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Clitoridectomy

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Clitoridectomy or clitorectomy is the surgical removal of the clitoris. It is used rarely as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. Most removals of the clitoris occur as female genital mutilation, defined by the World Health Organization (WHO) as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons."[1] This procedure is also ritual practice in certain tribes in Africa.

Clitoridectomies are performed for various different reasons. Many women, an estimated 125 million alive today, have had the surgery in 29 countries in Africa and the Middle East where it’s concentrated. The reason behind most of these surgeries is cultural or religious. FGM is often seen as a rite of passage that makes girls eligible for marriage. It is associated with cultural ideals of femininity and beauty, as it is seen to rid girls of their “unclean” and “male” body parts. (World Health Organization) Clitoridectomies are also often performed on intersex newborns in order to make their genitalia more “understandable.” This largely enforces a sexual binary and children born with penises that are not long enough, or clitorises that are too long, are seen as abnormal and needing of correction.

Historical use of clitoridectomy

Curbing Female Masturbation

Clitoridectomy was once used to curb female masturbation.[2] Gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation.[3] The first reported clitoridectomy in the West was carried out in 1822 by a surgeon in Berlin, a Dr. Graefe, on a teenage girl regarded as an "imbecile" who was masturbating frequently.[4]

Isaac Baker Brown (1812–1873), an English gynaecologist who was president of the Medical Society of London in 1865, believed that the "unnatural irritation" of the clitoris caused epilepsy, hysteria, and mania, and he worked "to remove [it] whenever he had the opportunity of doing so", according to his obituary in the Medical Times and Gazette. Peter Lewis Allen writes that Brown's views caused outrage, and he died penniless after being expelled from the Obstetrical Society.[5]

Clitoridectomy in the West

“Clitoridectomy is a technique long eschewed owing to poor cosmetic outcomes and significant damage to sexual sensation and function. Indeed, more than a decade ago, a European Society for Pediatric Endocrinology survey called it “appalling” that “clitoridectomy is still reported by 13%” of 125 European centers caring for DSD [intersex] patients, and expressed the “hope that this practice will be banned completely in the near future.” [6]

Western Feminist Argument

Western feminists believe that the reasons put forth to do clitoridectomy or circumcision are not legitimate because “women are merely confronting what men find attractive”. Also, Clitoridectomy is done to deny women sexual pleasure and satisfaction.

Western Feminist Experience

During the nineteenth century in the West, female circumicism was done for psycho-sexual reasons. According to Victorian medicine, women were vulnerable to emotional disorders and mental diseases due to the nature of their reproductive organs. Their organs, particularly the clitoris was to be tempered. According to the medical theory “if exciting the clitoris caused insanity, its removal would cure the neurosis”. It was then that the surgical treatment called, clitoridectomy was adopted. The operation stopped after the fall of Dr. Baker Brown (the main proponent of clitoridectomy) in 1867. Yet, the application of clitoridectomy continues to exist in Western medicine. Clitoridectomy is no longer used to cure female psycho-sexual disorders. [7]

However, a number of Western medical doctors still do practice clitoridectomy.

There was a recent controversy over performing clitoridectomy on young women athletes as part of the ‘package’ of surgery proposed when they are diagnosed with hyperandrogenism. A recent policy was introduced by the International Olympic Committee that regulated hyperandrogenism in female athletes. The policy required medical investigation of women athletes who were alleged to have hyperandrogenism. Under this policy, four young athletes from developing countries had gonadectomy and partial clitoridectomy after they were identified hyperandrogenic. This policy strongly identifies what it means to be a “normal” woman. It implies that if a woman is “too” good at her sport, it must be because of the male hormone, testosterone, in her body.[8]


Redirecting Female Sexual Behavior Upon the Basis of Heteronormative Vaginal Intercourse

Female circumcision and clitoridectomy in the United States are practices that have been widely conducted as methods to direct female sexual behavior within the act of “normalized” heterosexual vaginal intercourse. Often female sexual behavior is linked to the sexual organ of the clitoris. Thus, attention to understanding the structure and function of the clitoris has contributed to the overall socially constructed role that women play as sexual partners with their male counterparts.

