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Female Genital Alteration

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Assigning Responsibility for Children’s Health When Parents and Authorities Disagree: Whose Child?

Part of the book series: The International Library of Bioethics ((ILB,volume 90))

Abstract

Female genital alteration (FGA) encompasses a wide range of procedures. Minimal FGA consists of a simple nick with a sharp instrument, leaving no residua. Most Malay and Indonesian girls probably undergo such a vulvar nick. The other extreme of FGA is to remove the entire external genitalia and to surgically narrow the vaginal orifice to render penile penetration difficult or impossible. This procedure, called infibulation, has been prevalent in the Horn of Africa. FGA performance in various places by poorly trained operators under unhygienic conditions increases the risk of all variants of FGA. The frequent absence of analgesia augments likely psychological trauma, though these procedures have become increasing medicalized. All forms of ritual FGA in children are illegal in Western nations, so that outcomes have not been well studied. States in which FGA is indigenous must deal with FGA in the context of their own cultural and legal environment. Where it is tolerated, it is hoped that objective evidence of its effects will be forthcoming, so that policies can be informed by data. In the West, some ritual FGA procedures have acceptable comparable secular procedures. Aesthetic labia minora reduction and clitoral hood retraction (in physically mature women), for example, are legal. Application of the State Intervention Test shows no acceptable application of FGA in physically immature girls except, in some cases, for a vulvar nick. More extensive procedures, performed in physically mature and mentally maturing minors, should be evaluated for acceptability on the basis of individual procedures, in the context of mainstream practices.

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Notes

  1. 1.

    I define female genital alteration as any physical invasion of external female genitalia performed for non-medical or non-cosmetic reasons. This term ‘female genital alteration’ was probably proposed by Davis (2001). It is preferable to either ‘female genital cutting’ or ‘female genital mutilation’ (Arora and Jacobs 2016).

  2. 2.

    For an overview of evolutionary psychology, see Buss and von Hippel (2018).

  3. 3.

    Societies may reject the assimilation of members of some outgroups (Whitman 2017), while the membership status of others may be insecure; (Kremelberg 2016)

  4. 4.

    I have never performed an invasive procedure on a woman for religious, cultural, or aesthetic reasons. I have often removed some or all of the vulva for cancer or premalignant conditions, and have performed labia minora reduction on <5 adults who were experiencing pain or chafing from markedly hyperplastic labia minora.

  5. 5.

    I have practiced gynecology since beginning residency in 1973, and have performed a number of examinations of prepubertal girls for injuries, foreign bodies, and various lesions. Because of the small size of the prepubertal clitoris and the tight adherence of its hood, I believe that separation of the hood from the clitoral head before puberty runs a high risk of injury to the clitoral glans, even when done well. This would be true even with microsurgical techniques. I therefore believe that incision or resection of the clitoral prepuce (though performed commonly in mature women for sexual enhancement) is unsafe in prepubertal girls.

  6. 6.

    This is not necessarily true of some offshoots from Judaism, Christianity, and Islam, such as Unitarian-Universalists and Baha’i, who do not take the Hebrew Bible, New Testament, or Quran to be canonical. Some progressive adherents to the three principal Abrahamic religious traditions also reject binary gender norms.

  7. 7.

    Munzer does not believe that circumcision in children is warranted for non-medical reasons. He did not address FGA.

  8. 8.

    Most nations have embraced proportionality analysis in their constitutional jurisprudence, but the United States has not. Rather, American constitutional law employs three levels of scrutiny—rational, intermediate, and strict bases, described by Galloway (1988).

  9. 9.

    Somaliland is former British Somalia and is the northern part of Somalia. It is self-governing and considers itself independent, but the international community considers it part of the nation of Somalia, so it will not be found on political maps.

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  1. Gynecologic Oncology, Coney Island Hospital, Brooklyn, NY, USA

    Allan J. Jacobs

  2. SUNY Downstate College of Medicine, Brooklyn, New York, USA

    Allan J. Jacobs

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Jacobs, A.J. (2022). Female Genital Alteration. In: Assigning Responsibility for Children’s Health When Parents and Authorities Disagree: Whose Child?. The International Library of Bioethics, vol 90. Springer, Cham. https://doi.org/10.1007/978-3-030-87698-2_15

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