The sanctioning of child genital cutting at Cornell University

*Strong trigger warning*

Alarming research being conducted at Cornell University is creating quite a stir, and pretty damn understandably: pediatric urologist Dr. Dix Poppas has been cutting the genitals of infants and children, with parental consent, for having clitorises that are too large.

Alice Dreger and Ellen K. Feder at Bioethics Forum brought recent attention to the controversial (to put it mildly) treatment which Dr. Poppas claims to “fix” the genitals of children as young as 3 months so they can have a more “normal appearing vagina” after the doctor deem their clitoris oversized. But despite Poppas’ claims that “female patients are able to undergo a more natural psychological and sexual development” with clitoroplasty, the two professors have been challenging Poppas for some time, saying that is anything but the case:

We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm.

In fact, many of these procedures have resulted in nerve damage and lose sensation in their clitoris — permanently — but the doctor claims his procedure is “nerve sparing” by going to greatly disturbing lengths to make sure this is achieved by “sensory testing” on the children’s genitals:

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.

The fact that this “research” has been approved by an institutional review board and sanctioned at Cornell is completely baffling considering the psychological harm of conducting what can be considered sexual assault on young children. Melissa at Shakesville says it well:

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.

Furthermore, the F-Word points out Alice Dreger’s experience talking to a surgeon in the field, who very clearly demonstrates the absolute lack of awareness that his “subjects” are actually human:

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.

While Dreger and Feder refer to Poppas’ patients as female, I kept asking myself the question of whether he was “treating” non-intersex girls with larger clitorises, intersex children, or both? While the practice is abhorrent either way, what I ended up finding via Bird of Paradox is much worth noting: Alice Dreger has received severe criticism from the intersex community and trans community, most notably for seeking to replace the term, “intersex” with “disorders of sexual development” or DSD. (Which is obviously pathologizing and super problematic.)

So did Dreger intentionally not use the term, “intersex” in her report on Poppas although many, if not all, of these children may actually be intersex? Because this surgical procedure and others like it intending to “normalize” genitals is hardly new, and has been conducted for quite some time on intersex children. While I would believe that there may also be girls who aren’t intersex being treated by Poppas for simply having a larger clitoris, we have to make sure that we include all of the children being affected here who are at risk of physical and extreme psychological harm.

Contact Cornell’s Office of Research Integrity and Assurance — here is the direct email; tell them that human rights violations and sexual assault is far from ethical research.

More at the F-Word and Shakes.

and tagged , , , . Bookmark the permalink. Both comments and trackbacks are currently closed.

27 Comments

  1. Toongrrl
    Posted June 18, 2010 at 12:42 pm | Permalink

    Messing with children there?!?!? Doesn’t this classify as child sexual abuse? What is wrong with this world?

  2. Bridgette
    Posted June 18, 2010 at 12:47 pm | Permalink

    I’ve got an idea, how about we wait for these little girls to grow up and find out if their ‘overly large clitorises’ end up being more normal. This is truly barbaric, and is not any different from the treatment of many intersexed children when they are born. Heaven forbid, though, we do something similar to a boy when he is born.

  3. daireen
    Posted June 18, 2010 at 12:56 pm | Permalink

    We do, though – it’s called circumcision. That is also unnecessary, and my boyfriend is very firmly of the opinion that it qualifies as genital mutilation.

  4. anjali_k
    Posted June 18, 2010 at 1:01 pm | Permalink

    omg…this is awful. I can’t believe the parents of these girls actually consent to this!

  5. Wednesday
    Posted June 18, 2010 at 1:02 pm | Permalink

    I’ve been seeing posts about this on various sites, and I’m really glad to see someone bring up that many of the victims may be intersex.
    I’ve been wondering why this has been omitted by other sources reporting on it. At the levels where this information was had by the writer but omitted, what’s the motivation? Is it because of the entrenched assumption that sex is binary?
    Is it because on some level people posting decided not to pass on the intersex angle because it might engender less outrage if it’s intersex kids being “normalized” rather than non-intersex girls having their genitals cut for no fathomable reason?

