Thursday, June 17, 2010

Call 1-800-FEMNIST: Would Publicity About Unnecessary Genital Surgery On American Children Get Women Off Their Asses?

OK, I know I haven't blogged about the BP oil spill in the Gulf of Mexico ($20 billion? Not enough, Barack -- and do not point your finger at me to show how "tough" you are. Hyper-masculinity pisses me off.) I have also not blogged about the closing arguments in Perry v. Schwarzenegger, the California case that will nominally decide whether Prop 8 is overturned, but that will really decide that GLBT marriage will go to the Supreme Court sooner than activists on either side intended (see Georgetown law prof Nan D. Hunter at Hunter of Justice for updates.)

What I am thinking about a lot this summer, however -- since I am writing a book on radical feminism in the 1970s -- is: what could happen to kick women in the United States out of their torpor and provoke a feminist political revival? Specifically, what could get women to care about female genital mutilation here in the United States, rather than condemning people in the Islamic world as if Americans were not culturally obsessed with their children's genitals too?

Try this.

Although Cornell University's Institutional Research Board might easily demand authority over an oral history project, it appears that the medical school IRB has signed off on a research project in which pediatric urologist Dix Poppas (who holds a named chair at Weill Cornell Medical Center at New York Presbyterian Hospital) is performing clitoral reduction surgeries on little girls. Presumably, because none of the subjects is identified as having a dangerous condition (like cancer, which can also cause clitoral enlargement, or a blockage of the urethra) the subjects are being chosen because they had the bad luck to be born at a teaching hospital, and in possession of either a distinctly unladylike clitoris or a micropenis.

The so-called "medical condition" under study by Dr. Poppas and his team at Weil is called "clitoromegaly." Naming is a common strategy of the medical and pharmaceutical industries to declare something found in nature and non-lethal to be unnatural and of grave danger to one's health. See, for example, today's article in the The New York Times about the marketing of flibamserin, a new pill for "female hypoactive sexual desire disorder," or "female sexual dysfunction." Girls, after taking flibamserin daily for weeks, which may make you nauseated and cause you to feel faint, you may want to have more sex. Woo-hoo!

My guess? Poppas's research, which is about preserving urological "nerve bundles," will really find its market in prostate cancer surgery, which has a truly rotten record of success (surgeons also lie about the rate of prostate surgery complications, by the way, since somewhere between 8 and 50% of men suffer from permanent post-surgical incontinence. ) It will probably also be useful in female to male transsexual surgery, for which recipients pay cash as such surgery is specifically excluded from health insurance policies, even though transsexuals do often suffer from clinical depression (an actual medical condition) when they are denied treatment that adjusts their bodies to their felt gender.

The real question is: who cares if a child has a clitoris just like Mommy's? I mention this because one powerful rationale for male circumcision, another unnecessary medical procedure performed without consent, is that boys won't grow up right unless they look like Daddy. Although it appears that having a clit just like Mommy's are also prevalent among pediatric surgeons, opinions about what constitutes a "normal clitoris" vary widely, from something smaller to a pencil eraser to half the length of your thumb (I wish.)

How many women do you know who can report losing or gaining physical self confidence as teenagers from comparing vageegees in the shower with Mama?

As usual, researchers are pushing this on parents for their own reasons, when in fact the kind and ethical thing to do would be to tell parents and their growing children the truth: having genitals that are off the norm is no big deal unless the child hirself decides, later in life, that it is, or unless it indicates a life-threatening medical condition. As Dan Savage reported yesterday, because Poppas is promoting this as a "nerve sparing surgery" for children who may be intersexed, it also involves follow up examinations in which the children are stimulated with a vibrator on the clitoris and groin and asked to report their sensations to the researchers. See clinical findings by Poppas, Jennifer Yang (a Cornell graduate currently at UCSF) and Diane Felson here. Known as cliteroplasty (as opposed to "female genital mutilation," which is what we call it when people who are not First World physicians do it), the candidates for the study ranged in age from 4 months to 24 years old. Clearly, however, most of the people in the study required parental permission, as the mean age was 4.6 - 6.8 years.

