…the cutting edge of a double standard
In February, 2014, the Ontario’s Sexual Health Network organized an update on “female genital mutilation” (also known as “female genital cutting”). At the meeting, I raised the question that was so eloquently discussed in a paper on intersex surgeries about the cultural parallels between genital cutting practices in “developing” countries and genital surgery in “developed” countries. This issue was raised again in a recent discussion on CBC Radio’s program, The Current to which I listened attentively (yes, I took notes) as I am interested in these surgeries and have participated in two public discussions on the subject.
The Current invited the CEO of the Society of Obstetricians and Gynecologists of Canada (SOGC), Dr. Jennifer Blake, to speak about the SOGC guidelines on both female genital mutilation/cutting and female genital cosmetic surgery. They also invited Dr. Sean Rice, a plastic surgeon who performs labiaplasty as well as a triathlete who had requested—and was satisfied with—the surgery.
Labiaplasty involves reducing or removing the labia minora—or inner lips—of the vulva. Another common surgery is the reduction of the clitoral hood. The motivation for this surgery on a functional part of the body is generally either dissatisfaction with the appearance of the vulva or, in the case of labial reduction or removal, its interference with comfort, as was the case with the triathlete.
In the interview, Dr. Blake argued that women are made to feel inadequate about whether or not they look “normal.” In her practice, Dr. Blake tells adolescent patients that their inner labia will fill out and look more proportional as they continue the changes of puberty. She applauds initiatives like the Great Wall of Vagina for normalizing the diversity in genital appearance. Dr. Blake blames pornography in particular, for playing on women’s anxieties about what the vulva is supposed to look like. One wonders if this body anxiety can eventually lead to body dysmorphic disorder (where people think about their real or perceived flaws for hours each day); and whether this disorder is entirely a cultural creation of our society.
People associate female genital mutilation/cutting with Islam although it is practised by other religions and cultures as well. Although Muslim scholars are divided about the particulars, there is no Islamic religious basis to these practices. (“No verse of the Quran, or deeds or sayings of the Prophet, support FGM/C”). The practices are culturally driven.
In a film about female genital mutilation/cutting interviewees explain the norm for women’s genitals in their cultures; one woman interviewed in the film said the vulva must look “smooth and clean.” The societal implication for a woman who is not cut is tremendous in some cultures: in Somalia or Sudan, for example, she is not considered marriageable. Dr. Blake made the point that the same type of language is used with female genital cosmetic surgery. “The Barbie”—also known as “The Clam”—is a surgically created smooth version of a woman’s genitals. During the interview on The Current, the surgeon, Dr. Rice, took offense at this comparison between genital mutilation and genital cosmetic surgery, insisting that the issue of consent was central to cosmetic surgeries.
As a women’s health advocate since 1970, and formerly a counsellor in a sexual health clinic, consent—informed consent—has been paramount to my practice. On what basis does a woman make her decision about modifying her genitals? Where does she get her information aside from media images and biased advertisements for the surgeries? Part of the larger picture is our rigid cultural description of male and female genitals. What should they look like to be considered properly male or female?
In Ehrenreich and Barr’s article about the “selective condemnation of ‘cultural practices,’” they explore and critique the binary definitions of genitals and discuss how decisions are made about whether or not to modify the genitals of an intersex baby. The basis of the decision is shockingly simplistic.
If the penis of an intersex baby is too small (defined as under 2.5 cm stretched), the child is likely to undergo surgery to be transformed into a girl. Not surprisingly, the authors consider this rigid definition of biological male sexuality to be heteronormative. Similarly, a baby with what is considered to be an abnormally large clitoris would undergo a clitoroplasty to reduce the size of the clitoris.
These surgeries of “genital normalization” for intersex babies—an average of 3 to 5 surgeries per child—not only have repercussions emotionally, but also can impair sexual functioning because of scarring and nerve damage. Vaginoplasty to create an opening for an intersex child has a high failure rate in terms of the person’s ability to have/enjoy vaginal sex as an adult. Ehrenreich and Barr argue that North American medical practice as it applies to intersex children is not strictly based in science; nor is it culture-free. The authors make the point that we condemn the “cultural” practices of cutting in other countries while refusing to be self-critical about the cutting practices in North America, acknowledging them as a cultural practice as well.
Intersex children rely on their parents’ consent to the surgeries. Is a woman giving informed consent when she opts for labiaplasty if she does not know whether she will experience negative health effects when she reaches menopause, like a potential increase in vaginal atrophy? Moreover, clinics offering “mother/daughter specials” on genital cosmetic surgery are unlikely to discuss with either mother or daughter the potential damage to sexual sensation due to possible scarring and nerve damage.
In the article “Aesthetic Surgery of the Female Genitalia” published in Seminars in Plastic Surgery, the authors comment:
“The vulvar epithelium of labia minora is highly innervated and sensitive. During sexual arousal, the labia evert and contribute to erotic sensation and pleasure. Incision to any part of the genitalia could compromise this sensitivity and its sexual importance. Neuroma-like hypersensitivity has been reported after surgery.” In other words, when you cut during surgery, the result may be either insensitivity or hypersensitivity, neither of which is expected as part of the package.
In the 1970s, at a Geneva conference of the World Health Organization, feminists publicly decried female genital mutilation practices. Their sisters from countries where genital mutilation took place told them to stay out of it; that they would deal with the issue themselves. And they have been. In countries where genital mutilation/cutting is practised, slowly but surely, women are finding allies, including religious leaders, to put an end to these practices. Surely women in “developed” countries who long for designer genitals have something important to learn from them.