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Genital mutilation at Cornell
June 17, 2010 6:53 PM   Subscribe

A doctor at Cornell and his research team have been performing clitoroplasties on female infants and little girls who show "gender ambiguity." This involves cutting away the shaft of the clitoris on girls whose clitorises are deemed too large .

To test whether the girls retain clitoral sensation after the surgery, the doctors stimulate the girls with Q-tips and vibrators. Bioethicists are in disbelief.
posted by ms.codex (253 comments total) 23 users marked this as a favorite

 
What IRB in the world would approve such a thing?
posted by Pope Guilty at 6:59 PM on June 17, 2010 [7 favorites]


He should lose his license for this.
posted by caddis at 7:00 PM on June 17, 2010 [1 favorite]


/facepalm
posted by Sphinx at 7:02 PM on June 17, 2010


The...what?
posted by turgid dahlia at 7:02 PM on June 17, 2010 [2 favorites]


I read this story this morning and have been queasy about it all day. There are so many things wretched and wrong about it. Where do you even fucking start.
posted by bewilderbeast at 7:02 PM on June 17, 2010 [2 favorites]


Pope Guilty, the last link has some insight into that:
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]


I'm not a bioethicist and I'm in disbelief. Holy shit.
posted by blucevalo at 7:04 PM on June 17, 2010 [6 favorites]


Do the doctors do chromosomal testing around the genital area? I understand that there is chromosomal mosaicism. I think chromosomal mosaicism may permit something like XX tissue to coexist with XY tissue.
What other causes could there be? Could there be environmental causes in which, say, hormones could retard or negate gender development?
If I had a child born a hermaphrodite, I think I would like to have chromosomal testing done at several locations in the groin area and maybe wait for a few months or years to determine any gender preference with the hope that the measured genetics would correspond to the expressed behaviors.
posted by millardsarpy at 7:06 PM on June 17, 2010 [1 favorite]


I'm reading the FPP and I am in disbelief. It is beyond words, the wrongness of this.

This is bad, nazi wrong.
posted by Mike Mongo at 7:07 PM on June 17, 2010 [12 favorites]


This is insane.
posted by limeonaire at 7:07 PM on June 17, 2010 [1 favorite]


"...my colleague Ellen Feder and I express our shock over the follow-up techniques being used by pediatric urologist Dix Poppas"

hardly a snarkworthy subject, but really? really?
posted by triceryclops at 7:08 PM on June 17, 2010


This has actually made me physically ill.
posted by Evangeline at 7:08 PM on June 17, 2010 [2 favorites]


This is bad, nazi wrong.

Agree, Mengele wrong.
posted by Jikido at 7:10 PM on June 17, 2010 [3 favorites]


Holy shit. Holy shit.
posted by gaspode at 7:11 PM on June 17, 2010 [1 favorite]


This is called child abuse. Period.
posted by St. Alia of the Bunnies at 7:11 PM on June 17, 2010 [9 favorites]


I've exhausted all of the adjectives for what this is--vile, horrendous, appalling.... after "obscene," I don't know what else there is to say.

This is bad, nazi wrong.

You are not wrong. Mike Godwin himself would compare these people to the Nazis in a split second.
posted by tzikeh at 7:11 PM on June 17, 2010 [4 favorites]


holy shit. arrest that fucker.
posted by capnsue at 7:13 PM on June 17, 2010 [4 favorites]


Does this doctor perform a similar procedure on boys whose penises are deemed 'too large'?
posted by grounded at 7:15 PM on June 17, 2010 [24 favorites]


While this is hardly the important point, if this isn't quickly stopped, condemned and specifically prohibited, then, what moral standing will we have against genital mutilation in other countries?
posted by George_Spiggott at 7:16 PM on June 17, 2010 [3 favorites]


Far above Cayuga's waters
With its waves of blue
They perform clitoroplasties
Bet you never knew

First she had it
Then she lost it
Now it's gone for good
She got a clitoroplasty
Like an infant should
posted by ZenMasterThis at 7:19 PM on June 17, 2010 [3 favorites]


I think I would take a session of electro-shock therapy right now if there was chance it would erase the memory of seeing this from my brain.
posted by timsteil at 7:20 PM on June 17, 2010 [1 favorite]


Jesus Christ. That's insane.
posted by AdamCSnider at 7:20 PM on June 17, 2010


Just for anyone else who missed it at first, "vibrators" here doesn't mean like, actual vibrators. The q-tips were vibrating.
posted by floam at 7:23 PM on June 17, 2010


Well, actually, who knows. The first article says q-tips, but another says "cotton-tip applicator and/or with a “vibratory device,". So who fucking knows.
posted by floam at 7:25 PM on June 17, 2010


Class of '06, and vomiting a little here. WTF alma mater?
posted by Alterscape at 7:25 PM on June 17, 2010


Holy...why...wh...what the...what...HOW DOES A PERSON COME UP WITH THIS KIND OF FUCKERY and think that it's OKAY to do this to ANYONE? AND WHY DID IT TAKE THIS LONG FOR THIS TO COME TO LIGHT? And WHERE THE HOLY FUCKING HELL ARE THE PEOPLE WHO KNEW WHAT WAS GOING ON AND AND AND AND DID HE CUT THEIR TONGUES OUT OR SOMETHING? WHAT THE WHAT WHAT?

(Seriously, parents not liking how their kids genitals LOOK. WTF? Super sad face.)
posted by fluffy battle kitten at 7:25 PM on June 17, 2010 [1 favorite]


Even if the parents gave their consent, couldn't this still be prosecuted as child molestation? This is a legitimate question. I mean, if some father said a "doctor" could jack off his 6 year old son to make sure he could orgasm, that would still be molestation because the kid is unable to consent and that father can't consent for him. Or am I not understanding the law correctly?

There should be more than medical community condemnation for this. There should be prosecution and jail time.
posted by Chipmazing at 7:26 PM on June 17, 2010 [1 favorite]


What does the vibrator consist of? These are not like big phallic dildos. They're more like little buzzers, more like the kind of tiny little travel vibrator you can slip past the TSA without major embarrassment on the security line. ("Whose vibrator is this?") But they're still vibrators, and he's still purposely stimulating these girls' clitorises to prove his surgical technique is good.

From the third link.
posted by Ouisch at 7:26 PM on June 17, 2010


Uh, actually vibrators means vibrators. Not pink sparkle cock-shaped vibrators. But yeah, vibrators:

"What does the vibrator consist of? These are not like big phallic dildos. They're more like little buzzers, more like the kind of tiny little travel vibrator you can slip past the TSA without major embarrassment on the security line. ("Whose vibrator is this?") But they're still vibrators, and he's still purposely stimulating these girls' clitorises to prove his surgical technique is good."
posted by fontophilic at 7:27 PM on June 17, 2010


Sorry, FOURTH link.
posted by Ouisch at 7:27 PM on June 17, 2010


Any neurologists or pretend neurologists here know how nerve density, functionality, etc. is usually quantitatively measured in the sane world?
posted by floam at 7:27 PM on June 17, 2010


Also:

By the way, when Janet Green asked Poppas about these vibrators at a meeting, he cut her off and insisted she use the term "medical vibratory device."
posted by Ouisch at 7:28 PM on June 17, 2010 [2 favorites]


And I am seriously, seriously grossed out right now.
posted by Ouisch at 7:29 PM on June 17, 2010


Every piece of this stinks. Every bit. Appalling. Amazing. Outrageous. The fear that the girls are going to become lesbians so hey, let's cut them up, so they're "normal" makes me so goddamn angry... This is so wrong in every way, how can anyone have possibly approved this in a university setting? Or any setting?

These poor kids... Talk about child abuse.
posted by dancestoblue at 7:30 PM on June 17, 2010


Did nobody involved with this fuckery/torture/maiming not have the thought, "hey you know, things change and grow as we age. Maybe we should give that some extra hard thinking."

I'm seriously effing disturbed not only at parents going, "eh, don't like the way that looks" (Have these people never ever caught sight of their genital bits in a mirror as an adults and gone, "hey that didn't used to look like that when I was little") but also at the fact that some doctor who made it through medical school thought this was a GOOD AND MARKETABLE IDEA.
posted by fluffy battle kitten at 7:31 PM on June 17, 2010 [3 favorites]


BRB, throwing up forever.
posted by dipping_sauce at 7:32 PM on June 17, 2010 [11 favorites]


Adults are way too comfortable doing whatever they like to kids. That a doctor feels "okay" about this and the parents sign on is just a symptom of the complete lack of regard grown-ups have for the fact that children grow up into adults who might wish that their parents hadn't made some mostly unfixable choices for them.

And then afterwards ... you know, I even get that you might want some way to test sensation after a surgery. I do take issue with "If the testing shows a girl has lost sensation through the surgery, her lost clitoral tissue cannot be put back," because it ignores the idea that someone might think, "Hey, this isn't working out at all, maybe we should stop doing this." However, I kinda think more people should have had a look at the proposed process first.

A bonk! bonk! on the head to the doctor.
posted by adipocere at 7:32 PM on June 17, 2010 [4 favorites]


This is question is kind of tangential, but does anyone know the rate of intersex births (of anywhere/any country?) I've heard them to be as high as 1 in 5000. Of course, the definition of intersex is flexible. I'm googling around "birth rate," "intersex," and such and not finding much. A lot of 'disorder' this, 'disorder' that.

The really stringent standards for gender and of sex are really hurting all of us.
posted by one teak forest at 7:35 PM on June 17, 2010


Thanks Ouisch, fontophilic. What I was reading was so consistently outrageous that the only thing I could possibly imagine is that some parts of it had the crazy turned up to eleven for the sake of the story, but I guess not.
posted by floam at 7:35 PM on June 17, 2010


.
posted by cjorgensen at 7:37 PM on June 17, 2010


There's a Facebook group about this with over 500 members. It encourages people to call Dr. Poppas and tell him what you think (using the phone number from his public Cornell webpage).
posted by Jaltcoh at 7:37 PM on June 17, 2010 [1 favorite]


I don't even get why parents would care about their daughters clitorises. And even weirder, why would you worry about how it looked when the girl was an infant?

Hmm, is it possible that he was operating on girls with severely deformed clitorises? Like ones that people would mistake for being a penis? That's the only way I could even imagine this seeming reasonable.

You are not wrong. Mike Godwin himself would compare these people to the Nazis in a split second.

Okay, obviously this is fucked up. But it's not remotely comparable to starving, torturing and killing millions of people. This guy, most likely is some kind of weird perv. However, I really don't think he qualifies as a Nazi.
posted by delmoi at 7:37 PM on June 17, 2010


delmoi: "I really don't think he qualifies as a Nazi."

someone gave an apt comparison above, delmoi.
posted by boo_radley at 7:41 PM on June 17, 2010


So -- I'm outraged, furious -- who do I contact? Who do I call? Who do I write? I am not a doctor and I am not in the university world and I honestly don't know what direction to take but I know for a fact that many of you here DO know. Please help me here.

Mods, if this needs to be taken to MetaTalk or just not appropriate plz delete
posted by dancestoblue at 7:42 PM on June 17, 2010


Screw this guy. In these here parts we only allow genital chopping when the big guy in the sky tells us to do it.
posted by Justinian at 7:44 PM on June 17, 2010 [6 favorites]


The other two doctors on Poppas's research team are women -- Jennifer Yang and Diane Felsen. What the shit.
posted by Rora at 7:44 PM on June 17, 2010


But it's not remotely comparable to starving, torturing and killing millions of people.

Dr. Mengele performed all kinds of horrific medical experiments on prisoners, exactly like this.
posted by tzikeh at 7:45 PM on June 17, 2010 [1 favorite]


Sorry, boo_radley got there while I was trying to compose an even-handed answer.
posted by tzikeh at 7:46 PM on June 17, 2010


Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator

In Soderbergh's "The Girlfriend Experience," the antagonist, a creepy guy who reviews escorts and wonderfully played by Glenn Kenny, completely skeeves out Sasha Grey's character. We don't know exactly what happened during his "review," but she later breaks down crying that he "used a q-tip."

So I'm sure it is not written in the Book of Science, but when your methodology involves something that creeps out a prostitute, and you're using it on little girls, maybe it is time to rethink things.
posted by geoff. at 7:46 PM on June 17, 2010 [3 favorites]


The other two doctors on Poppas's research team are women -- Jennifer Yang and Diane Felsen. What the shit.

Uh, that isn't some kind of novelty. Female genital mutilation is usually performed by women.
posted by Jaltcoh at 7:47 PM on June 17, 2010 [1 favorite]


I don't even get why parents would care about their daughters clitorises. And even weirder, why would you worry about how it looked when the girl was an infant?

I suspect the parents want to make sure their child is normal and if they visit the Chief of the Institute for Pediatric Urology who just happens to study this, and yes you were right to be concerned, this is very serious, but we can take care of this no problems... How are the parents supposed to know if nothing is wrong with their child if a fucking Cornell professor is there telling them that yeah, we had better do this surgery.

Just FYI for people looking to get involved, Dr. Poppas and the rest of his Cornell collaborators are at Weill Cornell, which is in the Upper East Side of Manhattan, not up in Ithaca with the rest of Cornell's campus. The ethics board should be there as well.
posted by Endure You Are Not Alone at 7:47 PM on June 17, 2010 [4 favorites]


Hmm, is it possible that he was operating on girls with severely deformed clitorises? Like ones that people would mistake for being a penis?

So, not being an expert or anything, I think yes, to some extent this is the case.

It's also the only clit god gave them.
posted by fontophilic at 7:47 PM on June 17, 2010 [2 favorites]


caddis: “He should lose his license for this.”

Lose his license? He didn't bungle a surgery or misdiagnose a disease here. These kids will bear his marks for the rest of their lives.

Jail time.

And I can tell you: if one of them had been my daughter, his license wouldn't be what Dix Poppas would end up losing.
posted by koeselitz at 7:48 PM on June 17, 2010 [6 favorites]


This makes me want to punch him in the dick. Hard. Jesus fuck. WHY CAN WE NOT ACCEPT OURSELVES FOR WHO WE ARE??????
posted by symbioid at 7:48 PM on June 17, 2010 [1 favorite]


abstract of the original article, also referenced among others in this book.

