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.