Why do children need this surgery? Why, to ensure "normal sexual development." What could be more important?

This strikes me as a moment where women on the right and on the left might join forces to address both the reform of human subjects research, and the question of why children have no right to informed consent when their sexuality is under scrutiny by researchers and health providers. True, we might not agree on what constitutes "normal sexual development," gender norms or about the rights of parents over children more generally. But we might agree about the right of medical researchers to decide whether a child's genitalia look correct, and whether it is OK to give young parents false, coercive information. Women might agree that in this kind of research children are being harmed. They might agree that such surgeries are an adult vanity project masquerading as science. They might agree that invasive and artificial forms of gender construction should not be performed on children too young to give their consent, and that researchers gathered around a child, manipulating hir genitals, and asking questions about it promotes child molestation by scientists -- not "normal sexual development."

You thought genital surgery without informed consent was all over when John Colapintoexposed John Money and David Reimer's long-term research at The John's Hopkins University, in which boys with small or damaged penises were surgically transformed into girls? Think again. Although the National Organization for Women defines female genital mutilation done for religious and cultural reasons as a human rights violation, I have not found a single statement on their web page that addresses the question of surgeries done on female children, or children thought to be better off female by American medical researchers. The theme of this year's conference, by the way is "Loving Our Bodies, Changing the World."

For more information on this issue from the adult activists who have organized around the violation of their own rights as intersexed children, go to the Intersex Society of North America web page. This page includes a helpful guide for parents who, as the Colapinto book shows, can easily be frightened into "choosing" invasive surgery and research protocols on behalf of their child in the confusing and vulnerable hours following birth by being told that their child has a "medical condition." It includes this important advice:

If the doctors are offering genital surgeries to change the way your child’s genitals look, ask: Why do you think my child needs this genital surgery? What evidence do you have that this will help my child in the long run? If your child needs a surgery to save her life, obviously it is a good idea! If your surgeon wants to do a surgery to change how your child looks, pause and consider waiting. What we know about people who grew up with “ambiguous genitalia” tells us on average they do well! You may understandably worry that your child will be emotionally hurt by having something other than average-looking genitals, but the evidence suggests your child won’t be, especially if you’re open, honest, accepting, and supportive. Surgeries may leave your child with diminished health, diminished sexual sensation, scarring, a poor cosmetic outcome, and an unintended message that your child needed to be “fixed” to be accepted by you. So consider waiting and letting your child decide whether to take the risks. You may discover your child is fine with the way your child is, especially if you let your child know you are.

This should be required reading for every parent prior to giving birth. While comparatively few children are born intersexed, those that are are overwhelmingly healthy and more likely to remain so without surgical intervention and early childhood sexual experimentation.

11 comments:

Historiann said...

What is it with all of the urologists named Dick or Dix?

More seriously--I dig this post and agree with you, but I don't understand why you wrote this: "This strikes me as a moment where women on the right and on the left might join forces to address the reform of human subjects research, and why children have no right to informed consent when their sexuality is under scrutiny by researchers and health providers."

The American Right is famously hostile to children's rights, and would be moreso if they came up more often. (Does anyone else remember the pillorying of Hillary Clinton in the 1990s because--among many other reasons--she had worked on children's rights in particular in the course of her legal and public service career?) I agree that women should mobilize, but I don't think that the right wingers are going to be interested in jumping on this bandwagon.

Here's another example of why health care needs to be an individual right rather than something one gets access to through marriage or legal custody. Most insured children have health insurance through a parent. It's this paternalistic view of children, and the very real barriers to their making their own decisions about surgery, for example--that seem to be central to your critique here.

shaz said...

Wow, it's so Victorian -- get faint, have sex. Isn't that how it is supposed to work?

And I was certainly nauseous after reading those articles this morning...

If you haven't already, check out Elizabeth Reis' recent book, Bodies in Doubt, on the history of intersex in America. Plus ca change, unfortunately...

Comrade PhysioProf said...

