcision of male infants as a human rights violation". Journal of Medical Ethics 39 (7): 469–474. doi:10.1136/medethics-2012-101229. ISSN 0306-6800. 
  31. ^ Dekkers (June 2009). "Routine (non-religious) neonatal circumcision and bodily integrity: a transatlantic dialogue.". Kennedy Institute of Ethics Journal 19 (2): 125–46. doi:10.1353/ken.0.0279. PMID 19623819. 
  32. ^ Fadel, Petrina (Spring 2003). "Respect for Bodily Integrity: A Catholic Perspective on Circumcision in Catholic Hospitals". The American Journal of Bioethics 3 (2): 1f–3f. doi:10.1162/152651603766436379. PMID 12859800. 
  33. ^ "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. Retrieved 2009-03-04. 
  34. ^ http://wiki.bme.com/index.php?title=Meatotomy

External links[edit]