Playing devil's advocate here: apparently it is a plastic surgery that treats external symptoms (clitoral hypertrophy -- does this that discomfort during later sex life?) and are normally associated with congenital adrenal hyperplasia (the glands above your kidneys are too large). It appears to be a standard procedure in that case, and the good news is that usually with this procedure there's loss of sensitivity which Poppas is able to avoid. Obviously I believe sensitivity has to be tested after the operation.

Now, defining what's "normal", if it's "right" that there is a standard procedure in these cases, etc. is quite another matter. But I believe that screaming OMG GENITAL MUTILATION OMG CHILD MOLESTER with torches and pitchforks before getting the facts is lazy.
posted by _dario at 7:48 PM on June 17, 2010 [15 favorites]


In addition to the Facebook group that Jaltcoh mentioned above-- the Cornell Medical School webpage for Dix Poppas, with his contact information, is here. The 2007 article documenting the original experimentation and genital cutting is here (really get ready to barf).
posted by ms.codex at 7:49 PM on June 17, 2010


You can report a concern with the Cornell Institutional Review Board here.
posted by Endure You Are Not Alone at 7:49 PM on June 17, 2010


PZ Myers at Pharyngula weighs in.
posted by blucevalo at 7:50 PM on June 17, 2010 [1 favorite]


(I would also like to point out that the article is co-authored by two female doctors -- just a footnote)
posted by _dario at 7:50 PM on June 17, 2010


It's been noted, _dario. I agree that it doesn't make much difference.
posted by koeselitz at 7:51 PM on June 17, 2010


The parents are just as complicit. If you jail or strip the doctor, but let the parents go free, how is that just?
posted by polymodus at 7:52 PM on June 17, 2010


What. The. Fuck.

Reading this literally made me sick.
Now I have to watch some crap reality TV to numb myself from this awful awful story.

Also, can we have a MeetUp to take turns punching him in the gonads?
posted by ohyouknow at 7:54 PM on June 17, 2010 [1 favorite]


(I would also like to point out that the article is co-authored by two female doctors -- just a footnote)

Sorry to be a broken record, but again, saying women were involved doesn't contradict the idea that it's female genital mutilation. FGM is generally performed by women.
posted by Jaltcoh at 7:54 PM on June 17, 2010 [1 favorite]


Hmm, is it possible that he was operating on girls with severely deformed clitorises? Like ones that people would mistake for being a penis?

The post says these were performed on little girls with "gender ambiguity."

This guy, most likely is some kind of weird perv.

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.

All I can think for the vibrator test is that if the guy was thinking like a scientist, he just wanted to know that the nerve endings were still working and didn't think about how it would work on a personal level. Obviously it was a terrible idea.
posted by mdn at 7:55 PM on June 17, 2010 [3 favorites]


This is question is kind of tangential, but does anyone know the rate of intersex births (of anywhere/any country?)

According to the PZ Myers link, it's in the neighborhood of 0.1%.
posted by lexicakes at 7:55 PM on June 17, 2010


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.

Here's an example of one of mengele's experiments (from the article you linked too. Did you actually read it?):
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.

What this doctor is doing sounds kind of perverse. But he's not causing suffering, mutilation, and death. The comparison is absurd.
posted by delmoi at 7:56 PM on June 17, 2010 [15 favorites]


What what what WHAT the holy living fuck? This is beyond sick.
posted by Ratio at 7:59 PM on June 17, 2010


A good point, delmoi. He's not causing suffering, mutilation and death. Just suffering and mutilation.
posted by motty at 7:59 PM on June 17, 2010 [11 favorites]


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...)

Anyway, if this is really just an attempt to make "girls look like girls" then I'm not really sure it's that bad, assuming that it didn't damage the sexual sensitivity. While we would all like to live in a world where these things don't matter that's pretty Utopian. Little kids aren't going to have the maturity to handle something like this if their peers find out and start teasing her. I think the way some of these articles are written don't really make that clear and kind of amp up the outragefilter.
posted by delmoi at 8:01 PM on June 17, 2010


But I believe that screaming OMG GENITAL MUTILATION OMG CHILD MOLESTER with torches and pitchforks before getting the facts is lazy.

Yeah, I can't believe his colleagues would do that! Oh wait, you meant us.

But he's not causing suffering, mutilation, and death.

Well, two out of three?

I can imagine a too big clitoris. I can imagine wanting a smaller one. But I think this is a decision that should be made as an adult by the person affected.

This post is going barely better than I expected.
posted by cjorgensen at 8:01 PM on June 17, 2010 [1 favorite]


What kind of fucking parent stands there while a doctor uses a vibrator on their child's clitoris?
posted by nestor_makhno at 8:01 PM on June 17, 2010


Intersex rates are definitely higher than 1 in 5000. I'm intersex (Klinefelters 46/47 XY/XXY) and that particular kind of intersex is 1 in 500 in the U.S. Possibly higher. It's mostly been detected by detecting infertility, which is often blamed solely on the female in a heterosexual couple. Many Klinefelters simply go undetected. I think Turners is a similar rate, then there are many other forms of less common intersex genotypes/phenotypes.
posted by kalessin at 8:01 PM on June 17, 2010 [9 favorites]


Meanwhile, every day hundreds of baby boys lose their prepuces along with Schwann cell nerve bundles. That is just as barbaric, if not more subversive, because babies won't be able to recall the procedure done to them after they grow up.
posted by polymodus at 8:03 PM on June 17, 2010 [3 favorites]


Little kids aren't going to have the maturity to handle something like this if their peers find out and start teasing her.

Are you insane? You think it's all right for parents to have their children cut up because they might get teased?

Jesus fucking Christ.
posted by tzikeh at 8:03 PM on June 17, 2010 [7 favorites]



posted by BrotherCaine at 8:08 PM on June 17, 2010


What kind of fucking parent stands there while a doctor uses a vibrator on their child's clitoris?

This link will not answer your question, but perhaps an analogy will present itself.
posted by shii at 8:11 PM on June 17, 2010


I'm guessing it wasn't perversion as much as social blindness to the wrongness of what he was doing in the name of his own glory through science. We have two levels of wrongness, the clitoral mutilation of young girls, and the strong overtones of molestation in the testing.

If clitoral mutilation is the standard, then the problem goes beyond the doctor, and the pseudo molestation is a symptom of someone trying to solve a problem of nerve damage for a cosmetic correction, badly. But if most responsible doctors would not cut up some poor baby's clit, the doctor is twice as much in the wrong.

As far as the 'Mengle' comparison... Well, he's not -killing- anyone, but it certainly in the class with the psychologist Money who encouraged parents to raise a sexually mutilated boy as a girl.
posted by Phalene at 8:12 PM on June 17, 2010


It should also be noted that doctors and bioethicists have been at this sort of thing (genital surgery corrections) for babies with borderline genitalia for decades. In many countries and regions, the parents aren't even informed or given the option of refusing. I understand that as more intersex and other types of interested parties are now becoming aware of their or their loved ones' conditions and education is getting better that this kind of unilateral action on the part of the medical establishment is diminishing and more doctors are seeking informed consent from parents.

Additional information from some Intersex advocacy perspective can be found (though I note that these societies are not always strong on queer rights):
- At the Intersex Society of North America
- At Intersex Awareness New Zealand
- At Organization Internationale des Intersexués

These organizations spend a lot of time doing education and outreach with the medical communities and with parents. I think the reasons for that are pretty clear.
posted by kalessin at 8:13 PM on June 17, 2010 [7 favorites]


Well, _dario has suggested that we take some perspective here, so I've been reading a bit. This is the sort of thing that naturally will make people feel a bit sick, I think, and it's worth stopping and thinking about a little. After all, sick feeling isn't actually a moral indicator.

I want to say from the start that I still really don't know how I feel about this, and that I distrust surgery as a solution implicitly. I just want to know what I'm talking about. I'm not a medical person, so it seems like it's worth taking a few moments and trying to sort out what's going on here.

It's probably a propos to point out here that the girls this person was operating on were not little girls with "slightly larger" clitorises. The extreme enlargement of the clitoris in these cases was apparently a medical condition brought on by congenital adrenal hyperplasia, or "CAH." Now, even so, there's a lot of controversy surrounding it, so I'm not saying that this is just a medical condition, that transexuality doesn't exist or should be treated with surgery at birth, or anything like that. I'm only saying: this is the way it's seen by the medical profession, apparently. It's worth noting that, if that second article that _dario linked is correct, surgery is the common and accepted treatment in these cases. That is: this is apparently what many doctors do.

(I'm only reading the paper, which claims not that they've come up with the idea for surgery, but that Poppas et al have come up with a new form of the old surgery that leaves more nerves intact. The paper may not be correct, and I'd like to hear whether doctors really do this routinely.)

Finally, I was interested in how big these clitorises are that they feel like should be altered – because, well, the idea that a doctor was just clipping clitorises based on his own preconceptions about size is repugnant to me. Not that it necessarily makes this all right, but it's weirdly interesting to note that there is a scale for this called the Prader Scale. You may observe the Prader Scale in action with the help of this handy interactive (and quite not-safe-for-work) Prader Scale demonstration.
posted by koeselitz at 8:13 PM on June 17, 2010 [17 favorites]


I don't think they ought to do any surgery. These girls are given a unique opportunity. They get to skip right over the whole "penis envy" thing. Perhaps they'll be much more psychologically healthy as a result. I think the experiment should be tried.
posted by Crabby Appleton at 8:14 PM on June 17, 2010


And, on preview, I think kalessin's comment was a lot better informed than mine. Thanks, kalessin.
posted by koeselitz at 8:14 PM on June 17, 2010


Meanwhile, every day hundreds of baby boys lose their prepuces along with Schwann cell nerve bundles. That is just as barbaric, if not more subversive, because babies won't be able to recall the procedure done to them after they grow up.

OK, um, I hope I don't regret pursuing this contentious tangent, but how am I (male) harmed by not remembering when I was circumcised? Why would I want to remember it?
posted by Jaltcoh at 8:15 PM on June 17, 2010


Okay, did I read this correctly, he's been doing this for over a decade?!? Or has this barbaric practice been used by other doctors as well, for over a decade? Holy crap, there are other doctors doing this too.
posted by charlie don't surf at 8:16 PM on June 17, 2010


Just suffering and mutilation. -- motty

Well, two out of three? -- cjorgensen
Well, 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.

Anyway, I'm not saying what this guy is trying to do is a good idea. But some of the hysteria in this thread is a little over the top here. Comparing him to menegla? Seriously? The suffering of having cosmetic surgery is somehow comparable to the suffering caused by having limbs amputated and having your twin's eyeballs stuck to the back of your head?
posted by delmoi at 8:21 PM on June 17, 2010


Any neurologists or pretend neurologists here know how nerve density, functionality, etc. is usually quantitatively measured in the sane world?

IANA neurologist, but my father's endocrinologist used a vibrating pitchfork to test his diabetic patients' feet for neuropathy. He also poked their feet with the tip of a nylon filament for the same purpose. So I think that this doctor's use of Q-tip and/or vibrator devices is not as outrageous as it may sound.

However, subjecting girls to a painful and risky surgery because their genitals don't meet some arbitrary size/shape ideal is still straight-up child abuse and needs to be stopped, NOW.
posted by homuncula at 8:21 PM on June 17, 2010


Are you insane? You think it's all right for parents to have their children cut up because they might get teased?

I know a girl who was teased a lot growing up. She was telling a friend about one incident where kids threw peanuts at her or something like that. She said it was worse then the time she was raped.

Again, I'm not saying this is a good idea, but the idea that these girls wouldn't be bothered by this growing up seems kind of insane. I think the parents and the doctor are probably doing something they think will help, although it may be misguided.
posted by delmoi at 8:24 PM on June 17, 2010


[few comments removed - we do not do the "post people's phone numbers" thing here, even for bad people. Link to other sites if you want to rally the troops, thank you.]
posted by jessamyn at 8:26 PM on June 17, 2010 [5 favorites]


You're welcome, koeselitz. FWIW, I like your voice in this discussion too, and I don't see a lot of overlap between what I have to say and what you've said.

I should also say that I've pretty much done with doctors about my intersex genotype. I don't in general feel like genital corrective surgery is a good idea. But I also know that my opinions are so far to the left-leaning individual rights and privileges side with respect to this sort of thing that I don't consider my opinions or feelings representative.

But let me say that I don't think that genital corrective surgery is warranted until kids can make their own decisions that aren't driven purely by peer pressure, whether that decision is driven by peer pressure among doctors, among parents or among kids. I wish that I was given a choice about circumcision (my intersex wasn't discovered until I was 19), and I wish that other people I know who've been "corrected" without being given a vote were given the time and rights to make their own choices.

That said, it's too late to do anything about that now. I also understand why doctors felt it was necessary to do genital corrective surgery (starting in the '50s or so), and I understand the protocol involved, and I understand why doctors generally advised parents not to share the fact of the surgery with their children. And I don't know what to do about the damage that has already been done. I don't know what's fair or right, and I don't know what will repair it.

But I HAVE refused hormone replacement therapy that was pushed on me since the day of my diagnosis as an intersexed person in an attempt to normalize me. Dire medical predictions about the consequences of that decision have failed to play out and I end up feeling that the doctors' (whom I dealt with) drive to normalize or correct me, my physiology, my biochemistry as an adult were unwarranted and unwise and I'm glad I did refuse that hormone replacement therapy (and will continue to do so). I think that sometimes the quest for normalcy in their patients gets doctors to stop being caregivers and start proscribing treatments and protocols that are not always in the best interests of the patients, and I wish it didn't get down to that so often. (In my experience.)

