First, do no harm

[Note: I’ve changed the wording of this post because children with clitorises may not necessarily be girls. In the interests of transparency, I’ve indicated my earlier error with the strikethrough tag. My apologies for the earlier sloppiness. It seems to me this rush to classify everyone and their body parts in a binary way is part of what fuels this sort of surgery to begin with.]

A very distressing story is doing the rounds at the moment. Alice Dreger and Ellen Feder have cast a light on surgeries performed by Dix Poppas, a pediatric urologist at New York Presbyterian Hospital, Weill Medical College of Cornell University, to reduce the size of the clitorises of some little girls children, which he has deemed too big. It’s claimed that this procedure allows the girls children to “undergo a more natural psychological and sexual development”. The operations have been followed by examinations to assess whether clitoral sensation has been preserved, and these have been written up in a paper by Poppas and his colleagues, Jennifer Yang and Diane Felsen.

At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time. […]

In the course of our inquiries, made in preparation for this publication, nearly all clinicians to whom we described Poppas’s “clitoral sensory testing and vibratory sensory testing” practices thought them so outrageous that they told us we must have the facts wrong. When we showed them the 2007 article, their disbelief ceased, but they then seemed to become as agitated as we were. At an international conference two weeks ago, when Dreger told Ken Zucker, a psychologist at the Hospital for Sick Children in Toronto and member of the clinical establishment, about this, Zucker said that we could quote him as saying this: “Applying a vibrator to a six-year-old girl’s surgically feminized clitoris is developmentally inappropriate.” We couldn’t find a clinician who disagreed with Zucker.

Melissa McEwan succinctly sums up how deeply problematic this is:

First: There is no such thing as a clitoris that is “too big.”

Second: The follow-up examinations to evaluate sensation, referred to in Poppas’ paper by the remarkably clinical term “clitoral sensory testing,” consist of what is, by any reasonable definition, sexual assault. […]

Human rights violations exactly like this are the inevitable consequence of a culture in which female bodies and/or bodies with variant presentations outside some arbitrary spectrum of “normal” are treated as property of someone other than the person within whose body resides the mind capable of making decisions regarding autonomy and consent, but denied that fundamental right.

For many, bodies aren’t places for people to live in and from, it seems, but objects that should fit an approved standard template. This exchange between Dreger and a surgeon in the field demonstrates this amply:

One time I asked a surgeon who does these surgeries if he had any idea how women actually reach orgasm. What did he actually know, scientifically, about the functional physiology of the adult clitoris? He looked at me blankly, and then said, “But we’re working on children.” As if they were never going to grow up.

Update:I did more digging around and found this page on the Weill Cornell Pediatrics website. It includes the following language (emphases mine):

Classic congenital adrenal hyperplasia is usually detected in infancy or early childhood. Female newborns with the salt-wasting form of CAH may make the infant appear partially or very much like a male. In girls, the most obvious sign is often abnormal-appearing genitals that look more male than female, a condition called ambiguous external genitalia. The clitoris is enlarged and sometimes looks like a penis, and the labial folds may look something like a scrotum. […]

In some infant girls who have ambiguous genitalia, reconstructive surgery may be required to correct the appearance and function of the genitals, a procedure that may involve reducing the size of the clitoris and reconstructing the vaginal opening. […] Dr. Poppas has performed over 100 of these complex surgeries.

No purpose for the surgery, other than “correcting” “appearance and function”, is described.

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