{"id":3170,"date":"2017-05-16T17:26:45","date_gmt":"2017-05-16T16:26:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3170"},"modified":"2017-05-16T17:34:11","modified_gmt":"2017-05-16T16:34:11","slug":"how-different-are-female-male-and-intersex-genital-cutting","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/05\/16\/how-different-are-female-male-and-intersex-genital-cutting\/","title":{"rendered":"How Different are Female, Male and Intersex Genital Cutting?"},"content":{"rendered":"

By\u00a0Brian<\/a> D. Earp<\/a>\u00a0\u00a0(@briandavidearp<\/a>),\u00a0with\u00a0<\/em>Rebecca Steinfeld<\/a>, <\/em>Goldsmiths, University of London<\/a>\u00a0<\/em><\/p>\n

Three members of the Dawoodi Bohra sect of Islam were recently indicted<\/a> on charges of \u201cfemale genital mutilation\u201d (FGM) in the US state of Michigan. In Norway, meanwhile, one of the major political parties has backed<\/a> a measure to ban childhood male circumcision.<\/p>\n

Fearing that objections to female forms of genital cutting will be applied to male forms, some commentators<\/a> have rushed to draw a \u201cclear distinction\u201d between them. Others, however, have highlighted the similarities<\/a>.<\/p>\n

In fact, childhood genital cutting is usually divided not just into two, but three separate categories: \u201cFGM\u201d for females; \u201ccircumcision\u201d for males; and \u201cgenital normalisation\u201d surgery for intersex children<\/a> \u2013 those born with ambiguous genitals or mixed sex characteristics.<\/p>\n

In Western countries, popular attitudes towards these procedures differ sharply<\/a> depending on the child\u2019s sex. In females, any medically unnecessary genital cutting, no matter how minor or sterilised<\/a>, is seen as an intolerable violation of her bodily integrity and human rights. Most Westerners believe that such cutting must be legally prohibited<\/a>.<\/p>\n

In intersex children, while it is still common for doctors to surgically modify their genitals without a strict medical justification, there is growing opposition<\/a> to non-essential \u201ccosmetic<\/a>\u201d surgeries, designed to mould ambiguous genitalia into a \u201cbinary\u201d male or female appearance.<\/p>\n

Belgian model Hanne Gaby Odiele, for example, has spoken openly<\/a> about the negative impact of the \u201cirreversible, unconsented and unnecessary\u201d intersex surgeries she was subjected to growing up.<\/p>\n

In male children, by contrast, the dominant view is that boys are not significantly harmed by being circumcised, despite the loss of sensitive tissue<\/a>. Some even point to potential health benefits, although most doctors agree<\/a> that these benefits are not enough to outweigh<\/a> the risks and harms<\/a>. Even so, many people believe that parents should be allowed to choose circumcision for their sons, whether for cultural or religious reasons.<\/p>\n

But these attitudes are starting to change. Over the past few decades, and even more strongly in recent years<\/a>, scholars of genital cutting have argued<\/a> that there is too much overlap in the physical effects, motivations, and symbolic meanings of these three practices \u2013 when their full range across societies is considered<\/a> \u2013 for categorical distinctions based on sex or gender to hold up.<\/p>\n

<\/p>\n

Making comparisons<\/h2>\n

Take the Dawoodi Bohra case. The defendants claim that, like male circumcision, female \u201ccircumcision\u201d is required by their religion<\/a>. In the Western popular media, this claim is usually dismissed as mistaken<\/a>, because neither male nor female circumcision is mentioned in the Quran, the central scripture of Islam.<\/p>\n

But both practices are mentioned in the Hadith<\/a> (the sayings of the prophet Mohammed), which is another important source of Islamic law.<\/p>\n

Based on their reading of the Hadith, some Muslim authorities<\/a> state that \u201ccircumcision\u201d of both sexes is recommended or even obligatory, while others draw a different conclusion<\/a>. But there is no \u201cpope\u201d in Islam to make the final call: whether a practice counts as religious, therefore, depends on the local community and its interpretation of scripture.<\/p>\n

Motivations for genital cutting and associated \u201csymbolic meanings\u201d differ widely<\/a> from group to group. The claim that female genital cutting is always about sexual control<\/a>, while male genital cutting never is<\/a>, is an oversimplification<\/a> based on stereotypes \u2013 most anthropologists who study these practices regard<\/a> this claim as false.<\/p>\n

As they emphasise, nearly every society<\/a> that practices female genital cutting also practices male genital cutting, often in parallel and for similar reasons. When the cutting is part of a rite of passage into adulthood, for example, diminishing sexual experience is not typically the intention<\/a> for either the boys or the girls. Instead, the goal is to ceremoniously \u201ctransform\u201d the youths into mature adults, in part by having them show courage in the face of discomfort.<\/p>\n

What about the physical effects? These range widely, too. Some groups practice a female \u201critual nick\u201d<\/a>, which involves cutting part of the foreskin or \u201chood\u201d of the external clitoris. Although this procedure does not usually remove tissue<\/a>, it may certainly be painful and traumatic, and we have argued elsewhere<\/a> that it should not be done on non-consenting minors.<\/p>\n

Nevertheless, despite being federally prohibited in the US, this form of \u201cFGM\u201d is actually less invasive than either male circumcision or cosmetic intersex \u201cnormalisation\u201d surgeries \u2013 both of which are also painful and can be traumatic<\/a>, and neither of which is medically necessary.<\/p>\n

Informed consent<\/h2>\n

Based on these and other points of overlap, the emerging consensus<\/a> among some scholars is that the ethics of genital cutting should not be based on the apparent sex of the child (as judged by their external genitalia). Instead, it should be based on their age and ability to give informed consent<\/a>.<\/p>\n