Yeah, we should leave these fucking kids alone, instead of imposing our own adult fucked-up sexual hangups on them. And if we did that, I bet they'd have fewer fucked-up sexual hangups when they grow up.

Tenured Radical said...

Historiann: you are correct that the right is famously hostile to children's rights, but primarily where they see those rights as properly subsumed under paternalism. For physicians to be lying to parents on the other hand also conflicts with family authority and privacy.

Historiann said...

Ahh. . . gotcha. Now I follow your logic.

Anonymous said...

How on earth can any child develop a normal sexual identity or later enjoy normal sexual relationships when some asshole has mutilated their genitalia when they are between 4 and 6 years old?! My ex had to be circumcised at 6 because his foreskin did not grow, and was both painful and caused infections, and believe me, he never got over it. I wonder how many of these doctors would be willing to do this to their own kids?

RachelH said...

How the hell do they get this sort of thing past ethics review boards? I'm not in the medical field myself, but my (relatively innocuous) research has to get ethics approval, and frequently gets knocked back or asked for further explanation for such things as the chance it might catch a child on camera without their parents' permission, or for paying participants for their time spent answering a survey.

How can research involving stimulating a four-year-old's genitals (not to mention cutting them up!) POSSIBLY get passed???

right-wing prof said...

At least circumcision has some health benefits, I don't see any claimed for this procedure. Hey TR how about some comment on the US pediatrician association (or some group with a similar name) okaying some kind of "ritual snip" of the clitoris to placate Muslims. I hope you will strongly oppose this too.

Historiann said...

Right Wing Prof.: I think you're referring to the American Academy of Pediatrics, which first recommended and then immediately retracted a policy of a pediatrician "nicking" the clitoris for families who will practice FGM. (This position of the AAP was severely criticized, and then retracted: http://www.medpagetoday.com/Pediatrics/Parenting/20340)

I talked to a pediatrician about this. He seems to think that the recommendation for "nicking" came from the pediatric mindset, which is that you have to treat your patients through their parents. Pediatricians cannot treat just their patients alone--they must count on the support and cooperation of the parents. What you (as a pediatrician) think is right or wrong is irrelevant. For example, the pediatrician in question is big on vaccination, but some of his patients' parents are whingy and believe a lot of woo out there about vaccines. He doesn't insult them and kick them out of his practice--he tries to work with the parents and work towards a compromise. He has to have their confidence if he's going to serve as his patients' best advocate.

He thinks the motive for the "nicking" was to 1) ensure that any FGM happened under sterile conditions; 2) that girls so treated wouldn't be subjected to more invasive or barbaric surgeries in the future; and 3) that girls so treated would fit into their families and communities.

I'm just explaining what I heard from one pediatrician, not defending the AAP here. Personally, I think the AAP's original endorsement of any form of FGM was a bad idea, because I don't think that it would prevent outcomes #2 or #3 above. Never mind the fact that it's totally unnecessary and unrelated to a child's health and wellness. That said, I don't know what I would do were I a pediatrician in a practice with a lot of immigrant families who want to practice FGM on their kids.

Anonymous said...

Hello,

Even the health benefits of circumcision are fairly unclear. The AAP does not find that there is sufficient evidence of benefits to recommend the procedure, only that there are "potential" benefits (which more or less boil down to the rate of UTI's in infants and the extremely rare cancer of the penis - if there's no foreskin, it can't get cancer...) Here's their full report:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

(I should also point out that somewhat ironically, my word verification for posting this comment is "mantip")

m Andrea said...

But but but, girls don't compare their clitorises! You can't even SEE it unless you physically move the labia folds out of the way.

Thank you very much for this, I had no idea. And I will call, they hate that.

On the subject of AAP, they failed to consider "harm reduction", or more precisely, that while moving a society from routinely whacking off the entire clit with a rusty tin can to a symbolic nick would be helpful in countries which routinely practiced the tin can procedure, moving society to a nick procedure in countries where FGM was rare, would not achieve "harm reduction". Just the opposite in fact, it would legitimize the procedure where it hadn't been legitimate before. I called those AAP folks a dozen times in a week, I was so enraged. LOL