The American medical knowledge of the clitoris can be found in medical and gynecological textbooks, which are widely used by doctors to obtain the standard form and function of a clitoris. In fact, physicians would use these texts in order to confirm the explanations to clinical questions. Therefore, the history of these medical texts has indirectly created accepted ideas about the female body because this ‘legitimate’ information should be regarded as standard (5). Furthermore, medical and gynecological textbooks are also at fault in the way that the clitoris is described in comparison to a male’s penis. In fact, the importance and originality of a female’s clitoris is underscored through these contrasting descriptions: “This equation can be seen as a representation of the clitoris as a less significant organ, since anatomy texts compared the penis and the clitoris in only one direction”(6). Meaning the female’s clitoris was compared to the male’s penis and not the other way around. Therefore, a male’s penis created the framework of the sexual organ, which has been considered analogous, to a female’s clitoris. Nonetheless, it is known that many anatomical texts were written by men in the early to mid 1900s; a time when males dominated the field of medicine. [9]

Continuing the discussion of how the American society has included a male’s sexual organ into the understanding of a female’s clitoris is the rising notion of the vaginal sex model. Along with understanding the functionality of a clitoris comes with considering a female’s sexual response to clitoral stimulation. Contrary to popular belief most women have stated that they reach orgasm not only through penetration but also through stimulation of the clitoris. However, penetrative sex, also known as the ‘Male heterosexual response’ is considered as normative and thus has created an expectation of how women should act sexually: “Thus the presumption was that women would follow this model, and studies on the sexual response of women were set up under the assumption that women did (or should) respond sexually like men and receive sexual stimulation from vaginal intercourse” [10]. This model creates a limitation to the ways in which women are perceived to experience sex. This heteronormative model includes vaginal sex, which has the potential to produce vaginal orgasm. However, it undermines the possibility for women to experience clitoral stimulation and thus clitoral orgasm. By separating these two experiences the model has further deconstructed the importance of the clitoris in a female’s body.

The idea that vaginal orgasm was highly recognized/signified was popular during the mid-1940s through the 1960s. In fact there was an actual diagnosis for those who could not reach vaginal orgasm and a women was thus considered not “receptive” enough. [11]. Kroger is one of the many supporters who installed this idea in Americans that a vaginal orgasm was mature and healthy while a clitoral orgasm was not. These ideals then forced outsiders to not identify the clitoris as a sexual organ. As a result of the confusion regarding whether a healthy female orgasm was clitoral or vaginal, has led physicians to provide surgical procedures, such as clitoridectomy. These procedures have continued to contribute to the normative heterosexual sex model:

“Surgery on the clitoris, be it female circumcision, clitoridectomy…all underscored a medical understanding of the clitoris as sexual but in need of correction to maintain the primacy of the vaginal sex model. Through the use of these procedures, physicians sought to adapt the clitoris – and female orgasm – to fit the penetrative sex model. Physicians performed clitoral surgery by directing and, they believed, enabling female sexual response within this model” [12]

Corrective Procedure on Intersex Infants

Defining Normal

One aspect of a normative clitoris is size. In a study in the American Journal of Perinatology, the clitoral length of eighty-two infants was found to range from 0.2 to 0.85 centimeters, and the width of the clitorises ranged from 0.2 to 0.6 centimeters. In another study, the clitorises of infants that were surgically reduced ranged from 1.5 centimeters to 3.5 centimeters before surgery. [13] It is common to use food terminology such as "pea" or "small bean" to discuss normative sizes of clitorises.

Another aspect of the normative clitoris is aesthetic. A lack of ambiguity of genitalia is seen as necessary in the assignment of a sex to infants. The idea of ambiguity is shifting, however, since what one sees as ambiguous varies from person to person.[14] Anxiety about ambiguity of genitalia exists based on the fear of confusing the clitoris with a penis, which disrupts the rigid gender binaries that have been set in place by various societal institutions. In reality, there exists a range of natural variations in size and shape of genitalia. [15]

In order for a penis to be considered normal, it had to pass two tests of adequacy. First, if it would allow the boy to be able to pee standing up and feel “normal” and second, if the adult man’s penis would be large enough for vaginal penetration, which normalizes a heterosexual experience. According to one study of 100 newborn boys, penis size ranged from 2.9 to 4.5 cm. Dr. Patricia Donahoe from Harvard Medical School expresses concern about penises 2.0 cm long and says that one less than 1.5 cm long and 0.7 cm wide would result in a female gender assignment. However, many doctors offer advice to parents based on their general observations of the newborn’s genitals. [16] Clitoridectomies are then often performed for no other reason than that a newborn’s phallus doesn’t seem “sufficient” to the surgeon as a penis.