  6. Simone
    Posted June 18, 2010 at 1:10 pm | Permalink

    Bridgette,
    They do something to folks who are born with atypical genitials they “identify” as males. I should know, I had Reifenstein syndrome (PAIS type 3) which is characterized by severe hypospadias. They assigned me male…or let me put it this way, mutilated the hell out of me and took the decisions of assignment I actually was out of my hands at which point gender identity developed. Also it resulted in a botched surgery that resulted in genitial pain, scarring near the bladder and a deviated urinary tract. This type of thing happens to INTERSEX CHILDREN ACROSS THE BOARD, be it male or female assigned. My parents were never consulted about this properly either. That surgically assigning a child with reifenstien is the literal equivelent to flipping a coin. So yeah, when people get upset about this only happening in one direction, I think it is a bit uneducated. They do this to all children with atypical genitials. God forbid…they make up their own minds.
    I am a little pissed because I identify as female, and ALOT of medical information was kept from me. I am one of those intersex children they mutilated (oh assigned whatever). I have a problem with how the whole system works for intersex children.
    I am intersex, I transitioned to correct a medical mutilation made during childhood. My medical decisions were taken out of my hands at an infant and resulted in severe consequences. Sorry to rant….still kind of pissed this sort of thing STILL happens. I hate the fact they are trying to normalize these girls its fucking wrong, and yes intersex corrective surgeries ARE mutilations and should be addressed as such.

  7. Surfin3rdWave
    Posted June 18, 2010 at 1:27 pm | Permalink

    This is absolutely horrific. I agree that many of these girls could be intersex, and, as the former lover of a person who is intersex, I’m horrified by the lifelong scars that these procedures cause. I think that my lover was permanently traumatized, physically and emotionally, by the surgery she underwent as a baby.
    I was under the impression that most pediatricians now leave intersex infants alone. It’s far more traumatizing to have your genitals reassigned to fit the binary gender concept than it is to live with naturally beautiful– but different– genitals.
    Who’s to assume that these girls wouldn’t WANT to have large clitorises when they are older? Why is it that large penises are considered desirable, but large clitorises are considered to be defective? If they decided to opt for cosmetic surgery as adults, that’s their call– but we shouldn’t make it for them.

  8. Athenia
    Posted June 18, 2010 at 1:27 pm | Permalink

    “As if they never grow up.”
    WHAT?! I’d like to take this a step further—my clit worked just fine as a “kid”!

  9. Bridgette
    Posted June 18, 2010 at 1:42 pm | Permalink

    Circumcision is not like this. The only way that this would equate with circumcision is if the doctor was removing a large portion of the boy’s penis at the same time.
    However, I agree with not forcing a child to undergo any unnecessary procedure that removes portions of their bodies.

  10. Bridgette
    Posted June 18, 2010 at 1:48 pm | Permalink

    Simone,
    Unfortunately, I am well aware of the way that the medical establishment treats intersexuals, and it is horrific. A lot of this smacks of his trying to assign these girls, who appear to have a mild form of intersexuality, into a specific gender form. Unfortunately, we have a society right now which values this idiotic and destructive look for how a woman’s vulva is suppose to look.
    It is horrific how this entire medical establishment treats women and girls as if we are somehow valueless, and it is even worse how they treat interesexuals as if we are complete ‘things’ to be experimented upon.

  11. Moe
    Posted June 18, 2010 at 1:50 pm | Permalink

    Let’s not forget that this happens all over the country to infants, male and female, with ambiguous genitalia. This points to an even larger problem concerning the binary that exists between males and females. If the clitoris is too big then it is not feminine enough and if the penis is not big enough then it will not be able to effectively penetrate a woman so OF COURSE the only answer is to change that genitalia to look like a vagina. There is no room for ambiguity when it comes to gender, sexuality, and even biology.

  12. Nicole
    Posted June 18, 2010 at 1:58 pm | Permalink

    Seriously, no one took a minute to say “Wait a second…maybe we SHOULDN’T use vibrators on little kids”?
    What the hell. These doctors-and parents-have some weird freaking priorities.