I also wanted to mention that in my experience not only are the medical/parent-facing Intersex organizations not generally so good at queer rights but also not really friendly to transpeople. I think it's essentially a conflict of interest. A lot of organizations (and medical practitioners) spend a lot of time focusing on the normal with intersex people who are in therapy. The idea they try to convey is that being intersex doesn't make you trans, it doesn't make you queer. You're as normal as anyone else. So that doesn't leave a lot of subtlety or room for things like thinking that queers and trans people are normal (though I think we are).
posted by kalessin at 8:29 PM on June 17, 2010 [18 favorites]


The thing is, delmoi, that depending on the sample size, it's not about making "girls look like girls." It's about making these girls look like those girls. This doctor is passing on his conception of "normative" genitals to these little girls and their families. And sure, he's seen a lot of genitals, but why should he be the one drawing the line? Looking at the handy Prader Scale link (thanks, koeselitz -- exactly what I was wondering), I definitely see that a girl on the far end could have some issues with infection as well as intercourse. But my layman's approach to the issue would be to separate the labia -- not to cut off pieces of the clitoris because it's too big.
posted by freshwater at 8:29 PM on June 17, 2010


delmoi: "The only comparison here is that this doctor's experimentation also grosses people out. (...) But he's not causing suffering, mutilation, and death."

delmoi, I disagree with the above.
It is not merely "grossing me out". The surgeries are not done to alleviate pain or suffering, only to reduce the size of the clitoris. Here's an example of the symptom being treated by this surgery -- yes, it's nsfw.

It is impossible for me to accept that cutting away part of a clitoris (even when it is done with care) is not mutilation. Reading the articles linked, it seems he's removing a cross-section of the clitoris ("Poppas is saving the glans (tip) but cutting out parts of the shaft."). Dr. Poppas is performing surgeries on very young girls for reasons of sexual normalcy and not of need or comfort -- there is no clear benefit. This is, as a bit of the wiki article you didn't bold says, brutal surgery.

Even while using "nerve-sparing" techniques, the rate of sexual function in patients is greatly curtailed in later years. Additionally, continence is affected; these girls may have to wear diapers for the rest of their lives.

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.
1) The surgeries are unwarranted.
2) The surgeries are performed on patients who cannot consent, and whose parents may be pressured unethically to consent.
3) The surgeries have a not-insignificant chance of harming the patients and their well-being.

I'm annoyed that you suggested I argued that everyone who conducts medical experiments is a de facto Nazi. Of course many medical researchers do good and beneficial work, but they do so in rigorous and ethical ways. Poppas has fallen so far afield of what might be considered normative for human subject research that it's reflexive to call his work experimentation, even for you, and 'human experimentation' is not too far away from Mengele in my estimation.
posted by boo_radley at 8:29 PM on June 17, 2010 [1 favorite]


fast moving thread.

delmoi, I understand if you're a bit tired of responding to, uh, your response.
posted by boo_radley at 8:31 PM on June 17, 2010


Are you insane? You think it's all right for parents to have their children cut up because they might get teased?

Jesus fucking Christ.?


I'm not sure there really implicitly a serious problem with that, in itself. For the sake of argument, if I was born with a tail, I'd prefer it were removed ASAP and not to have to keep it until I'm a grown adult.
posted by floam at 8:31 PM on June 17, 2010 [1 favorite]


See, floam, Here is where you and I disagree. I think I'd rather make the choice as an adult. I say this having been the short-sighted nerdy kid with asthma as a child. I know what it's like to be singled out in school. Still, a tail would be worth it.
posted by kalessin at 8:35 PM on June 17, 2010 [1 favorite]


Also imagine that you needed your tail in order to have an orgasm.
posted by internet fraud detective squad, station number 9 at 8:38 PM on June 17, 2010 [25 favorites]


The thing is, delmoi, that depending on the sample size, it's not about making "girls look like girls." It's about making these girls look like those girls. This doctor is passing on his conception of "normative" genitals to these little girls and their families.

And that makes the guy a Josef Mengele who should be stripped of his medical license and thrown in jail? Because that's what people seem to be calling for. Which is I think a little over the top for "passing on his conception of 'normative' genitals"
posted by delmoi at 8:40 PM on June 17, 2010


The question is whether growing up as an intersex girl would cause less suffering

The answer is yes.

I would imagine that would be the basis of the parents concerns.

I would agree. The answer there is to educate the parents, not to mutilate the children.

Some of the hysteria in this thread is a little over the top here

I would agree that there is a certain amount of hysteria here, and yes, the comparison to Mengele is unhelpful, but it's on a par with comparing a bad case of flu to necrotising fasciitis: it is quite clear which is worse, but it is just as clear that you really don't want either one. As such I do not think the hysteria in this case is over the top. It is hysteria, and it is right to be wary of hysteria, but the case is egregious. Sometimes it is right to get the pitchforks out and I think this is one of them.
posted by motty at 8:40 PM on June 17, 2010


polymodus: Meanwhile, every day hundreds of baby boys lose their prepuces along with Schwann cell nerve bundles. That is just as barbaric, if not more subversive, because babies won't be able to recall the procedure done to them after they grow up.

This is a discussion about the mutilation of girls' genitals. "Poor little boys" is yet another example of using "but men have it bad too!" in a discussion about something that is happening to women in order to marginalize the topic at hand. If you want a discussion about male circumcision, post an FPP.

floam: For the sake of argument, if I was born with a tail, I'd prefer it were removed ASAP and not to have to keep it until I'm a grown adult.

I'm going to let someone whose head isn't going to explode due to the comparison of a tail to an enlarged clitoris take that one on.
posted by tzikeh at 8:41 PM on June 17, 2010 [10 favorites]


Also interesting to note that apparently (judging from that very interesting article which _dario linked above) the doctors who do this believe that these kinds of "congenital abnormalities" can make sexual intercourse painful or even impossible, and that they are therefore alleviating pain by doing these surgeries. Again, I have no idea what they base this conclusion on.
posted by koeselitz at 8:44 PM on June 17, 2010


Is this tail prehensile? Because that would be very handy; you'd be like the Hanuman of the playground! Any trouble from bullies, and you could just set fire to the tip of your tail & burn their houses down.
posted by UbuRoivas at 8:47 PM on June 17, 2010 [1 favorite]


delmoi, I don't think the guy is Mengele. I think this guy is probably a pretty normal guy doing what's pretty normal in his profession. I just think his profession are in this case a lot of arrogant professionals who really don't put a lot of thought into the far-reaching consequences of their profession, at least in this respect.

When Hollywood and other media depict doctors as arrogant people with god-complexes, this kind of decision-making and policy-making would be why. They make far reaching decisions like this according to a standardized chart that they use to justify making these sorts of decisions with or without "informed" consent of the patients or the guardians.

As an aside, I also don't think that the consent is that well informed or that the informing is often done that well. Having been the subject of this sort of thing, I can tell you that without developing my own medical literacy, I would have been unable to cope with making any choice other than the forced one provided by my doctors. My caregivers. The ones who are supposed to care about me and my desires.

So no, I don't think this guy is Mengele. But I do think we should rattle these doctors' cages a bit. Shake them up and let them think about it, because I personally am not interested in going quietly into the night on this one. I want doctors and bioethicists to hear me when I say I think that this kind of thinking and this kind of medical protocol is bullshit that they should stop doing unilaterally. At the very least I desire that legal guardians be given real information and the time and ability to give actual informed consent with real alternative options available during the time of the decision.
posted by kalessin at 8:49 PM on June 17, 2010 [6 favorites]


The question is whether growing up as an intersex girl would cause less suffering
The answer is yes.
You have a citation for this?
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.
1) The surgeries are unwarranted.
Yes, cutting off someone arms and legs for fun was "unwarranted", that was the problem.
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?

And I don't think Mengele got any consent at all.
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?
posted by delmoi at 8:49 PM on June 17, 2010


WHAT THE FUCK? FUCKING HELL. That child abusing son of a bitch needs to be prosecuted and sent to jail forever. :(
posted by zarq at 8:53 PM on June 17, 2010 [2 favorites]


koeselitz, it really depends on the abnormality. You're right that it's hard to read the article you and _dario linked to figure out what the heck they're talking about. As far as I know, sexual pain is not generally associated with enlarged clitorises, but could certainly be associated with other disorders described (like fused labia, imperforate hymens, incomplete fusion, etc). (IANAD)
posted by kalessin at 8:54 PM on June 17, 2010


My friend, Hida Viloria is an intersex activist. She was born with what is known as clitoromegaly (or enlarged clitoris), but
her parents refused to have her surgically altered as a child & she
is very happy about that.

She is a spokesperson for human rights for the Organization Intersex International.

MeM

(posted on behalf of my girlfriend :)
posted by gkr at 8:54 PM on June 17, 2010 [3 favorites]


Kalessin, I guess my problem is when it comes down to it I really don't feel there is anything particularly innately perfect about the human form (I mean, just look at our noses, eww!). I don't believe in a God, so there's none of that either. The body I'm born with is the result of a lot of chance, and whether I have a tail or not comes down to a few uncommon codes sneaking into my genome. If anything, natural selection has selected against having a tail, and it'd be easy to go so far as to take that as a sign as they're probably not a good idea, but like I said, I don't think there's anything perfect (although damned novel!) about what we are or where we're headed, so I think that's a poor way to look at things. Evolution also made us pretty aggressive, and the things that are good for survival and fitness are just that, and only that.

But: A tail would serve no practical purpose to me, and would lead to trouble with things like sitting down comfortable and my getting along my peers. I don't think the peer thing is a small deal. I couldn't imagine how horrible a sad childhood would be. So I'd want it gone. Piece of cake. Parents make a lot of choices that affect their kids lives more than that kind of decision.
posted by floam at 8:54 PM on June 17, 2010


Good to see the discussion here focusing so much on intersex rights. Dan Savage's report (the first link) annoyed me no end by completely avoiding the term "intersex", even though that's precisely what it's about.
posted by jiawen at 8:56 PM on June 17, 2010


The question is whether growing up as an intersex girl would cause less suffering
The answer is yes.
You have a citation for this?


I think this example demonstrates the limits of science's ability to advise public policy. No one is going to be able to conclusively prove whether or not, in general, the risks of this kind of surgery is greater than the risk associated with growing up intersexed.

However, I think the precautionary principle applies here. On the one hand, we have a surgery with the associated risks of trauma and permanent physical damage. On the other, we have potentional psychological damage that would be inflicted purely for cultural reasons.

Stated this way, I think it seems insane to force surgery on individuals who can't consent purely in order to make them fit in with some socially established norm. Wouldn't it make more sense to push for a more inclusive, open society? Then no one needs to get mutilated....
posted by heathkit at 8:57 PM on June 17, 2010 [4 favorites]


I'm going to let someone whose head isn't going to explode due to the comparison of a tail to an enlarged clitoris take that one on.

That was intentional, because I wanted to distill it down to just that portion of the dilemma here: is it bad to change a kids form if it's not unhealthy? I did not mean to use that as a real analog. My point was only that that part of the equation is a non-issue for me, and the things that are different between a tail and a enlarged clitoris are what's important in figuring this out.
posted by floam at 8:58 PM on June 17, 2010 [1 favorite]


"But: A tail would serve no practical purpose to me, and would lead to trouble with things like sitting down comfortable and my getting along my peers."

I really don't know where you're going with this analogy

I can't speak for all clit-havers but mine serves the practical purpose of getting me off

Not as practical as legs, okay, sure, but I like it, and so do my partners
posted by internet fraud detective squad, station number 9 at 8:59 PM on June 17, 2010 [11 favorites]


Poppas should have had a subscription to the Lancet and then he would have read in 2003:
Abstract
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.
The additional problem here is, as stated in the 'Q-tips and vibrators' link, "shock and concern over the follow-up examination techniques".
posted by unliteral at 9:00 PM on June 17, 2010 [2 favorites]


floam, while I appreciate your analogy-crafting I think it's important to point out that analogies in heated discussions generally only work well for the analogy-crafter. Folks it's meant to convince generally still end up not only disagreeing but also feeling a bit insulted. Might be better to talk about the actual surgery at hand instead of make-believe surgeries for non-existent hypothetical tails.
posted by kalessin at 9:00 PM on June 17, 2010 [4 favorites]


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.

Regardless, I don't think we're going get much more discussed since we're both agreeing that Poppas' actions were all kinds of fucked up. It's reasonable for you to say that his nazi-esque qualities are in doubt due to his smaller scope, and I maintain that he's closer to human experimentation and insanity (hallmarks of Mengele in my own mind) than not.
posted by boo_radley at 9:02 PM on June 17, 2010 [1 favorite]


analogies should be amputated at birth
posted by delmoi at 9:03 PM on June 17, 2010


now you're just tormenting me.
posted by boo_radley at 9:05 PM on June 17, 2010


My legs are crossed so tightly I may never walk again.
posted by rtha at 9:06 PM on June 17, 2010


the things that are different between a tail and a enlarged clitoris are what's important in figuring this out.

A woman is supposed to have a clitoris.
posted by tzikeh at 9:08 PM on June 17, 2010 [7 favorites]


"You may observe the Prader Scale in action with the help of this handy interactive (and quite not-safe-for-work) Prader Scale demonstration."

I don't think it's hard to see how parents whose child is at the far end of that scale might elect for surgery.
posted by Mitheral at 9:10 PM on June 17, 2010


kalessin, good point, and it's clear to me now it would have been better and less typing overall if I had just tried to make a point directly. Since I have no point to make because anything more complicated than a vestigial tail gets tough fast, I'll call this a good point to duck out and wait for a controversy involving the removal of non-sexual non-functional organs.
posted by floam at 9:11 PM on June 17, 2010


tzikeh: Sorry. My original reasoning was something like spine : tail :: clitoris : penis-sized clitoris.
posted by floam at 9:12 PM on June 17, 2010


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.

I don't think the comparisons here are helpful, or make any sense. I think there's been a lot of sensationalist writing about this, and that people don't understand that he's correcting birth defects that move girls into the intersex range. If you read the articles, it sounds like parents are arbitrarily deciding their daughters clitorises are just 'too large' and then he's just hacking away and then giving the girls annual 'checkups' where he uses a vibrator on them. Which sounds pretty fucked up. I think if you understand what the goal is it doesn't sound unreasonable, but perhaps misguided.
posted by delmoi at 9:13 PM on June 17, 2010 [1 favorite]


floam - apology not only accepted, but appreciated.
posted by tzikeh at 9:13 PM on June 17, 2010


If you look at the PDF linked in the article, or the Prader scale graphic, it's pretty clear that this is surgery to correct ambiguous genitalia. If you think it would be hard to grow up with a tiny phallus instead of a normal clitoris, then you might think this surgery was a good idea. If you think having an in-between set of genitals is just as good as having girl or boy, then you wouldn't. But it isn't that someone thinks the labia are too long or something. This is the formation of the phallus, which is the clitoris on a girl, and extends into various stages of a small penis in an intersexed individual.

