How come the article says Poppas had IRB (ethics oversight) approval and we suggest he probably didn't? Because what he has approval for is retrospective chart review, a harmless little look back at what he recorded in the charts as having happened to his patients. What he didn't do was to get approval in advance for the "clitoral sensory testing" that he was writing down in the chart and then used to produce the systematic and generalized conclusions about his technique. This may sound like a technicality. It isn't. If he had sought IRB approval for the "sensory testing," the ethics staff might have sat up and asked him what the heck he thought he was doing to these girls, and they would have tried to make sure the parents were informed about the unknowns and risks, and the girls could have refused to participate.posted by bewilderbeast at 7:04 PM on June 17, 2010 [1 favorite]
someone gave an apt comparison above, delmoi.I'm not an idiot. I know how Josef Mengele was. Not everyone who performs medical experiments is a Nazi. Jesus. The nazi's medical experiments didn't even have anything to do with sexuality (as far as I know), or at least that's not what they were notorious for doing.
Mengele's experiments also included attempts to take one twins eyeballs and attach them to the back of the other twin's head, changing eye color by injecting chemicals into children's eyes, various amputations of limbs, and other brutal surgeries. Rena Gelissen's account of her time in Auschwitz details certain experiments performed on female prisoners around October 1943. Mengele would experiment on the chosen girls, performing sterilization and shock treatments. Most of the victims died, either due to the experiments or later infections. ... At Auschwitz, Mengele did a number of twin studies. After the experiment was over, these twins were usually murdered and their bodies dissected.The only comparison here is that this doctor's experimentation also grosses people out. It does not compare to taking someone else's eyeballs and attaching them to the back of another person's head. he's not murdering and dissecting the girls after the operation.
WHile I personally would support maintaining gender ambiguity and letting the individuals get surgery later if they so desire, I don't think this is based on perversion. It is based on a binary notion of gender, and an interest in making sure little girls look like little girls, rather than having an intersex / ambiguous identity.Okay, I take the 'weird perv' thing back actually. I wrote that before I thought of the possibility that he was operating on 'intersex' sized clitorises (despite the fact I mentioned it earlier in the comment, I wrote that sentence later and pasted it. Anyway...)
Just suffering and mutilation. -- mottyWell, the question is whether growing up as an intersex girl would cause less suffering. While there's not really anything wrong with it you can't expect children to understand that. I would imagine that would be the basis of the parents concerns.
Well, two out of three? -- cjorgensen
You have a citation for this?The question is whether growing up as an intersex girl would cause less sufferingThe answer is yes.
You are correct to say that Mengele's acts were far worse, but in simple terms I think the comparison is not wholly without merit.Yes, cutting off someone arms and legs for fun was "unwarranted", that was the problem.
1) The surgeries are unwarranted.
2) The surgeries are performed on patients who cannot consent, and whose parents may be pressured unethically to consent.Right, that was the problem with Mengele's experiments parents may have been pressured into do it. Oh wait, that's actually true of any procedure given to a child. Do you have any evidence that any parents actually were pressured into anything here or are you just spewing accusations?
3) The surgeries have a not-insignificant chance of harming the patients and their well-being.Yes, cutting out someone's eyeballs and attaching them to another person and then killing them both and cutting up their bodies has a 'not-insignificant' chance of harming the patients and their 'well-being'. Seriously, wtf?
AbstractThe additional problem here is, as stated in the 'Q-tips and vibrators' link, "shock and concern over the follow-up examination techniques".
BACKGROUND: The effects on sexual function of surgical removal of parts of the clitoris are unknown. For infants with intersex conditions and ambiguous genitalia being raised female, this surgery is often undertaken in early childhood. Our aim was to assess the effects of surgery on sexual outcome in this population.
FINDINGS: Of the 39 individuals enrolled, 28 had been sexually active and all had sexual difficulties. The 18 women who had undergone clitoral surgery had higher rates of non-sensuality (78%) and of inability to achieve orgasm (39%) than did the ten who had not had surgery (20% [p=0.002] and 0% [p=0.03], respectively).
INTERPRETATION: Sexual function could be compromised by clitoral surgery. Debate on the ethics of the use of this surgery in children should be promoted and further multicentre research is needed to ensure representative samples and comprehensive outcome assessment. Meanwhile, parents and patients who consent to clitoral surgery should be fully informed of the potential risks to sexual function.
delmoi, I'm lost as to why you seem to be applying my summary of Poppas to Mengele. It reads like you're reinforcing what I wrote rather than rebutting it.It's because you wrote:
You are correct to say that Mengele's acts were far worse, but in simple terms I think the comparison is not wholly without merit.As in, there is merit in comparing the two people. I was pointing out why that was wrong. (or at least that he is no more like Mengele then any other medical researcher). And actually I get annoyed by the "you can't compare anyone to the Nazis" thing. Sometimes people really are slightly naziish. I would argue that, for example, the Gitmo 'doctors' who experimented on detainees are inching in that directly. They don't equal what Mengele did but it's the same type of evil, but not the same magnitude.