Procedural Details

Four types of female genital mutilation have been identified by the World Health Organization. Type 1 is the clitoridectomy, which involves “partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).” Type 2 is called excision and involves “partial of total removal of the clitoris and the labia minora, with or without excision of the labia majora.” Type 3, infibulation, in the most severe, and involves “narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.” Finally, type 4 is the “other” category that includes all other harmful procedures to female genitalia for non-medical purposes. [17]

Anne Fausto-Sterling describes some of the surgeries performed on intersex newborns in Sexing the Body. In the clitoral reduction, the surgeon cuts the shaft of the elongated phallus and and sews the glans and preserved nerves back onto the stump. In a less common surgery called clitoral recession, the surgeon hides the clitoral shaft under a fold of skin so only the glans remains visible. [18]

Additionally, Suzanne Kessler states:

“There are different clitoral options and no medical consensus on how much of the clitoral surgical options need to be removed by a variety of ‘trimming and wedging techniques’ in order to make it a ‘suitable’ size. Some physicians argue for amputation of all erectile tissue, claiming that retention of even just the glans is complicated by tissue sloughing. Those in favor of this complete extirpation claim that to do less is a halfway measure ‘because this allows the bulk of the clitoral shaft and both corporal extensions to remain (and)…such tissue can become turgid and painful.’ A medical justification is not always offered; sometimes the physician recommends clitoridectomy only because it produces a more satisfactory appearance” [19]

Need for Procedure

Clitoridectomies are performed on clitorises that are classified as larger than typical. The procedure is seen as imperative in order to rid potential normative females of embarrassing phallic structures. [20] The procedure is also condoned by the parents of intersex infants who exhibit grave concern for the ambiguity of their child's genitalia. [21] The procedure is also necessary because a large clitoris challenges the normative female aesthetic because it is "imperfect and ugly." [22]

Also of concern is the ability of a person to engage in normative heterosexual sex that enables reproduction. Anne Fausto-Sterling states, “Why should we care if there are individuals whose ‘natural biological equipment’ enables them to have sex ‘naturally’ with both men and women?”[23] She speaks of a woman who had a clitoris large enough to penetrate a vagina, but also had a vagina that could be penetrated by a penis. [24] This bodily situation is disruptive to current norms about sex that exist because of the pervasiveness of heteronormativity. Reducing an enlarged clitoris would ensure that the type of sex the body is allowed to engage in is policed. Fausto-Sterling also emphasizes surgeons' preoccupation with the ability to bear children after surgery.[25] This preoccupation illuminates the importance that is given to people, especially women, who are able to reproduce.

Cultural Significance of Procedure

Clitoridectomies are often used as a way for parents of a newborn to ensure that his/her biological sex and genitalia match what they perceive to be the baby’s gender. It’s important then to realize that these surgeries meant to “fix” intersex children deal with both the child’s sex and gender. The genitalia of the infant will inform the gender expectations that the child will face.

Therefore, clitoridectomies signify the medicalization of gender, as well as sex. Intersex individuals are made to seem like they have a "medical problem that needs fixing, but only a small number of intersex children have medical problems."[26] This procedure also illuminates the dual construction of gender: the social construction of gender and the surgical construction of gender. The binary of male and female is constructed socially, as well as in a corporeal sense based on the genitalia that is surgically produced.[27]This surgical procedure perpetuates ideas of sexual dimorphism and makes biological sex seem like a given.