  13. winniemcgovens
    Posted June 18, 2010 at 2:07 pm | Permalink

    Jesus people can we stop freaking over our children’s junk and cutting it up. I agree male circumcision on infants is wrong, I think clitorial cutting is more physically damaging but both are unnecessary cosmetic surgeries that cause needless pain and possible permanent medical damage to someone who could not consent to it. I don’t see what the problem is with waiting until children are 16-18 and letting them decide if THEY want to change their genital situation.

  14. EndersGames
    Posted June 18, 2010 at 2:13 pm | Permalink

    That’s horrible. Let the girls decide what they want to do when they grow up.
    I do understand Dreger’s desire to avoid the term “intersex” in a medical context. Intersex can refer to an identity, not just a biological condition, and is overly broad
    . I also understand the issues people take with “Disorders of Sexual Development” because it is, by definition, pathologizing the condition. Perhaps something like “Variations of Sexual Development” would be an acceptable substitute when discussing the actual physical traits involved in a medical context?
    Is “disorder” ever okay? For something that is just externally atypical, it seems ridiculous to call that a disorder. If it interferes with typical functioning in a way that the individual finds unacceptable, however, is it safe to call that a disorder? For example, being born with out a uterus or testicles?

  15. Dena
    Posted June 18, 2010 at 2:34 pm | Permalink

    This is absolutely disgusting. I don’t understand how this has gone unpublicised for so long.
    Hopefully, this exposure will put an end to this. Those poor girls…

  16. rhian
    Posted June 18, 2010 at 2:47 pm | Permalink

    Just wanted to clarify some things, because there’s a lot of talk going on about “porn-perfect” genitalia and such that I think is misguided.
    Congenital adrenal hyperplasia is a real disease. It’s caused by an enzyme deficiency in the adrenal glands that screws up the levels of several hormones, most dangerously ones that affect your salt regulation. It also affects the levels of sex hormones, leading to high androgen levels in XX people, and causing, to various degrees, “virilized” female genitalia. Thus these people would generally be considered intersex. (XY people can also have CAH, but the higher androgen levels don’t sway their genitalia away from “normal”.)
    Dangerous and questionable assumption made by many in the medical field AND by many parents of these kids: There are negative psychosocial implications of having “ambiguous” genitalia. IF you’re running with that assumption, surgery during infancy, while healing of tissue and nerves is easy, is actually the best treatment. But those surgeries have historically been really bad, sacrificing a lot of sexual sensation and function for the sake of appearances. So establishing techniques that reduce scarring, tissue damage, loss of sensation, etc would be beneficial. That’s what they believe they’re doing here.
    That being said, I don’t support these surgeries, which I believe do more harm than good, and I certainly don’t support this research, which sounds shockingly unethical and traumatising for the patients. But it is not so simple as a doctor cutting every clitoris he deems a little big.

  17. Lydia
    Posted June 18, 2010 at 3:04 pm | Permalink

    This. I am against circumcising infant boys, but it’s not nearly as damaging as Poppas’ surgery. Removing of the clitoral hood would be the equivalent procedure to male circumcision, because the foreskin and the hood are homologous structures. However, the clitoris and the glans penis are homologous structures, so the equivalent of Poppas’ surgery on a boy would be the removal of part of the glans. I don’t like circumcision but this is much worse.

  18. artdyke
    Posted June 18, 2010 at 7:00 pm | Permalink

    AAAAAAAAAAAAAAAAAAHHHHHHH!!!!!!!!!!!
    D:D:D:

  19. sparky17
    Posted June 18, 2010 at 8:01 pm | Permalink

    Can people just PLEASE stop cutting up their children’s genitals? I think putting any kind of knife or surgical instrument anywhere near your child’s nether-regions should be a federal offense.

  20. Chris
    Posted June 18, 2010 at 8:58 pm | Permalink

    “But those surgeries have historically been really bad, sacrificing a lot of sexual sensation and function for the sake of appearances. So establishing techniques that reduce scarring, tissue damage, loss of sensation, etc would be beneficial. That’s what they believe they’re doing here.”
    If the techniques are not beneficial, why shouldn’t greater acceptance and understanding be promoted instead? Why should *any* such surgeries be recommended?