According to the PDF, these girls ranged from 2 to 5 on the Prader scale, and had an average phallus length of 2.4cm.
posted by mdn at 9:14 PM on June 17, 2010


Jaltcoh, I don't think he's saying that not remembering it makes it more barbarous, but more subversive, as the affected don't have any memories to give as testimony, whereas with various forms of FGM are often done at an age where the affected does remember it and can speak out from personal experience.
posted by dhens at 9:16 PM on June 17, 2010


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? Even if your penis were "too long" according to a chart? And if you heard of someone doing that, you wouldn't have a hard time being empathetic, would you?

These fun "devil's advocate" derails and sidewinding debates about the applicability of Nazi comparisons speak to the fact that some people are able to view a doctor cutting into clitorises as an abstract intellectual exercise. I find that really unsettling, considering the high esteem in which men tend to hold their penises. You know they're pretty much the same thing, right? And you know how extremely much you don't want anyone to mess with yours? Voila, instant empathy.
posted by Powerful Religious Baby at 9:22 PM on June 17, 2010 [4 favorites]


But it isn't that someone thinks the labia are too long or something.

No, they think the clit is too long.

2.4 centimeters is really not even all that long. I get wanting kids to be normal and happy but I just don't think that we can divorce that from the desire that people have to normalize female bodies far beyond what is necessary and healthy for the females themselves.

Sexual function is a Big Deal. If a child is getting teased mercilessly, or hates their body in a serious way, okay, consider surgery. But risking sexual function in order to preform preemptive surgery in case they have psychological problems at some point is way overboard.

Oh, give her a nose job or she'll never hear the end of it! Oh and she's 6. But she'll thank us, even if she loses her sense of smell.

It's fucked up. It's not okay just because we might think their bodies are "ugly".
posted by internet fraud detective squad, station number 9 at 9:25 PM on June 17, 2010 [16 favorites]


Prof. Myers seems to indicate that not all of Poppas's surgeries are for "tiny phallus/ambigious gentialia surgeries" though. If even a minority of the surgeries are done "to meet some nonexistent esthetic ideal... for entirely cosmetic purposes" then those are genital mutilations and ought to be illegal.
posted by Chipmazing at 9:25 PM on June 17, 2010


Jaltcoh, I don't think he's saying that not remembering it makes it more barbarous, but more subversive, as the affected don't have any memories to give as testimony, whereas with various forms of FGM are often done at an age where the affected does remember it and can speak out from personal experience.

"Subversive" is a very negative term, and I strongly object to this word choice in the context of something as personal as my genitals. I know you're trying to paraphrase what someone else said, but you're still dignifying the comment, and I wish people would think more clearly about this. Calling it "subversive" is presupposing that male circumcision is a bad thing, which I don't think it is. Saying it removes nerve endings isn't convincing. Assuming for the sake of argument that the statement about nerve endings is true, it doesn't make sense as an argument against circumcision. Having heightened sensation in one's penis does not necessarily lead to better sex.
posted by Jaltcoh at 9:33 PM on June 17, 2010


Clitoral hypertrophy

Hypertrophy of the clitoris is observed in cases of fetal exposure to androgens. The disorder is usually the result of congenital deficiencies of the adrenal enzymes of cortisol synthesis; more rarely, it is caused by idiopathic virilization or exposure to progestational agents in utero. Although rare, clitoral hypertrophy caused by neurofibromas of the clitoral corpora has been described, including a case of localized neurofibromatous infiltration of the prepuce only.

Treatment is dictated by the degree of masculinization, specifically by the degree of clitoral hypertrophy and, if relevant, the level at which the vagina enters the urogenital sinus.


This is a medical condition, something classed as a disorder. It is entirely possible that the parents in these cases are not indifferent, rigid Mengelites but simply parents making a medical decision for their child based on the best range of medical advice they can acquire. I can't speak for all women but I'm pretty sure most mothers wouldn't consent to this surgery without asking about effects on sensation, and in fact this particular surgical technique was developed to preserve sensation.

I'm not saying that this is the clear choice and that there are no legitimate, complex issues or that not doing this might not be better. I'm just saying that from my reading, neither the parents nor the doctor should be dragged into the town square to be hung.
posted by DarlingBri at 9:36 PM on June 17, 2010 [2 favorites]


How did he recruit the patients?
posted by anniecat at 9:37 PM on June 17, 2010


Wait wait wait... Cornell, Iran? Cornell, Somalia? Is there another Cornell I didn't know about?
posted by GilloD at 9:40 PM on June 17, 2010


But a bris is okay.
posted by clarknova at 9:44 PM on June 17, 2010 [1 favorite]


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.

But isn't the comparison more with someone born with a penis that was too small, not too big? If you had a kid with a micropenis and there was a chance that you could surgically fix it as a kid with a good chance of success would you want them to have it?

That said, having a penis that is too small seems much worse to me then a clitoris that is too big. (like I said, I'm not a fan of analogies)
posted by delmoi at 9:45 PM on June 17, 2010


E-mail sent to Cornell from link in the first article to voice my outrage at this bullshit!
posted by 6:1 at 9:48 PM on June 17, 2010


Direct Link--voice your opinion to Cornell University.
posted by 6:1 at 9:50 PM on June 17, 2010


90% of the patients in the 2007 study had congenital adrenal hyperplasia, as DarlingBri states. This was surely the medical justification presented to the parents in most cases for the surgical procedures (along with whatever language was used to convey to the parents that the girls' genitals were ambiguous or "masculinized" and therefore abnormal).

Patients undergoing the surgical procedures were as young as 4 months old.

I don't have any way to imagine what the parents in these situations were told, but it seems to me that the situation had to have been firmly presented as a medically necessary procedure to normalize the girls involved. Not that that makes the situation any less disturbing. In my mind, it makes it more disturbing, what with the history in the past 150 years of erroneous decisions that have been made that alter people's lives irrevocably in the pursuit of medical, psychiatric, or scientific necessity.
posted by blucevalo at 9:53 PM on June 17, 2010


No, they think the clit is too long...

Sexual function is a Big Deal.


It's not as simple as that - when the clitoris is extended, it becomes more like a penis, and the vaginal opening becomes more fused. In fact, if sexual function is a big deal, this operation might be preferred, since having a small penis in front of a partially fused vagina will probably make ordinary sex more difficult. And making sure the post-op tissue was still sensitive was part of what grossed everyone out to begin with...

Basically, it isn't about "ugly" bodies, but about having a little penis when you're a girl. Gender norms are pretty powerful in our culture, so having mixed genitals might be a big deal to some people. I'm not supporting it, but it's hardly nazism. It's just a binary version of gender, instead of a continuum.
posted by mdn at 9:54 PM on June 17, 2010 [1 favorite]


Aside from the ickiness of it, doing this surgery before puberty seems premature. I wonder if clitoral size would tend to normalize during puberty anyway? Other bodily features of a person (or any other animal) that are disproportionately large during childhood, including overall height, are often "grown into"; why not the clitoris?
posted by aeschenkarnos at 9:56 PM on June 17, 2010 [1 favorite]


It's just a binary version of gender, instead of a continuum.

And that is exactly one of the problems. We take as given that "gender norms are pretty powerful in our culture" ..... and then feed into that normativity by saying that gender is "just" binary instead of questioning why it should be that the binary persists.
posted by blucevalo at 10:03 PM on June 17, 2010 [1 favorite]


I don't want to become too embroiled in this argument (and I don't want to shift the focus away from the matter at hand -- this person's activities at Cornell) but it is true I was paraphrasing polymodus's comment. I agree with Jaltcoh in that one's genitals are a personal matter -- which is why nothing should be done to them until a person has reached adulthood.

With that, I am going to take my leave of this thread.
posted by dhens at 10:08 PM on June 17, 2010


What the hell is wrong with these people? What are the parents doing while their children are being "stimulated" by doctors?
posted by mr_negativity at 10:16 PM on June 17, 2010


When the girls this guy has mutilated all come of age and become adult, we can hope they will band together to bring a class action suit against him that will at least financially decimate the motherfucker. Though revoking his license or even criminal charges would be preferable.

Christ on a cracker--who are these fucking parents that approve of this?? Are they so gullible to believe this doctor? And where the fuck are the Cornell medical board members on this? They've known about this for a decade and have done nothing? This is like news from third world Africa, not one of the top universities in the U.S. Utterly baffling.
posted by zardoz at 10:18 PM on June 17, 2010 [1 favorite]


This is not to defend the surgery at all.

I'm interested in the micropenis analogy. Would folks' reaction here be different if the surgeon was correcting a micropenis by hacking the genitals and (say) inserting tissue from elsewhere in the body? Imagine a similar risk of reduced sexual feeling.

Here are some anecdotal examples of what it feels like to be an adult with micropenis.
posted by dontjumplarry at 10:34 PM on June 17, 2010


"In fact, if sexual function is a big deal, this operation might be preferred, since having a small penis in front of a partially fused vagina will probably make ordinary sex more difficult."

So see if that happens, and if it does, and the person is bothered by it, then fix it.

If it affects their mental health and when you weigh their distress against future sexual function it seems worth it, fix it.

"This might cause a problem at some point" is not enough to risk hindering someone's ability to orgasm.
posted by internet fraud detective squad, station number 9 at 10:35 PM on June 17, 2010 [2 favorites]


And just to follow up on the micropenis analogy: if you object to that too, do you object to all corrective plastic surgery on children which is performed to reduce the risk of psychological harm, but involves physical risk? I don't know enough to construct an analogous example, but imagine if cleft palate surgery involved a certain risk of reduced taste. Is this as objectionable? Why or why not?
posted by dontjumplarry at 10:42 PM on June 17, 2010


Let's assume there's a legitimate medical reason to do surgery on a clitoris -- for example a worrisome mole.

How would you propose testing to see that the surgery didn't damage sensitivity, or is this just not a concern? Obviously it's not good in general for people to go around touching a baby's genitals, but there are cases when a doctor should be allowed to do it, no? Sometimes hysteria about pedophilia gets a little out of control. Do any of you really think that there is going to be long lasting psychological harm because of a few seconds of a vibrating qtip in a doctors office when they're under a year old?

Now, the issue of actually whether this surgery is warranted is a separate issue entirely and I can see both sides of the issue. (I think I lean towards being against it, but goddamn, my childhood was fucked up enough with normal genitals, I can really understand wanting to be normal at any cost).
posted by empath at 10:44 PM on June 17, 2010


The additional problem here is, as stated in the 'Q-tips and vibrators' link, "shock and concern over the follow-up examination techniques".

Yes, that's kind of being glossed over now that the debate is all about the surgery and whether or not it's ever ever ever justified. These are girls 6-10 years old who are being made to lie back on the exam table while this man stimulates them with "vibratory" devices on their genitals and thighs. So what you have is a combination of the genital cutting and what could be an extremely uncomfortable "exam". All along these girls had no choices. They're supposed to be patients who can trust their doctor, not lab rats.
posted by Danila at 10:45 PM on June 17, 2010 [1 favorite]


empath, they weren't babies at the time of testing, I read that they were between the ages of 6-10.
posted by Danila at 10:46 PM on June 17, 2010


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.
posted by empath at 10:47 PM on June 17, 2010


In the course of our inquiries, made in preparation for this publication, nearly all clinicians to whom we described Poppas’s “clitoral sensory testing and vibratory sensory testing” practices thought them so outrageous that they told us we must have the facts wrong. When we showed them the 2007 article, their disbelief ceased, but they then seemed to become as agitated as we were. At an international conference two weeks ago, when Dreger told Ken Zucker, a psychologist at the Hospital for Sick Children in Toronto and member of the clinical establishment, about this, Zucker said that we could quote him as saying this: “Applying a vibrator to a six-year-old girl’s surgically feminized clitoris is developmentally inappropriate.” We couldn’t find a clinician who disagreed with Zucker.

Yang, Felsen, and Poppas describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”


http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4730&blogid=140#ixzz0rBHRRIEh
posted by Danila at 10:49 PM on June 17, 2010


I surmise that a large portion of Mefites are of a counterculture, any counterculture. So, the high passions in response to this slanted and sensational article don't suprise me. A large part of the fundamental issue here is about being born into a specific counter-culture rather than being a part of the dominant culture.

I really can't imagine most girls being ok with having a penis though. And the chances that she will have psychological problems outweigh the chances of her embracing it, even with encouragement. Even if she is gay and she has penis envy, the vast majority of gay females would be just like her.

There is, however, something to be said about the limits of modern medice. If, perhaps the doctors can tell the parents which androgens (testosterone or estrogen) will be prevalent throughout the child's lifetime, then the parents, after having been educated, can make an informed descision.
posted by Student of Man at 10:53 PM on June 17, 2010


OK, so, I see the facepalms and the what-the-what and people being literally physically sickened, etc. etc., aaaaaand, the front page of the Cornell newspaper has a story about a grad student getting 25-to-life for killing his wife, Penn State got a new coach (I didn't bother checking which sport) and further down it looks like they're taking the suicide barriers off the bridges at Cornell (infamous for being jumped off of by distraught students).

So, really, Cornell, fellow physicians, Ithaca and/or NY state police. WHAT ARE YOU GOING TO DO ABOUT THIS? Seems like a lot of disasters are being quite passively reacted-to lately.
posted by Lukenlogs at 10:54 PM on June 17, 2010 [1 favorite]


A large part of the fundamental issue here is about being born into a specific counter-culture rather than being a part of the dominant culture.

