Monday, June 21, 2010

Cornell University and clitoroplasty

I've been sitting on this story since I first heard about it last week, trying to figure out what it's all about and how one even writes about it. After reading multiple articles on the topic, this is the best I can figure: A doctor at Cornell University has been performing a procedure called clitoroplasty (specifically, "nerve sparing ventral clitoroplasty"), which involves removing part of the clitoris, on girls* and women* ages 4 months to 24 years. And then, to see how the procedure went, the doctor and his team tested the girls' and women's clitorises to find out if they could feel sensation. The tests involved a cotton-tip applicator and "vibratory sensory testing." On young girls, just so we're clear.

Those are the facts, so to speak. But this has raised a lot of questions: is this surgery is even necessary in the first place; will it even "work" in the long term; the impact of the surgery and resulting testing on the patient's well-being; how does such a study get approved; etc.

As best as I can tell, this procedure was performed on girls and women who have enlarged clitorises, or clitorises that are bigger than "normal," as determined by the doctor. I am no expert on this, of course, so I don't know how one determines that, say, a 4-month-old has a too-big clitoris. Here is what Alice Dreger and Ellen K. Feder say in their article at Bioethics Forum (I recommend reading the whole thing):
... With parental consent, these girls’ clitorises have been cut down in size after the physician deemed these clitorises too big.

For over a decade, many people (including us) have criticized this surgical practice. Critics in medicine, bioethics, and patient advocacy have questioned the surgery’s necessity, safety, and efficacy. 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.
And then there is this, from Feministing, which is so important:
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.
Yeah, I really don't know what to do with this. I mean, "first do no harm," what does that mean here? I can't imagine there is no harm. But, I figured the least I can do is pass it on and make people aware that this happened. If you can stomach more, read Dreger's follow-up article on Psychology Today, check out Dan Savage's article on The Stranger, and see a PDF of the study here. Also, Shakesville has an open discussion thread on the topic.

**I have referred to the patients as girls and women as the study itself has, but I cannot say with any certainty that those terms are correct. If anyone has more detailed information about that, please let me know.

1 comment:

Advocates for Informed Choice said...

Advocates for Informed Choice is a non-profit organization advocating for the legal and human rights of children with intersex conditions or differences of sex develoment, like the ones in this story. We work in collaboration with bioethicists, doctors, parents, affected adults, and many others. If you are interested in taking action to help protect these children, and to be sure that possible human rights violations are investigated, please join our Facebook page at http://www.facebook.com/pages/Advocates-for-Informed-Choice/266159729604 or sign up for our Twitter feed at http://twitter.com/aiclegal. You can also donate to support our work at http://aiclegal.org/we-need-your-support/

LinkWithin

Blog Widget by LinkWithin