Now that \u201cbinary\u201d conceptions of both sex and gender<\/a> are generally understood to be too limited to capture the full reality, judgements based on perceived maleness or femaleness will be increasingly hard to defend. For example, at what point along the intersex spectrum<\/a> does a small penis (legal to cut) become a large clitoris (illegal to cut)? Any such distinction would be subjective and arbitrary.<\/p>\n

In a recent paper<\/a> for the European Parliament, we spelled out these arguments in greater detail. We encourage you to give it a read<\/a>. In it, we ask: what are the policy implications of taking a gender-neutral approach to genital cutting?<\/p>\n

In other words, what happens when moral considerations centre around medical necessity, autonomy, and respect for the bodily integrity of all children \u2013 regardless of their sex or gender? We see three practical advantages to this approach:<\/p>\n

1) It deflects accusations of sexism by recognising that boys and intersex children \u2013 just like girls \u2013 are vulnerable to genital alterations that they may later come to seriously resent.<\/p>\n

2) It reduces the moral confusion that stems from Western-led efforts to eliminate only the female \u201chalf\u201d of genital cutting rites in communities that practice both male and female forms in parallel.<\/p>\n

3) It neutralises accusations of cultural imperialism and anti-Muslim bias by avoiding racially tinged double standards<\/a>.<\/p>\n

This is because the same moral concern would apply to medically unnecessary genital cutting practices that primarily affect white children in North America, Australasia and Europe, as to those affecting children of colour (and immigrants) from Africa, the Middle East and Southeast Asia.<\/p>\n

Adopting such an approach does not necessarily mean \u201cbanning\u201d all pre-consensual forms of non-therapeutic genital alteration. History shows that attempting to pass strict legal prohibitions<\/a> before cultural readiness can backfire, creating intense resistance among those who are dedicated to modifying children\u2019s genitals for whatever reason, and often driving such practices further underground.<\/p>\n

Prohibition of female genital cutting, for example, has been largely unsuccessful in many countries where it is customary and deeply culturally embedded (rates are higher than 90% in Egypt, for instance, where it has been illegal since 2008<\/a>); and recent attempts to criminalise circumcision of boys, such as in Germany<\/a> in 2012, have been blocked, overturned<\/a> or ignored.<\/p>\n

There are many levers that societies can pull to discourage unethical practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors have proposed<\/a> step-wise regulation of medically unnecessary childhood genital cutting, along with community engagement<\/a> and education, as alternatives and\/or supplements to formal prohibition.<\/p>\n

Whatever specific policies are implemented, it is clear that fundamentally different treatment of female, male and intersex children, in terms of their protection from non-therapeutic genital alteration, will become increasingly difficult to justify in the years to come.<\/p>\n

———————————<\/p>\n

Articles in the\u00a0Journal of Medical Ethics<\/em>\u00a0cited in this piece:<\/strong><\/p>\n

Arora, K. S., & Jacobs, A. J. (2016). Female genital alteration: a compromise solution<\/a>. Journal of Medical Ethics<\/i>, 42<\/i>(3), 148-154<\/p>\n

Ben-Yami, H. (2013). Circumcision: what should be done?<\/a>\u00a0Journal of Medical Ethics<\/i>, 39<\/i>(7), 459-462.<\/p>\n

Earp, B. D. (2016). In defence of genital autonomy for children<\/a>. Journal of Medical Ethics<\/i>, 42<\/i>(3), 158-163.<\/p>\n

Merkel, R., & Putzke, H. (2013). After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault?<\/a>\u00a0Journal of Medical Ethics<\/i>, 39<\/i>(7), 444-449.<\/p>\n

——————————–<\/p>\n

Brian D. Earp<\/a>, Associate Director, Yale-Hastings Program in Ethics and Health Policy<\/p>\n

Rebecca Steinfeld<\/a>, Visiting Research Fellow, Goldsmiths, University of London<\/a><\/p>\n

This article was originally published on The Conversation<\/a>. Read the original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

By\u00a0Brian D. Earp\u00a0\u00a0(@briandavidearp),\u00a0with\u00a0Rebecca Steinfeld, Goldsmiths, University of London\u00a0 Three members of the Dawoodi Bohra sect of Islam were recently indicted on charges of \u201cfemale genital mutilation\u201d (FGM) in the US state of Michigan. In Norway, meanwhile, one of the major political parties has backed a measure to ban childhood male circumcision. Fearing that objections to […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7933,1],"tags":[395,2611,8000,137,7964,7999,8001,7942],"class_list":["post-3170","post","type-post","status-publish","format-standard","hentry","category-brian-earps-posts","category-uncategorized","tag-bioethics","tag-circumcision","tag-dawoodi-bhora","tag-ethics","tag-female-genital-mutilation","tag-fgm","tag-intersex","tag-research-ethics"],"yoast_head":"\nHow Different are Female, Male and Intersex Genital Cutting? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/05\/16\/how-different-are-female-male-and-intersex-genital-cutting\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How Different are Female, Male and Intersex Genital Cutting? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By\u00a0Brian D. Earp\u00a0\u00a0(@briandavidearp),\u00a0with\u00a0Rebecca Steinfeld, Goldsmiths, University of London\u00a0 Three members of the Dawoodi Bohra sect of Islam were recently indicted on charges of \u201cfemale genital mutilation\u201d (FGM) in the US state of Michigan. In Norway, meanwhile, one of the major political parties has backed a measure to ban childhood male circumcision. 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