No, it's not. It's about what's going on here eliciting a reaction that the situation is viscerally wrong, regardless of the "countercultural" or "dominant-cultural" nature of the person who is having the reaction. I don't have to be a homosexual or a hermaphrodite or a freak to see this as fundamentally unsettling, unnerving, and disquieting. I just have to be a human being.
posted by blucevalo at 11:05 PM on June 17, 2010 [2 favorites]


This is one of the more shocking posts I've ever read on metafilter. Merits of the surgeries aside, the post-operative clitoral sensory testing and vibratory sensory testing sound criminal to me. The link to the Bioethics Forum says it all--the testing was done to gather data for the researchers' studies, not solely or at all for the girls' treatment (what could be done to restore sensation if the tests showed diminished sensation?), and is thus subject to oversight and approval by Cornell's IRB, which was apparently not sought. Furthermore, as the Bioethics Forum article points out, the research goals of these follow ups are not even coherent beyond a poor attempt by a single surgeon to show that his techniques preserve clitoral sensation better than older techniques--there is no control data presented for most of the measures in the linked study, making the sensory testing data almost useless.
posted by holympus at 11:10 PM on June 17, 2010 [1 favorite]


Yang, Felsen, and Poppas describe the girls “sensory tested” as being older than five. They are, therefore, old enough to remember being asked to lie back, be touched with the vibrator, and report on whether they can still feel sensation. They may also be able to remember their emotions and the physical sensations they experienced. Their parents’ participation may also figure in these memories. We think therefore that most reasonable people will agree with Zucker that Poppas’s techniques are “developmentally inappropriate.”

This experience is so outside normal that it results in a sort of brain jolt that's hard to process.

However, I would also point out that if someone explained to you in a similar fashion that the best thing you could do for your child's continuing best health is to take them to the pediatrician, who would hit them with a rubber hammer and then inject them with live viruses and make them scream, you'd think this was the very definition of insanity.

The child has had surgery on a part where nerve damage is a significant possibility. Sensation yay or nay is a pretty critical piece of data. A vibrator is an instrument, one that has a number of uses from laboratory settings to concrete mixing to recreational bedroom use. Context is, as with vaccinations, critical.
posted by DarlingBri at 11:12 PM on June 17, 2010


Also imagine that you needed your tail in order to have an orgasm.

Hey now, I don't know about the rest of you, but I know I like a little ta--

Hrm. Nope. Can't do it. I think I just found my limit.

This is just reprehensible.
posted by rokusan at 11:21 PM on June 17, 2010


“Applying a vibrator to a six-year-old girl’s surgically feminized clitoris is developmentally inappropriate.”

The question is: how do you verify post surgery sensory functionality in the clitoris? You prescribe masturbation and ask for a 2-page essay afterwards? And I'm sorry, I'd wager the above cited psychologists, biologists or bioethicists are less qualified to speak than, say, a veterinarian.

Aside from the vast and controversial cultural implications in this particular case, medicine is medicine, no matter what organs are implied.
posted by _dario at 11:24 PM on June 17, 2010 [1 favorite]


From ms.codex's link to the artile: A total of 51 patients 4 months to 24 years old (mean age +-SD 4.6 +- 6.8 years)

!! Some of these girls were much older than babies.

There is certainly doubt all over about what should or should not be done. I appreciate all the comments that discuss this in terms of the appropriate treatment or non-treatment of this condition and of developing societal awareness and appreciation of things that don't fit comfortably into the bell curve.

Comparisons to Nazis and pedophiles are not so helpful. Cotton swabs are a pretty standard tool for sensitivity testing in a doctor's office. There is no reason for OMGQtips. Small children, girls and boys both, have procedures done 'down there' every day without making them feel molested.

Focus instead on the extreme violation of experimental protocol, IRB rules, patient/parent rights. The way this was done sounds pretty f'd up.
posted by SLC Mom at 11:30 PM on June 17, 2010


"The child has had surgery on a part where nerve damage is a significant possibility. Sensation yay or nay is a pretty critical piece of data."

To researchers, sure. To the child? I think they can figure out on their own what they can and can't feel. And that's the issue. I am sure that it is good to test and treat a child for the benefit of that child, within reason.

I do not think it is good to do such an invasive and potentially traumatic test for the purpose of some sketchy research.

Yet another aspect of this whole thing that shows serious disregard for these girls' ownership of their own bodies and demotes their future sexual comfort and pleasure to an afterthought. Who cares if she feels violated or ends up remembering this experience every time she tries to masturbate! WE NEED INFORMATION FOR HALF-ASSED SCIENCE!
posted by internet fraud detective squad, station number 9 at 11:33 PM on June 17, 2010


Emailed sent. How the fuck does this kind of "research" get approved?
posted by New England Cultist at 11:51 PM on June 17, 2010


Bloody hell.

In everything I've read so far, there has been no mention of Pappas also helping fix any of the actual health/comfort issues that might arise from someone being in the middle of the Prader scale (like having their uterus and urethra linked) when he did the clitoris removal surgery. Did I miss that part? I hope I missed that part, because if those surgeries were 100 % cosmetic, it leaves an even worse taste in my mouth than before, and I didn't know that was possible.

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% internal--and all of that erectile tissue is a part of the clitoris. Also: vaginal orgasms? g-spot orgasms? From what I've read, those are all a result of stimulating different parts of the internal clitoris. So--in my non-doctor opinion--messing with such an essential organ for purely cosmetic purposes seems mad.
posted by colfax at 11:58 PM on June 17, 2010


Except we do surgically alter boys penises. About 50% of American boys are circumcised, mainly for cosmetic or traditional reasons.


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. Nerve damage, loss of sensation, incontinence, and inability to orgasm are par for the course with clitoroplasty in a way that they simply aren't with circumcision.
posted by Powerful Religious Baby at 12:01 AM on June 18, 2010 [1 favorite]


This is a discussion about the mutilation of girls' genitals. "Poor little boys" is yet another example of using "but men have it bad too!" in a discussion about something that is happening to women in order to marginalize the topic at hand. If you want a discussion about male circumcision, post an FPP.

What the hell? I think it's a perfectly valid discussion point and I'm genuinely confused by the "THIS FEMALE GENTIAL MUTILATION MEDICAL PROCEDURE IS AN OUTRAGE AND A BLACK MARK ON SOCIETY AND HORRIBLE" while having no such qualms about male genital mutilation, which is effectively what male circumcision can be equated to.

Where's the distinction? Understand, I'm fully in the "please, let's not mutilate ANYone's genitals unless there is a serious health risk that requires intervention" camp, without their consent. And I'm having a very tough time reconciling the ragefilter up above with a completely blasé reaction towards male genitalia.

This is in no way "marginalizing" either topic. It's general befuddlement why one is so very much worse than the other. Seething, full-of-rage worse. Especially when, arguably and variably, the females operated on in this manner were better candidates from a medical perspective for their surgery than the vast majority of boys subjected to male circumcision.

So please, someone, explain your feelings. My gut reaction was "what the fuck this is HORRIBLE" but reading through the rationale and the actual mentality behind the operations (more "correcting perceived abnormality" less "Mengele's sick fun-house of fucked up experiments") I'm really having trouble grasping the disproportionate levels of outrage for male vs. female circumcision.
posted by disillusioned at 12:13 AM on June 18, 2010 [1 favorite]


I can imagine a too big clitoris. I can imagine wanting a smaller one. But I think this is a decision that should be made as an adult by the person affected.

So much this. Genital surgery is not something to be entered into lightly; there is always the risk of losing sensation, or ending up with continence problems. Before I signed the papers for mine I had two doctors and a nurse go through all the possible ways it could go wrong, and all the possible ways it could go kind of right -- as in, everything would be intact but I would have little to no sensation. These are the sorts of decisions that can only be made by the owner of the parts themselves, as an adult, and the fact that this sort of shit is done to healthy children, around the world, every day, makes me weep.

And that's not even going into how many people, including adult women seeking similar operations and the people that encourage them to do so, have a really unrealistic idea of what "normal" female genitalia look like.

Basically, it isn't about "ugly" bodies, but about having a little penis when you're a girl.

Woah there. Okay, my background makes me a bit more disposed to thinking like this than most people, but I'd read about intersex people whose genitals were operated on as a child -- say, to make them a "normal" girl -- and who grew up feeling like they were a boy. You can't know this about a child -- any child -- without their testimony.

I want to add my rage about how many medical practitioners wring their hands and scream blue murder over teenage trans kids getting hormone blockers but have no problem with fucking surgically altering other kids to make them look more like their parents think they should, but that's not what this thread is about, so I'll resist. Oh, damn.
posted by ArmyOfKittens at 12:25 AM on June 18, 2010 [7 favorites]


Even if she is gay and she has penis envy, the vast majority of gay females would be just like her.

I've read this sentence over a couple of times and have no idea what on earth it's supposed to mean.
posted by jokeefe at 12:25 AM on June 18, 2010 [6 favorites]


The issue is not that circumcision isn't unproblematic. The issue is that we are not talking about circumcision, this thread is not about circumcision, and every mention of a cutting implement within six inches of genitals is not an excuse to steer the conversation toward your thoughts on circumcision.
posted by Pope Guilty at 1:23 AM on June 18, 2010 [14 favorites]


Yeah, it's more like castration.
posted by UbuRoivas at 1:28 AM on June 18, 2010


The issue is not that circumcision isn't unproblematic. The issue is that we are not talking about circumcision, this thread is not about circumcision, and every mention of a cutting implement within six inches of genitals is not an excuse to steer the conversation toward your thoughts on circumcision.

God dammit, it's like you somehow managed to miss the entire point of my post. My post had nothing to do with steering a conversation towards thoughts on circumcision. It was about questioning the disproportionate outrage because I truly don't understand why there's such a disparity. Remembering that the thread is already ABOUT circumcision one way or another is germane to my point.

This wasn't "why don't we talk about male circumcision which is also wrong AMIRITE," it was "what's the basis behind the dramatically louder outrage for female vs. male circumcision?"
posted by disillusioned at 2:06 AM on June 18, 2010


What fucked up back asswards country is this?
Oh America?

Well what fucked up back asswards state is this?
Oh...New York?

Well what fucked up back asswards kind of research is this?
Oh...Ivy League?

Maybe...just maybe...there are people from all over the world that will use their power and knowledge to do fucked up stuff.
posted by hal_c_on at 2:33 AM on June 18, 2010


As I understand it, most common forms of medical protocol that check for neural function actually use pain. Via either pinching or needles.
posted by kalessin at 4:15 AM on June 18, 2010


This wasn't "why don't we talk about male circumcision which is also wrong AMIRITE," it was "what's the basis behind the dramatically louder outrage for female vs. male circumcision?"

Because with male circumcision, they are removing the foreskin, but with female circumcision, they are removing THE CLITORIS ITSELF.

The group is saying, "come back to us when male circumcisions start meaning you're whacking off a whole three inches of the dick."
posted by EmpressCallipygos at 4:15 AM on June 18, 2010 [6 favorites]


Actually, I'd like to expound upon my comment above.

* If male AND female circumciscions were truly equivalent, they would be removing only the clitoral hood. But, as I've said above, they remove a portion of the clitoris proper itself, if not the whole entire thing. That's why the more proper name for "female circumcision" is actually 'clitoridectomy," becuase they're removing the clitoris itself.

* Also, clitoridectomies leave almost 100% of those thus treated completely anorgasmic. To my knowledge, and in my own personal experience, total anorgasmia amongst men who've had circumcisions is vanishingly rare.

* "Female Circumcision" is performed with the express purpose of curtailing women's sexuality itself. It's still a cultural reason, but in societies where male circumcision is performed for religious reasons, male sexuality is still approved of.

So, the reason that female circumcision gets more shock than male circumcision is because male circumcision doesn't leave you totally anorgasmic, it still leaves you WITH a penis, and it still leaves you with the ability to have sex. When male circumcision starts cutting your entire penis off and starts being about how you shouldn't be allowed to have sex, THEN you've got an equivalent situation.

Mind, I'm not saying that you haven't got the right to be bothered by your circumcision. But -- complaining about it in this arena is rather like complaining to someone who just got foreclosed upon that "dammit, I knew I had $20 in my wallet and I can't find it now."
posted by EmpressCallipygos at 4:34 AM on June 18, 2010 [17 favorites]


I should also try to make clear that when I mentioned my personal (male-ish) circumcision, I mentioned it from the point of view that it was done without consent, which is the mode that many genital corrective surgeries are also done.

I did not intend to compare this clitoroplasty surgery in any other way to my circumcision, nor did I mean to imply that this clitoroplasty under discussion here was in any other way equivalent to male (-ish) circumcision.
posted by kalessin at 4:42 AM on June 18, 2010


mdn: "It's not as simple as that - when the clitoris is extended, it becomes more like a penis, and the vaginal opening becomes more fused."

I think you're getting confused between phenotype (physical expression of genotype) and genotype (genetic coding of the organism) here. As well as between healing and surgery. Surgery won't really keep flesh from fusing unless other interventions (keeping that fusing flesh apart) continue to intervene. The phenotype knows who it wants to be.

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.
posted by kalessin at 4:59 AM on June 18, 2010


> So, really, Cornell, fellow physicians, Ithaca and/or NY state police. WHAT ARE YOU GOING TO DO ABOUT THIS?"

Not Ithaca, probably -- New York City. This guy is part of Weill Cornell Medical College, and I have never wanted a bigger distance between the Ithaca and New York campuses than I do right now.
posted by dorque at 5:06 AM on June 18, 2010


For some background and perspective on this alarming practice, see past comments by MeFi's "carmen" on the subject.
posted by clvrmnky at 5:34 AM on June 18, 2010


Several thoughts:

1) I understood floam's analogy completely and I don't understand the outrage. 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.

2) Maybe it is because I am older, but I'm not that shocked by the doctor performing these surgeries (and the parents requesting them.) It has only been within the last 10 or 20 years that intersexual rights have been debated on a wide scale. I imagine that many American parents in non-metropolitan areas have yet to receive the information that it's OK to grow up sexually ambiguous.

3) I don't know if these surgeries are necessary medically, but I can agree with everyone if it is just a cosmetic fix, that can wait until adulthood.