Yeah, tails obviously don't apply here as a comparison, but penises do. So think of it as your penis. You wouldn't want someone to cut a few inches out of the shaft of your penis and then sew it back together and hope for the best, would you?Except we do surgically alter boys penises. About 50% of American boys are circumcised, mainly for cosmetic or traditional reasons. The surgery isn't as invasive as this, it sounds like.
Oh, wait. That's different. I think I'd prefer some kind of home test in that case. No reason the doctor needs to be involved. That's kind of icky.Is it really less icky then having parents do it? I think if I were a parent, I would rather have a doctor do it then do it myself.
I'm opposed to all genital mutilation that is performed without consent, but if you really don't see the difference between circumcision and clit-reshaping surgery, then I don't know what to say.I didn't say I didn't so WTF are you talking about? I was responding to someone who said "what if this was boys!" I was pointing out that we already operate on boys and it's not considered (by most people) to be that big of a deal.
Also, it seems to me that a lot of people--both men and women--underestimate the importance of the clitoris in women's sexual function. It's not just that little nubbin: it's a whole lot larger (um, NSFW?) although the majority of it is internal. I've read that women have as much erectile tissue in their genitals as men do--but again, it's just 99% internalWell, this operation only affects the external parts.
Because with male circumcision, they are removing the foreskin, but with female circumcision, they are removing THE CLITORIS ITSELF.This isn't female circumcision, this is surgically correcting what's medically considered a birth defect.
The phenotype knows who it wants to be.That's not true at all. The body doesn't really heal in any directed way; the cells in the body don't have any 'knowledge' of where they are and what they are supposed to be surrounded with. When there's an injury of trauma specific signals are sent and if it's on the surface you end up with scar tissue.
The body knows how it was coded to be and grows or heals toward that. Doing a clitoroplasty won't keep the labia from fusing if the phenotype is predisposed to do that.
We're glad Poppas cares about function. But if he really cared about maximizing these girls' function, he would not be doing surgery on their healthy clitorises. To quote from a follow-up study published in the Lancet, "Although surgery has advanced in many ways, this is not a valid reason for complacency. In this study surgery was done 8-40 years ago, and most individuals had undergone clitorectomy [complete removal of the visible clitoris]. Of the three sexually active participants who had undergone the newer technique of nerve-sparing clitoral reduction, however, two had the worse possible score for orgasm difficulties."Note the phrase "of ... sexually active participants". Holmes and other researchers have noted that sexual activity, marriage, and motherhood are statistically lower than average among CAH-affected women who have had clitoral surgery during infancy or childhood. The lack of follow-up in terms of emotional, sexual, and physiological reactions by affected individuals (which I mentioned in my previous comment), as well as the lack of research on women who have been affected by CAH and *not* had clitoral reduction, means that it is hard to know whether to attribute this difference to CAH or to the surgical ramifications; however, to suggest that these surgeries actually "correct" a problem is simply not supported by evidence: the problem is poorly defined and the effects beyond the immediate post-surgical recovery are not really known.
but doctors who don't know wtf they are talking about with pet theories shouldn't be pressuring parents in to making incompletely informed decisions about genital surgery.Is there any evidence that he was pressuring anyone? This is like the third or fourth time I've heard someone claim or imply that the doctor was "pressuring parents"
On the other hand:
I'm opposed to all genital mutilation that is performed without consent, but if you really don't see the difference between circumcision and clit-reshaping surgery, then I don't know what to say.
[later]
I said, the two surgeries are not comparable. -- Powerful Religious Baby
My personal opinion is that it is important to consider all infant and childhood genital alterations in a single categoryWell you two hash it out. I obviously don't think all alterations are in the same category.
When you present mostly good options for surgery and mostly bad outcomes without surgery, that is pressuring.So you don't actually know anything, but you're just going to go ahead and assume he's a horrible person. Seems reasonable.
Doctors are hired experts. They are presumed to know and to have the knowledge to sort through information and to come up with the best options. There is an inherent power inequality between doctor and patient.
So, delmoi, do we have proof he pressured the parents? Not on tape. I'm assuming he used the same types of arguments that Dr. Money used. If that is the case, pressuring is far too mild a word.
"187Secret Life of Gravy: Someone earlier asked why would you ever perform surgery on a child to prevent teasing? I can think of a number of surgeries including, yeah, removal of a tail or removal of an extra digit.The surgery reduces the size of the clitoris (to the size that most women have), it doesn't remove it.
Which aren't supposed to be there. Unlike the clitoris.
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posted by Pope Guilty at 6:59 PM on June 17, 2010 [7 favorites]