See also

Notes

  1. ^ "New study shows female genital mutilation exposes women and babies to significant risk at childbirth" (Press release). World Health Organization. 2006-06-02.
  2. ^ Duffy, John (October 19, 1963). "Masturbation and Clitoridectomy: A Nineteenth-Century View". JAMA. 186 (3): 246–248. doi:10.1001/jama.1963.63710030028012. PMID 14057114.
  3. ^ Rodriguez, Sarah W. "Rethinking the history of female circumcision and clitoridectomy: American medicine and female sexuality in the late nineteenth century", Journal of the History of Medicine and Allied Sciences. 63(3), July 2008, pp. 323–347.
  4. '^ Elchalal, Uriel et al. "Ritualistic Female Genital Mutilation: Current Status and Future Outlook", Obstetrical & Gynecological Survey, 52(10), October 1997, pp. 643–651.
    • For a report of this procedure, see Black, Donald Campbell. On the Functional Diseases of the Renal, Urinary and Reproductive Organs. Lindsay & Blakiston, 1872, pp. 127–129.
  5. ^ Allen, Peter Lewis. The Wages of Sin: Sex and Disease, Past and Present. University of Chicago Press, 2000, p. 106.
    • For the obituary, see J.F.C. "Isaac Baker Brown, F.R.C.S.", Medical Times and Gazette, 8 February 1873.
    • Also see Brown, Isaac Baker. On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females. Robert Hardwicke, 1866.
  6. ^ Riepe, FG; Krone, N; Viemann, M; Partsch, CJ; Sippell, WG (2002). "Management of congenital adrenal hyperplasia: Results of the ESPE questionnaire". Hormone Research (58): 196–205.
  7. ^ Atoki, M (1995). "Should Female Circumcision Continue to be Banned". Feminist Legal Studies. 3.
  8. ^ Jordan-Young, Rebecca; Sonksen, P; Karkazi, K (28 April 2014). "Sex, Health, and Athletes". BMJ.
  9. ^ Rodriguez, Sarah (2014). Female Circumcision and Clitoridectomy in the United States: A History of Medical Treatment. University of Rochester Press.
  10. ^ Rodriguez, Sarah (2014). Female Circumcision and Clitoridectomy in the United States: A History of Medical Treatment. University of Rochester Press.
  11. ^ Rodriguez, Sarah (2014). Female Circumcision and Clitoridectomy in the United States: A History of Medical Treatment. University of Rochester Press.
  12. ^ Rodriguez, Sarah (2014). Female Circumcision and Clitoridectomy in the United States: A History of Medical Treatment. University of Rochester Press.
  13. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 43. ISBN 0813525292.
  14. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 44. ISBN 0813525292.
  15. ^ "Medical Lawsuit: Stop Wrecking Babies' Genitals". ONTD Political. LiveJournal. Retrieved 5 December 2014. {{cite web}}: |first1= missing |last1= (help)
  16. ^ Fausto-Sterling, Anne (2000). Sexing the Body (1. Paperback printing. ed.). New York, NY [u.a.]: Basic Books. p. 57. ISBN 0465077145.
  17. ^ "Female genital mutilation". World Health Organization. Retrieved 3 December 2014.
  18. ^ Fausto-Sterling, Anne (2000). Sexing the Body (1. Paperback printing. ed.). New York, NY [u.a.]: Basic Books. p. 61. ISBN 0465077145.
  19. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 47. ISBN 0813525292.
  20. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 35. ISBN 0813525292.
  21. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 36. ISBN 0813525292.
  22. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 36. ISBN 0813525292.
  23. ^ Fausto-Sterling, Anne (2004). Sexing the body : gender politics and the construction of sexuality (1. ed., [Nachdr.] ed.). New York, NY: Basic Books. p. 8. ISBN 0-465-07714-5.
  24. ^ Fausto-Sterling, Anne (2004). Sexing the body : gender politics and the construction of sexuality (1. ed., [Nachdr.] ed.). New York, NY: Basic Books. p. 43. ISBN 0-465-07714-5.
  25. ^ Fausto-Sterling, Anne (2004). Sexing the body : gender politics and the construction of sexuality (1. ed., [Nachdr.] ed.). New York, NY: Basic Books. p. 48. ISBN 0-465-07714-5.
  26. ^ "Medical Lawsuit: Stop Wrecking Babies' Genitals". ONTD Political. LiveJournal. Retrieved 3 December 2014. {{cite web}}: |first1= missing |last1= (help)
  27. ^ Kessler, Suzanne J. (2000). Lessons from the intersexed (2. Paperback printing. ed.). New Brunswick, NJ [u.a.]: Rutgers Univ. Press. p. 46. ISBN 0813525292.

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