4) Prior to the pioneering work of Poppas, the enlarged clitoris was simply cut off with no preservation of sensation. Poppas improved on that butchery. I imagine the reasearch he now conducts is an attempt to refine the technique in order to preserve the greatest amount of clitoral sensitivity. If (BIG IF) this surgery is medically necessary, than I think we can all agree that improving the surgical method is of tremendous importance, therefore we are left with how should the post-op research be conducted. Not by stimulating children. Certainly NOT by conducting annual exams over time. That is an abhorrent idea, however I don't have any good answers. The best I can come up with is wait until these girls are grown for a follow-up questionnaire.
posted by Secret Life of Gravy at 5:49 AM on June 18, 2010


OMG!!! He should be stripped of his license and sent to jail.
And the facts that the parents are letting this be done, EDUCATE PEOPLE PLEASE!!!!!!!!!
posted by VickyR at 6:27 AM on June 18, 2010


The last link in the OP (linked Bioethicists) is a good read and answers a lot of the questions that casual readers and commenters to this post seem to have.
posted by kalessin at 6:38 AM on June 18, 2010 [1 favorite]


I can't imagine anyone wanting to dig through my comments trying to find stuff I've said about genital cutting and intersex, so I'll add a bit to this discussion. For background, I did my master's thesis comparing African and American genital surgeries. With respect to intersex surgeries, I certainly side with the Intersex Society of North America in my personal feelings that all non-life-threatening genital conditions should not be surgically treated until adulthood, or at least until the person in question is old enough to give what we could reasonably consider informed consent.

There is very little research on a number of important things surrounding these surgeries: there is little research on the experiences of children growing up without the surgeries, both in terms of how childhood conditions affect their adult physiology, and in terms of emotional adjustment and sexual function in non-surgically treated individuals. This essentially means that we do not know what effect surgery has compared to no surgery.

There is very little follow-up on how the surgeries affect intersex people, in terms of their emotional, physiological, or sexual function. This particular study illustrates part of the problem of conducting such follow-ups. Most new surgical procedures are followed up only by the doctors that develop them, rarely follow patients into adulthood, and rarely look at sexual satisfaction or function, but are rather concerned with basic post-operative health of the tissues and appearance. In one study, researchers followed up on infant CAH clitoroplasties by asking parents if they were satisfied with the outcome. Over 70% of parents were, and the study concluded that the surgeries were therefore successful and appropriate.

For these reasons, claiming that these surgeries are medically necessary for conditions that are not life-threatening is unjustified. Concerns about teasing also seem misplaced to me: what if you cut away your child's clitoral shaft and they get teased for being fat, or awkward, or for having red hair, or liking astronomy, or reading too much, or being bad at sports? Children find things to tease each other about, and in my experience as a child, it was rarely genitals (this may differ somewhat for boys, but wouldn't you rather campaign at schools for bathroom stalls and shower stalls than remove your boy's fertility and turn him into a girl--the current treatment for a micropenis that does not respond to hormone treatment, btw).

Very little research has been done on why parents choose to have these surgeries performed. Some indication is given in Suzanne Kessler's Lessons from the Intersexed, in which she studied doctors, and describes the very authoritative ways in which our scant information about surgeries and about the life-long effects of intersex conditions are presented to parents.

I suspect that male circumcision also has a role in any discussion of understanding how parents come to see these surgeries as okay: it is a common, mainly acceptable type of genital surgery that has very few side effects, and that we feel comfortable (as a society) doing on babies. Some of the reasoning behind people's choices to do it is the same: to prevent teasing, so a boy can look like his father. My guess is that broad acceptance of male circumcision makes intersex surgeries seem less drastic and more palatable to parents who are facing a very confusing and demanding set of choices.

It's been several years since I finished my master's, and I'm not up on all the recent research. However, if you want to really know a lot more about these surgeries, Kessler, Anne Fausto-Sterling, and Morgan Holmes are the scholars to start with.
posted by carmen at 6:42 AM on June 18, 2010 [12 favorites]


The arguments in favor of this procedure for intersex children or against it ARE overlooking that the source material indicates that NOT all the procedures are for that, that SOME are for purely cosmetic reasons. So even if some of the doctor's work is acceptable as a surgerical response to intersex birth (correct or not), SOME of the doctor's work is straight up textbook genital mutilation for aesthetic reasons.

And as the bioethicists have pointed out, his testing is inappropriate through the lens of the doctor-patient relationship.

So from a professional, ethical and human rights perspectives the OMFGGENITALMUTILATORCREEPYCHILDMOLESTER hubbub is pretty justified.
posted by Chipmazing at 6:46 AM on June 18, 2010


There shouldn't be an issue with a child being made fun of; children's genitalia should not be on view. Boys may typically change in open locker rooms; girls typically don't, at least in my experience. From what I've read about genital/sexual ambiguity, the best course seems to be to let the person grow up and make a decision.

This brings me to tears. I do think there's a large aspect of hatred for women's bodies and women's sexuality.

There are a great number of very thoughtful and informative comments here, but I had to stop reading because I hate crying at work.
posted by theora55 at 6:58 AM on June 18, 2010


it is my understanding that the clitoral glans is protected from irritation by the skin of the clitoral hood.

i imagine that a glans that is completely exposed at all times could cause intense discomfort to a child, and a perfectly reasonable parental response to this concern would be to ask a doctor how to protect the glans.

i have no idea if it is feasible to construct a bigger hood or find a way to tuck the clitoral shaft deeper into the groin without damaging the tissue. cutting the tip off and reattaching it to a... clitoral stump (sorry) sounds way too risky for me. but Poppas believes he can microsurgically perform this procedure to remove excess skin tissue without nerve damage.

frankly i don't think he can and he should stop trying. but punishing the man for having the audacity to suggest he is skillful enough to remove what he views as benign tissue should not be viewed as grounds for terminating his license to practice more orthodox pediatric urology.

inappropriate follow-up and lack of cooperation with regulatory investigation should be punished but i think there's a legitimately PAINFUL (albeit rare and non-life-threatening) anatomical condition being addressed by the research.
posted by Hammond Rye at 7:08 AM on June 18, 2010


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% internal
Well, 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.

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.
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.
posted by delmoi at 7:23 AM on June 18, 2010


This is surgically correcting what's medically considered a birth defect.

If you think this sentence isn't full of ambiguous political, social, and linguistic ambiguities, I think we have found the crux of our argument.
posted by edbles at 7:50 AM on June 18, 2010 [9 favorites]


There are two issues here:

Surgery with possibly serious consequences without the informed consent of the most interested party. As an adult, even if I had a seriously embarrassing and even uncomfortable genital malformation of my naughty bits, I'd really ponder before agreeing to surgery with even a limited potential of leaving me without sensitivity "down there". That this decision is made on behalf of small children, when adults would very possibly not agree to it, seems wrong, even if the intentions are good.

Subsequently "testing" genital sensitivity on young girls with a procedure that, quite frankly, is not only skeezy, but could quite possibly land the person performing it in jail and a sexual offenders' register. The fact that this testing was withheld from the IRB moreover suggests that the surgeons responsible were very well aware that they were beyond the pale, and that any ethics board would not just object to the testing itself, but also become aware with a jolt of the very serious risk to which the patients were being exposed with this surgery.

While the outrage may be disproportioned in that the doctors here are neither pervs not Nazis, this seems a clear-cut case of scientific tunnel vision, in which researchers become so obsessed with their target that they forget about the ethical implications of what they are doing. Seriously: they seem to have acted as if they were veterinarians (no offence meant to vets), not medical staff with human patients.
posted by Skeptic at 7:51 AM on June 18, 2010


And BTW, I'm no fan of circumcision, but, equating this with circumcision is the purest definition of trolling.
posted by Skeptic at 7:52 AM on June 18, 2010 [2 favorites]


Secret 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.

Which aren't supposed to be there. Unlike the clitoris.

I don't know about you, but other little girls didn't see my clitoris when I was growing up--or, you know, ever--so there is no way I could have been teased about it (or teased another girl). Girls don't, as a rule, compare genitals the way boys do, because they don't see other girls' genitals. (As far as adult lesbian women are concerned, I can't speak to that, but my guess is that their childhood experiences of not comparing genitals would be the same. I'm sure I'll be corrected if I'm wrong.) So no, this surgery is not at all about being teased; maybe that's what some of the parents are using to justify it to themselves, but it's simply not the case.

On preview: this is an expansion on theora55's comment.
posted by tzikeh at 7:54 AM on June 18, 2010


To the questions of emotions and how the girls may feel and remember the experience of the post-surgery aspects of the study, I offer you this anecdote (and, yes, we all now a =/= d):

I was about four or five. I had a doctor's appointment. At some point, my mom got the little blue plastic cup from somewhere for me to pee in. She told me I had to pee in the cup. I was mortified. Pee in a cup???? I refused. I cried. I was embarrassed. I was upset. I didn't understand why on earth I had to pee in a cup. Now, my mother didn't offer me any explanations as to why that I remember, but I do remember how fiercely this simple, every day doctor's procedure upset me. It was definitely trauma with a lower case t for me.

I finally did pee in the cup when my mother left it in the bathroom and left me to my own devices for a few hours. She let it alone, and I did as I was asked. I told her I peed in the cup. She brought it to the doctor's office, and that was the end of it.

I'm almost 29 years old, and I still remember how upsetting, embarrassing, and horrifying that experience was, even though I did come around in the end.

I believe IFDSNN and the others who agree are right that stimulating the clitoris on a 6 - 10 year old girl would be well remembered and would have with it a number of confusing and conflicting feelings and emotions. I can't speak to the surgery itself, though I'd never authorize it until my child could tell me something that would seem to require me to look into it (bits always hurting, being uncomfortable all the time, and so forth) and would leave it until the child is much older or an adult able to make his/her own decisions about such matters. But the follow-up piece is disturbing, and unless the girls were properly counseled by child psychologists and their parents about what would happen and why (and I can't imagine any psychologist except for that asshole Dr. Money responsible for destroying the Reimer family) agreeing to any participation in the study, leaving these poor girls a possibly traumatizing and most certainly uncomfortable experience (stimulating to orgasm??? WTF???) with no way of adequately processing and understanding it. It's unconscionable and gives science a bad name.

I certainly wouldn't want to be the Cornell Med School's communications director for the next few months.
posted by zizzle at 8:03 AM on June 18, 2010


*know*, not now
posted by zizzle at 8:05 AM on June 18, 2010


If you think this sentence isn't full of ambiguous political, social, and linguistic ambiguities, I think we have found the crux of our argument.

Someday I will actually click and then read the preview.
posted by edbles at 8:08 AM on June 18, 2010


If you think this sentence isn't full of ambiguous political, social, and linguistic ambiguities, I think we have found the crux of our argument.

Well, I didn't say it wasn't. But that's the society we live in. Simply saying "Well, being intersex shouldn't matter!" doesn't change the fact that it does. Even if other kids never see it, I think that's it's reasonable that parents might think it could make their kids feel bad and therefore want to correct it.

Now you can say that there's nothing wrong with being intersex, but that doesn't mean everyone will agree with you. And for people who think being "normal" is better then being intersex, this surgery isn't going to seem like it's necessarily a bad idea. It seems like what people have been saying in this thread is that those people are just "objectively wrong" which isn't actually an argument.

The surgery, the way it's described definitely sounds gross, and when I first heard it, I was disgusted, but I didn't realize that it was actually being done for people who were intersex. In my First comment I said he sounded like some kind of "weird perv", but I actually said

"is it possible that he was operating on girls with severely deformed clitorises? Like ones that people would mistake for being a penis? That's the only way I could even imagine this seeming reasonable."
posted by delmoi at 8:13 AM on June 18, 2010


The more I read about intersex issues, the less I know about gender. It is really clear that it isn't binary, that it is some kind of continuum. But, our culture treats gender as binary, so it gets very complex and screwed up.

This, like the reading I've done on Dr. Money's work, makes me both furious and very sad. I can understand parents wanting to spare their children pain, 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.

On the other hand, I had a friend who had an overly large clitoris. Exactly how big, I'm not sure, even though we had sex, because she wouldn't let me anywhere near it. Now, that nearly makes me weep. Then, I was just a very confused and drunk college kid who figured we all had our hangups.
posted by QIbHom at 8:14 AM on June 18, 2010


It's not as simple as that - when the clitoris is extended, it becomes more like a penis, and the vaginal opening becomes more fused. In fact, if sexual function is a big deal, this operation might be preferred, since having a small penis in front of a partially fused vagina will probably make ordinary sex more difficult. And making sure the post-op tissue was still sensitive was part of what grossed everyone out to begin with...

I'm not sure this thing you refer to "ordinary sex" actually exists. My assumption is that you mean penis in vagina and I assure there are a wealth of other behaviors that can fall under the description "normal healthy sex" and still provide orgasmic stimulation for both parties male or female. Although the male side of that I'm basing on word of mouth.
posted by edbles at 8:16 AM on June 18, 2010


Now you can say that there's nothing wrong with being intersex, but that doesn't mean everyone will agree with you. And for people who think being "normal" is better then being intersex, this surgery isn't going to seem like it's necessarily a bad idea. It seems like what people have been saying in this thread is that those people are just "objectively wrong" which isn't actually an argument.

Fair. But I would argue that as an educated medical professional, that you have a responsibility to the child first and the parents second. The parents to a certain extent only have to deal with the decision tangentially and for 18 years, that's the kid's body. That kid will one day be an adult. And that adult will live in that body for the rest of their lives. It should be up to them what happens to it and that's absolutely not a decision a child can make.
posted by edbles at 8:23 AM on June 18, 2010


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.

You were responding to...me, actually, if the record is to be trusted.

I said, this would be like cutting a length out of the shaft of a penis and sewing the glans back on.

You said, but we do surgically alter boys' penises, via circumcision.

I said, the two surgeries are not comparable.

You said, I know that, I was pointing out that we already operate on boys and it's not considered (by most people) to be as big of a deal.

And I'm saying, see my original statement for an explanation why.

This is the actual definition of a circular argument, so on that note, I'm out.
posted by Powerful Religious Baby at 8:27 AM on June 18, 2010


This isn't female circumcision, this is surgically correcting what's medically considered a birth defect.

This is getting into a bit of semantics. Older CAH surgeries did remove the entire clitoral shaft and glans. Newer ones remove the clitoral shaft and attach the glans closer to the body. The "nerve sparing" surgery attempts to spare the nerves of the shaft during this process, but if you read the last link from the OP, they quote a different follow-up study published in the Lancet:
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.