  21. makomk
    Posted June 19, 2010 at 6:24 pm | Permalink

    Indeed. The male equivalent was probably performing feminising surgery on babies who appear male aside from the fact that their penis is too small or otherwise misshapen to be functional in order to raise them as girls. Thankfully that’s gone out of fashion in the last decade or two, because it was a disaster. (Then-popular feminist theories of gender as a social construct suggested this should’ve worked out well. They were, as it turns out, completely and utterly wrong – though that doesn’t stop some people from advocating them even now.)

  22. vcmaude
    Posted June 20, 2010 at 11:23 am | Permalink

    Does law enforcement know about this? How can this be allowed to continue? I don’t understand how this isn’t child abuse.

  23. southern students for choice
    Posted June 20, 2010 at 1:38 pm | Permalink

    Two quick points:
    1) The strongest arguement to make here is that operations to “correct” intersex infants is unnecessary for their physical health and arguably — certainly not in the world we want to to work towards, and probably not in the one we have today, at least in the so-called enlightened western world — unhelpful to promote their future mental health, as has been shown in numerous cases, most famously David Reimer.
    There’s sooo much else that’s offensive about this account, particularly the part about stimulating an infant or child’s genitals to determine if the surgery caused nerve damage, it’s important to be focused on what is the most important ethical point to make — this form of surgery is unnecessary and possibly harmful in ways that can’t be (reliably, ethically) determined in children.
    If this sort of surgery were performed on an adult — including the tests for nerve damage — it could not only be ethical but very well worth a feminist’s time in defending. This is important to note because we assure you the antis and antifeminist right will be all over this as another example of how sex research too easily involves unethical experimentation on children (a la the accusations leveled over the decades against Alfred Kinsey of the Kinsey Report and Kinsey Institute).
    2) It’s not clear who is/are the author (or all of the authors) of the article linked to in the blog post above titled “The Surgical Management of Congenital Adrenal Hyperplasia,” but in any case it includes the following:

    An early one stage repair is recommended because female patients are able to undergo a more natural psychological and sexual development when they have a normal appearing vagina.

    It may be said that this is meant to be read in context of surgery that goes beyond clitoral reduction, but in any case it’s probably more accurate to say that what this sort of surgery is supposed to do is to give the patient a more normally appearing vulva or labia. The appearence of the vagina isn’t especially important because it’s an internal structure, but in common use a lot of people (men especially but also many women) use the word vagina to refer to the overall genital area.
    A minor point, perhaps, but any critique of this unnecessary and arguably unethical procedure ought to be as strong and (space permitting) as comprehensive as possible. Whoever it was who wrote the article, it was intended for a professional audience, probably a peer-reviewed audience, one that probably knows the right words to use and would have wanted them used in this context.

  24. Chris
    Posted June 20, 2010 at 8:07 pm | Permalink

    “my boyfriend is very firmly of the opinion that it qualifies as genital mutilation”
    A form of sure, but not directly comparable to the severity of FGM involved here and practiced regularly.

  25. liv79
    Posted June 22, 2010 at 2:22 pm | Permalink

    A great reference on this topic is the fabulous book, Woman: An Intimate Geography by Natalie Angiers. There is a whole section on the clit and intersex genital experimentation. Blech.

  26. noRisknoFun!
    Posted June 22, 2010 at 6:18 pm | Permalink
  27. colleen
    Posted June 24, 2010 at 2:19 pm | Permalink

    While I agree with your BF about circumcision, this isn’t the same thing. The equivalent would be a lopping off the top of a boy’s penis and then testing to see if he still had some sensation.
    It’s funny how folks never get upset about small or hooded clitoruses.
    What I want to know is what sort of parent would allow this to happen to their child. It’s barbaric, cruel and unnecessary.

Feministing In Your Inbox

Sign up for our Newsletter to stay in touch with Feministing
and receive regular updates and exclusive content.

216 queries. 0.518 seconds