In considering the validity of these surgeries, it is worth noting a few things about how these surgeries evolved medically. Cheyrl Chase (who is the founder of the Intersex Society of North America) reports that early proponents of clitoral reductions used the African practices of altering or removing the clitoris as evidence that it was a reasonable thing to do, that would not unduly harm women. Suzanne Kessler reports that doctors' writing about large clitorises uses words and phrases like “disfiguring and embarrassing,” “offensive,” “unsightly,” and “incompatible with satisfactory feminine presentation”--pain (a propo of Hammond Rye's comment) is not the main concern in proposing these surgeries: appearance is. Anne Fausto-Sterling points out that the American College of Surgeons recommends early infant surgery on large clitorises even when there is a high risk from the use of general anesthesia (this may be changing, I'm not current on this particular information--but it was certainly the case into the early 2000s).

My personal opinion is that it is important to consider all infant and childhood genital alterations in a single category. Why is it that reports coming from Africa claim that any alteration of the clitoris at all, including small alterations that remove only the clitoral hood (equivalent to male circumcision) have adverse affects on women's health and on their safety during childbirth, but surgeons who operate on CAH girls claim there are no negative health effects? Why is it that some women grow up happy with their genital operations and others grow up unhappy? Drawing a medical/non-medical distinction or a male/female distinction among genital alterations obscures important questions about the people involved and their experiences.

on preview: delmoi and others wondering about what having a big clitoris actually means to a person, you might be interested in this interview with a mother and daughter, where the mother decided not to have the surgery done.
posted by carmen at 8:33 AM on June 18, 2010 [6 favorites]


The phrase "girls with gender ambiguity" seems to be putting the cart before the horse, no?
posted by mattholomew at 8:36 AM on June 18, 2010


Also, carmen, don't leave out the fact that Freud and other psychiatrists at the time that the practice started in Western medicine had a whole mythos (I'm not sure how debunked it is these days but my impression is that the debunking is pretty thorough) about how women with mature sexualities would move from a clitoris-based orgasm to a vaginal-based orgasm, so really those doctors were just doing these young women a favor by forcing them to go that route when they removed the clitoris entirely.

Which I think is total bullshit, but contextually that's where some of these decision-making and policy-making doctors were coming from.
posted by kalessin at 8:37 AM on June 18, 2010


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"
posted by delmoi at 8:39 AM on June 18, 2010


So, having read up on all these links, I wonder why this story is coming to light now.

This study was published in 2007, these surgeries are performed by many doctors and have been done so for decades. Don't get me wrong, I think this is a great topic for fruitful discussion, and I'm as outraged as anyone, but why did this get picked up by blogs now?
posted by fontophilic at 8:40 AM on June 18, 2010


On the one 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
On the other hand:
My personal opinion is that it is important to consider all infant and childhood genital alterations in a single category
Well you two hash it out. I obviously don't think all alterations are in the same category.
posted by delmoi at 8:44 AM on June 18, 2010


So - correcting hypospadias, chordee, undescended testes, are these all 'mutilation' as well?
posted by mattholomew at 8:47 AM on June 18, 2010


fontophilic: I think the bioethicists Alice Dreger and Ellen Feder came across the 2007 study recently and wrote up an opinion piece, and it was picked up by Dan Savage (first OP link) and PZ Myers (second OP link) from there.

As for how these surgeries have been done for decades-- yes, it's true, and it has provoked far too litte outrage. Some posters have already mentioned John Colapinto's book on David Reimer, The Boy Who Was Raised as a Girl, which gives some useful background on the history of corrective surgery for intersex genitals.
posted by ms.codex at 8:48 AM on June 18, 2010


Sorry, hasty addendum: David Reimer wasn't intersexed; he lost his penis in a botched circumcision but was otherwise unambiguously XY and male. The book nevertheless goes into the history of intersex surgery.
posted by ms.codex at 8:51 AM on June 18, 2010


delmoi, I don't know this particular doctor, but I have definitely been pressured by doctors to get hormone replacement therapy (HRT) which it turned out I didn't need (or haven't needed so far). Given the scare tactics of promises of osteoporosis, mobility issues, lack of desire for sex and other sexual function problems, I did end up feeling pretty pressured even though there was at the time (and continues to be) evidence that long-term HRT is implicated somehow in long-term liver damage.

Again I don't know this particular doctor and I don't know his motive or delivery but if he or his colleagues painted surgical intervention as the only way to proceed that could easily be as pressuring as the treatment I received. Or he could be a saint. I really don't know. The fact that he and his colleagues proceeded with an ethically questionable diagnostic process for followup appointments, though, certainly makes the open question of his ethics in recommending a procedure a bit muddy and hard to be open-minded about.

Given the principle of "first, do no harm" it seems to me that doctors involved in recommending such things should be more careful about what they recommend and how they recommend it. I'd prefer to see more doctors spending more time providing comprehensive information about treatments, side effects and long-term prospects than they do now, and I'd like to see the stampeding method (used on my countless times) made officially unethical and something doctors could lose their licenses over.
posted by kalessin at 9:05 AM on June 18, 2010


delmoi: "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""

When you present mostly good options for surgery and mostly bad outcomes without surgery, that is pressuring.

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.
posted by QIbHom at 9:22 AM on June 18, 2010


ms.codex, why are you referring to these children as female if they are 'ambiguous'?
posted by mattholomew at 9:24 AM on June 18, 2010


mattholomew, I don't know if ms.codex is doing this but I am. The reason is that a lot of folks who discuss these sorts of things from an intersex education perspective are careful to separate out two meanings of sex/gender.

To me, sex is the biological sex. My sex is neuter or semi-neuter if you really want to get technical because some of my chromosomes are XXY and some are XY, but medical convention usually refers to folks like me as "male", so take our pick.

Gender, on the other hand, is the cultural construct that for most people is composed of whatever gender is most appropriate to their sex. For intersex people, it's not so clear. A lot of folks base it on genitals, but other people base it on upbringing or on self-identity. Generally I identify as a man, as a masculine human.

I hope that makes at least that set of assumptions clear.
posted by kalessin at 9:28 AM on June 18, 2010


When you present mostly good options for surgery and mostly bad outcomes without surgery, that is pressuring.

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.
So you don't actually know anything, but you're just going to go ahead and assume he's a horrible person. Seems reasonable.
posted by delmoi at 9:30 AM on June 18, 2010


P.S. the above applied to the females in this discussion is probably right because there exists a lot of genital morphology (shape, size, etc.) variation even among normally-sexed populations. It's possible or even likely that the humans we're talking about who've had their clitorises "corrected" are biologically female, even if their genitals put their gender into question.
posted by kalessin at 9:30 AM on June 18, 2010


delmoi, I'm not sure what the point of telling me to hash it out was... both of my comments have sought to contextualize what I meant by the statement you pulled out of context. I responded to you specifically because you seem interested in an evidence-based discussion, but the definition of these surgeries as medical seems to be obscuring some of the evidence. What matters, surely, in the case of any kind of surgical alteration on a child, is the outcome for the child, which is why I think these surgeries/alterations should all be considered in light of each other. It doesn't mean that all should be defined as good or as bad, it doesn't mean that all have equivalent risks or outcomes. What it means is that we shouldn't simply dismiss what one type of genital alteration might tell us about another type.

Defining "clitoroplasty" and "female circumcision/cutting/mutilation" as different things has allowed two very different bodies of research to arise, one claiming that there are no affects on women's health and the other claiming that there are dramatic effects on women's health. This seems hugely problematic to me, especially in light of the facts that a) clitoroplasty often involves the removal of at least as much tissue as African practices and b) African practices have become increasingly medicalized, meaning they are more often performed by doctors in medical facilities on infants and children rather than teens and adults.

Suggesting that male circumcision has no place is this discussion obscures the fact that it is the kind of genital surgery that parents are most familiar with and may influence parental choice.

I'll add as well that some intersexed males also have a very similar set of surgeries performed as the ones described in this thread, which is one reason why I said that making male/female distinctions is not particularly productive. If a boy has a penis that is three standard deviations smaller than the norm and it does not respond to hormonal treatment, doctors may suggest a gender reassignment surgery that involves removing the shaft of the penis to create something that looks like a clitoris, as well as the removal of the testicles and the surgical creation of a vagina (either in early childhood or in teen years: the artificial vagina has to be dilated every day for some period of time, which many feel is a problematic thing to do to a very young child). The reasons given for performing this surgery on boys are in part the same for clitoroplasty on girls: they might be teased, they might be confused about their gender, they might not be able to have "normal" (heterosexual, penetrative) sex.

I think it is important to consider these surgeries as a single category (that category being genital surgeries/alterations on minors for non-emergency reasons) because what emerges is the relationship between reasoning and evidence. It brings out assumptions: about gender, about sex, about childhood, that allow us to better understand both what might be at stake in these decisions and what questions remain unanswered.
posted by carmen at 9:35 AM on June 18, 2010


Woah there. Okay, my background makes me a bit more disposed to thinking like this than most people, but I'd read about intersex people whose genitals were operated on as a child -- say, to make them a "normal" girl -- and who grew up feeling like they were a boy. You can't know this about a child -- any child -- without their testimony.

Yes, I do agree with this, although of course leaving the mini phallus doesn't make them a boy either... but leaving surgery until a point when they can choose what variety of surgery is of interest to them is probably the best solution, and personally I think embracing intersexed people without having to define them as male or female from out of the gate is a great direction to head in.

However: that's a radical change from where we are now (the first thing people ask about your baby is what sex it is; most bathrooms and changing rooms are divided by sex; many people consider gender identity fundamental) so suggesting that people who don't think that way deserve to be on trial for crimes against humanity seemed a little over the top to me. I wouldn't get this surgery for my kid, but I wouldn't tell a parent who did, or a patient who wanted it, that they couldn't do it. Like having a tail removed - to me, it seems to take away from the variety of human life. But the individual doesn't necessarily care about the variety of human life - they have a personal story, and they may or may not want it to involve an unusual component.

Remember again, the age range was from 4 months to 24 years, with the average at 6.8 years, and only 9 out of 51 patients underwent vibratory testing. We don't know the details of each case. It's possible these decisions were made with careful consideration and even input of many patients.

I'm not saying I would have made the same choice, but that doesn't mean it was a completely ridiculous choice either.
posted by mdn at 9:35 AM on June 18, 2010


Not everything is about your penis, and not everything that can be made about your penis needs to be made about your penis.
posted by Pope Guilty at 9:40 AM on June 18, 2010


delmoi: "So you don't actually know anything, but you're just going to go ahead and assume he's a horrible person. Seems reasonable."

No, I'm assuming that this doctor was influenced by Dr. Money and the general attitude that doctors dealing with intersexed babies have.

From the interview that Carmen linked above;

Cheryl: When we talk to doctors who are managing intersexed babies, they just really scoff at the idea that surgeries shouldn’t be performed. I mean, one of the things that they say is that the child will be confused about their own sex, and that they will be ashamed, and that they won’t be able to be intimate with anybody as they grow up.

There is a strong bias towards surgery for babies with "non-standard" genitalia. I am assuming, since this doctor was doing surgeries on babies with "non-standard" genitalia, that he shared that bias.

I don't see where that is illogical.
posted by QIbHom at 9:40 AM on June 18, 2010


QIbHom, I think delmoi is saying that we can't know this doctor's motives, bedside manner or communication style without meeting him and/or being his patient.

Which I agree with.

That said, I agree with you that we can infer some of his priorities from some of his already apparent and well-documented priorities in diagnostics and protocol.
posted by kalessin at 9:44 AM on June 18, 2010


I don't understand the hash it out comment either--carmen and I essentially agree. Surgeries can belong to the same category while still being miles apart in severity of consequence. When I say the surgeries aren't comparable, I mean they aren't comparable in degree of risk, not that they have nothing in common whatsoever.
posted by Powerful Religious Baby at 9:45 AM on June 18, 2010


kalessin, I do appreciate your unique perspective and I'm honestly not trying to be a troll, but I'm still not clear on why the FPP referred to the children as female. My understanding is that they showed 'mosaicism' which means that their chromosomes do not consistently express a single gender. There is no clear biological marker, and gender (as a social construct) doesn't seem relevant if these are infants.
posted by mattholomew at 9:47 AM on June 18, 2010


Are you saying you don't think gender as a social construct doesn't apply to infants?
posted by kalessin at 9:54 AM on June 18, 2010


Gender as a social construct doesn't seem relevant if it is being imposed directly upon them through surgery?


Anyway... I have a question that may have been addressed, but I haven't read through the whole thread. Why, if the article that discussed the doctor's practices was published in 2007, is this just coming to our attention in mid-2010?
posted by Saxon Kane at 10:12 AM on June 18, 2010


Are you saying you don't think gender as a social construct doesn't apply to infants?

Not at all, I'm asking why someone who (correct me if I'm wrong) sees the forced application of this 'social construct' as a bad thing would do just that.
posted by mattholomew at 10:15 AM on June 18, 2010


Well, I see the social construct of gender as not being an isolated thing, but a thing that happens society-wide, so I don't think that any creature inside the society is really empowered to do a lot about the enforced mapping of the gender construct when they're born into it.

I tend to see the most influential folks who are into deconstructing and reconstructing gender doing that sort of work after they've reached the age of majority.

With respect to the term "male" and the term "female", though, I see that as more inescapable as it derives from our phenotypical (biological) response to our chromosomes. Obviously I think as an intersexed person that there may be more choices that are reasonable than just the two that are the most popular.
posted by kalessin at 10:21 AM on June 18, 2010


Saxon Kane: "Gender as a social construct doesn't seem relevant if it is being imposed directly upon them through surgery?"

I think that's definitely an open question. From my perspective the imposition derives from the doctors and the doctors' fixation normalizing bodies to avoid social and peer pressure derived anxiety for children and teens with non-normative bodies.

But it's still a social construct. Many folks I know present a gender that is not consistent with their phenotypical morphology, and these folks are as far as we know owners of completely typical and normative (biological sex-wise) bodies. So it can still be overcome, even by folks who haven't had any normativity assigned to them by the medical establishment.
posted by kalessin at 10:26 AM on June 18, 2010


kalessin, thanks for your perspective. I wish you the best.
posted by mattholomew at 10:28 AM on June 18, 2010


Are you saying you don't think gender as a social construct doesn't apply to infants?

The average age was six, this wasn't done to infants.
posted by delmoi at 10:39 AM on June 18, 2010


Gender as a social construct doesn't seem relevant if it is being imposed directly upon them through surgery?

That doesn't make any sense. In most instances we are talking about the social construction of gender as something that applies to our actions and ideas- the social construction of social concepts- but in this case we are letting our socially-constructed concept of gender literally construct the bodies of children, mutilating them to eliminate the threat that ambiguity poses to our binary conception.
posted by Pope Guilty at 10:40 AM on June 18, 2010


Pope Guilty: Yeah, that's what I meant -- the question was directed to mattholomew, not kalessin.
posted by Saxon Kane at 11:23 AM on June 18, 2010


I was mortified. Pee in a cup???? I refused. I cried. I was embarrassed. I was upset. I didn't understand why on earth I had to pee in a cup. Now, my mother didn't offer me any explanations as to why that I remember, but I do remember how fiercely this simple, every day doctor's procedure upset me. It was definitely trauma with a lower case t for me.

I finally did pee in the cup when my mother left it in the bathroom and left me to my own devices for a few hours. She let it alone, and I did as I was asked. I told her I peed in the cup. She brought it to the doctor's office, and that was the end of it.


I remember that I had to poop on a newspaper once when I was a little kid, which my mother took to the doctor's office or some lab where they did specimen testing. I felt really important. Which is weird because I remember having a fit when she bought me a red backpack that I, for whatever reason, felt too embarrassed to carry. I had no problem pooping on a newspaper, but I'd be damned if I was going to be seen wearing a red backpack. Red was for boys, you see.
posted by anniecat at 11:27 AM on June 18, 2010 [2 favorites]


See also:

http://www.feministing.com/archives/021581.html

http://www.thefword.org.uk/blog/2010/06/first_do_no_har


http://shakespearessister.blogspot.com/2010/06/discussion-thread-cornell-university.html


This is beyond abhorrent. Absolutely unethical, unforgivable, and should be stopped immediately. 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.
posted by SecretAgentSockpuppet at 11:33 AM on June 18, 2010


Ah, my apologies, Saxon.
posted by Pope Guilty at 12:02 PM on June 18, 2010


delmoi: I think the parents and the doctor are probably doing something they think will help, although it may be misguided.

You know who else thought they were doing the right thing but were misguided?
posted by coolguymichael at 1:17 PM on June 18, 2010


However: that's a radical change from where we are now (the first thing people ask about your baby is what sex it is; most bathrooms and changing rooms are divided by sex; many people consider gender identity fundamental) so suggesting that people who don't think that way deserve to be on trial for crimes against humanity seemed a little over the top to me.

From my perspective, the desperate need of (some? many? most?) parents to categorise their children as boys or girls, and then shower them with affection when they behave in a manner that reinforces this categorisation and react negatively or even punish them when they behave otherwise, seems thoroughly destructive. Just because most children won't be damaged by such an attitude it doesn't make it any less awful for the kids that are. I see surgeries like this as part of that attitude.

I appreciate that I have a minority opinion on this, however, since I see painful parallels to my own childhood here -- and my parents loved me very much. But at least nothing surgical or physically irreversible was done to me by doctors in pursuit of "normality".
posted by ArmyOfKittens at 2:06 PM on June 18, 2010 [5 favorites]


I had a friend who had a baby a couple of decades ago. When folks would ask him or the baby's other two parents what sex the baby was, they'd say "Ask the baby."
posted by kalessin at 2:07 PM on June 18, 2010 [2 favorites]


You know who else thought they were doing the right thing but were misguided?

Saruman?
posted by Pope Guilty at 2:10 PM on June 18, 2010


grounded asks:
Does this doctor perform a similar procedure on boys whose penises are deemed 'too large'?

carmen says:
this may differ somewhat for boys, but wouldn't you rather campaign at schools for bathroom stalls and shower stalls than remove your boy's fertility and turn him into a girl--the current treatment for a micropenis that does not respond to hormone treatment, btw).


And I want to clarify that carmen is very politely saying something really really horrific: Boys (babies who are genetically xy) who are determined at or shortly after birth to have "micropenis" are often "transformed" into girls via surgery and hormone treatment. Many of these xy children are never told about their genes, and are pressured to act more like girls, even as they grow up and protest.

Doctors who perform these surgeries have a crude saying that is used justify these actions. "It's easier to dig a hole than it is to build a pole."

So, the surgeries for making baby boys into baby girls are acceptable failures because they can be made to look "normal," regardless of emotion and function. Making micro-penises larger is not something that can be faked, because erection would be nearly impossible. An artificial vagina can receive penetration, so it is considered to "work," regardless of what the patient wants, and without much medical hand wringing over comfort.

Not only do the xy babies subjected to this surgery lose their fertility, they lose a lot of other things as well. Anne Fausto Sterling is, indeed, a great resource if you're interested in learning more.

And yes, there are people born with a penis and a vagina. Again, leaving the vagina and removing the (micro)penis is seen as preferable in many practices, because the penis may not be big enough to "work." But, penises do more than just enter vaginas, and I wish that some medical experts would stop ignoring that fact and let the owner of the penis (or clitoris, or ambiguous genital part) decide what works and what doesn't, on a timeline that is more normal for the working of said body parts.

I'm going out drinking now. To anybody who is intersexed or has undergone a forced gender or sex change of any kind, or been denied a sex or gender change that you desire, I'm sorry that our society doesn't (generally) respect your circumstances. I can only imagine how much that must hurt.
posted by bilabial at 2:12 PM on June 18, 2010 [8 favorites]


If these articles referred to the children who were operated on as intersex instead of females, would everyone still have the same moral outrage?
posted by inertia at 3:55 PM on June 18, 2010


Uh...yes?

Is this some kind of AHA! reverse sexism thing? What are you getting at?
posted by internet fraud detective squad, station number 9 at 4:10 PM on June 18, 2010


My outrage is partly grounded in the (usual) lack of generic testing to determine sex.

These children are being forced to conform to a standard that actual medical science indicates is a spectrum rather than a binary.

And I'm even more pissed off because infant micropenis sometimes resolves, (I have no memory of the stats on that one) and this 'problem' of large clitoris probably does too.

Can you imagine a baby born with micro small fingers and the parents being told, 'the fingers won't function normally, we'll be taking them off?'

(right, I know, I don't use my clit to eat, write, move things, or gesture. but it's mine to use how I want, and frankly I find it very useful.)
posted by bilabial at 4:18 PM on June 18, 2010


If these articles referred to the children who were operated on as intersex instead of females, would everyone still have the same moral outrage?

Is this some kind of AHA! reverse sexism thing? What are you getting at?


I don't think inertia meant that there's lots of reverse sexism going on in this thread. I think the point is that calling them "girls" presupposes that their gender is unambiguous. If the whole piece were phrased in terms of intersex kids, that would be a very different framing and could cause people to think of the procedure differently -- perhaps, as a reasonable solution to a genuine problem. The problem being: hey, what if some kid grows up wondering if they're a boy or a girl. No matter what we might say about the constructed nature of gender, you can see how that could do a number on a kid's psyche. I'm not saying I agree with the foregoing view -- just saying I don't think it was supposed to be a reverse-sexism gotcha. [Obligatory disclaimer about how I don't approve of what the doctor is doing.]
posted by Jaltcoh at 4:26 PM on June 18, 2010 [1 favorite]


Okay, thanks.
posted by internet fraud detective squad, station number 9 at 4:47 PM on June 18, 2010


right, I know, I don't use my clit to eat, write, move things, or gesture.

Ah, but think what a magical world it would be if you could!
posted by Saxon Kane at 6:09 PM on June 18, 2010 [2 favorites]


tzikeh: "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.

Which aren't supposed to be there. Unlike the clitoris.

I don't know about you, but other little girls didn't see my clitoris when I was growing up--or, you know, ever--so there is no way I could have been teased about it (or teased another girl). Girls don't, as a rule, compare genitals the way boys do, because they don't see other girls' genitals. (As far as adult lesbian women are concerned, I can't speak to that, but my guess is that their childhood experiences of not comparing genitals would be the same. I'm sure I'll be corrected if I'm wrong.) So no, this surgery is not at all about being teased; maybe that's what some of the parents are using to justify it to themselves, but it's simply not the case.

On preview: this is an expansion on theora55's comment.
"

I see what's happened here; we simply have two different styles of debate. I take a more analytical, compartmentilized approach. Someone earlier asked "Is surgery ever necessary to prevent teasing?" Without bringing the issue of clitoroplasty into it, I believe the answer to that particular question is "Yes." I never compared the clitoris to a vestigial tail.
posted by Secret Life of Gravy at 6:21 PM on June 18, 2010


There's a Facebook group about this with over 500 members. It encourages people to call Dr. Poppas and tell him what you think (using the phone number from his public Cornell webpage).
posted by Jaltcoh at 10:37 PM on June 17


Since I posted this two days ago, the number of members has roughly quadrupled to over 1,600.
posted by Jaltcoh at 6:09 AM on June 19, 2010


"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.

Which aren't supposed to be there. Unlike the clitoris.
The surgery reduces the size of the clitoris (to the size that most women have), it doesn't remove it.
posted by delmoi at 6:51 AM on June 19, 2010


Oh.

I would have missed this thread if not for someone mentioning it in the "This" Meta thread.

This is dreadful beyond words and has brought me to tears.

It strongly reminds me of what happened to David Reimer in 1966 when his parents chose to have him and his twin brother circumcised.

John Colapinto wrote a compelling book about the Reimer family, As Nature Made Him, The Boy Who Was Raised As A Girl.
As well as telling the story of the Reimers, I think Colapinto's experiences documenting other people with unusual genitalia shows that messing a child's genitalia before they are old enough to consent is a terrible idea. Childhood teasing is nothing compared to a lifetime of suffering after you've been mutilated by some quack. The Reimer twins are both dead. Brian, who was not circumcised after the brutal malpractice that mutilated his brother, died of an overdose, possibly due to the emotinal trauma of finding out, at age 15, that his sister was actually his brother.
David Reimer, who was born as Bruce Reimer and then between his mutilation and the age of 15 was raised as Brenda, shot himself in the head.

I expect their parents, who only ever did what they thought was best on the advice of doctors, are still suffering from the consequences of the decision they made in 1966.

There is no justification for experiments like this. Can't we could learn from the suffering of the Reimers (who were exceptionally interesting as the boys were identical twins, one with a penis, one without and therefore suffered much worse exploitation that they would have otherwise) and families like them. FFS, this shit was known to be going on in Nazi Germany as others have mentioned. These practices need to me made illegal for anyone unable to give informed consent.
posted by goshling at 9:16 AM on June 19, 2010 [3 favorites]


Thanks dario and delmoi for not utterly losing your shit like so many other people in this thread. There are certain subjects that seem to make this community turn into a raging, frothing, murderous echo chamber.

We could stand to be a little more vulcan sometimes.
posted by tehloki at 11:02 AM on June 19, 2010


Thanks dario and delmoi for not utterly losing your shit like so many other people in this thread. There are certain subjects that seem to make this community turn into a raging, frothing, murderous echo chamber.

Some subjects are worth losing your shit over.
posted by tzikeh at 3:34 PM on June 19, 2010 [6 favorites]


Are these intersex children being labelled as "girls" based solely on their ambiguous external sex characteristics (without consideration for their chromosomes or other internal sex characteristics, that is) ? That seems like quite an assumption to base risky and irreversible cosmetic surgery on. Ignoring the questionable ethics of performing surgery on intersex children who are too young to consent or understand, it seems like there's an awfully big risk of being wrong about the gender that these children would ultimately identify as if only the most obvious external sex characteristics are being used to inform decisions about surgical procedures.
posted by cheerwine at 3:44 PM on June 19, 2010


Are these intersex children being labelled as "girls" based solely on their ambiguous external sex characteristics (without consideration for their chromosomes or other internal sex characteristics, that is) ?

Again, the PDF provides the details. Of 51 patients, 46 were "genetic females with congenital adrenal hyperplasia", 3 were "46XY who had undergone sex reassignment surgery" and 2 were "46XX disorder of sexual development".
Four had a prader score of two, 22 of three, 11 of four, and 6 of five.
posted by mdn at 5:31 PM on June 19, 2010


You know who else thought they were doing the right thing but were misguided?

Everyone in the history of everything?
posted by Bookhouse at 7:31 PM on June 19, 2010 [3 favorites]


Jaltcoh, that is exactly what I mean. This article refers to these children only as "girls" and maybe they will all grow up to identify female. My point was, surgery like this happens to intersex babies who cannot understand or consent in attempts to "fix" them, and many people don't take issue with that.

I think that what this doctor is doing is wrong, and I think performing surgery to "fix" intersex children is also wrong. I think it's an example of how a binary approach to sex and gender (which are different things!) does both physical and emotional harm to children.
posted by inertia at 11:01 PM on June 19, 2010 [1 favorite]


Saw this article today, which was interesting/horrifying. It's probably a little too similar to the issues discussed in this thread to warrant a FPP, so I thought I'd drop it here.
posted by Mavri at 3:43 PM on June 29, 2010 [1 favorite]


Just dropped back in, and I am in awe that there is bona fide conversation about [:Dr Poppas:]* being anything but a Very Bad Person.

The benefit of the doubt here being that [:Dr Poppas:]* is merely a sociopath who does not in fact know the difference between right or wrong?

Ahem. I must work to reign in my irrational anger.

"Sociopaths are people, too. They do not know what they do."

It's a mantra!

[thinks about it]

So why does my stomach hurt so? Like someone is killing me?

*Oh yeah you better believe I am quarantining that [:unacceptable concept:].
posted by Mike Mongo at 11:33 PM on July 5, 2010


Update!: In conversations with my sweetie, it evolved that I'd overstated the prevalence of intersex in the general population. Her assertion is that the most reliable large n studies were ones which were biased towards college kids. Some colleges apparently took tissue samples, anonymized and karyotyped entire incoming classes. Looking at those figures, I believe, intersex seems to happen in about 1 in 1800 participants. So 1 in 500 like I stated is too frequent.

Sorry!
posted by kalessin at 12:25 PM on July 6, 2010


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