I recently read a series of articles discussing Dr. Dix Poppas(*), a Pediatric Urologist who specializes in, among other things, (pediatric) genital reconstruction. I should note before I begin that Dr. Poppas is a very respected pediatric urologist who has helped many young children in his field of work.
I have an issue with one of Dr. Poppas “side” specialties, genital reconstruction. His “clitorectomy” procedures on infant girls has come under serious scrutiny of late, and has brought the phrase genital mutilation to the halls of America’s hospitals, specifically the halls of Weill Cornell Medical College.
Poppa’s job is to engaged in the clitoridectomies of infant girls with the consent of their parents because these little girls have overly large clitorises.
But Dr. Poppas would say that Bridgette LaVictoire’s definition above in her article, “…Genital Mutilation of Girls” is slightly off kilter. He would say that portions of the clitoral shaft of infant and young girls are being reduced to give them a more normal looking vagina, with minimal damage to clitoral nerves. He would further explain his followup procedure,
“which involves Poppas stimulating the girls’ clitorises with vibrators while the girls, aged six and older are conscious. He also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch.”
These things, he would remark, should not paint him as a perverted doctor, but a concerned physician trying to make sure the child has sensitivity in that area for future pleasure.**
Medically necessary or cosmetic?
Mainly, I have issues with the procedure itself: a cutting of the clitoris of infant and young girls to make the clitoral shaft smaller. And more normal? Clearly some definitions need explaining–to the minute detail. We are talking about the psychological and sexual health of young girls. Will this procedure have adverse effects? I’m not a doctor of any kind so I scanned the waves of the net looking for reasons why a child would NEED to have their clitoris thinned and/or trimmed.
There is no medical reason to have this surgery.
There is a condition called congenital adrenal hyperplasia (or CAH) that is commonly associated with the procedure.
“CAH is an inherited disorder present at birth that affects a baby’s adrenal glands. A baby with CAH cannot make the proper amount of certain steroid hormones.”
As a result, girls with CAH can have over-sized or masculine genitals. However, there is no definition of what qualifies, specifically, as over-sized or masculine. This is a subjective definition. And, even if this were something a child has, it is not medically necessary to alter the child’s genitals. A history of American abuses at the hands of doctors in regards to children born as hermaphrodites has taught us well. There are mounds of research that backs the universal findings: cutting ANYTHING below the belt should be done with INFORMED consent of the affected child, at a mature age, not during childhood when sexual identity, and sex patterns are still developing.
What do the professionals say?
Well, after a bit of confusion on the subject, the American Academy of Pediatrics has issued a policy statement on the subject of female genital mutilation:
The American Academy of Pediatrics:
Opposes all forms of female genital mutilation (FGM).
Recommends that its members actively seek to dissuade families from carrying out FGM.
Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGM .
Recommends that its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents.
The question that we need to ask here is how will altering a little girls genitals, and then subjecting her to in-visit masturbation at each yearly physical exam, affect her thoughts and ideas on sex as she matures? This question is important because early sexual experiences often are a driving force for sexual desires in adulthood.
Also, how will she develop sexually as she matures: children of all ages masturbate or feel pleasure from touching themselves. Will the young girls subjected to this procedure learn to associate sex with pain–or decide that having sex or being touched “down there is a bad thing?
(many parents might smile here, but really sexual dysfunction has ruined many a marriage and quite a few relationships. It matters, and the time to instill positive ideas about sex as a part of adult relationships begins quite young.
* * *
In the end, I vote to leave infant girls the way they are: large clitoris and all! Who’s to say that swelling from birth is not an issue here? Or, who’s to say that having a large clitoris is, well, a negative thing? And what is to prevent that clitoris of reducing in size naturally, as the girl grows into maturity?
Most importantly, as parents our job isn’t to decide what will be aesthetically and sexually pleasing to our children when they are adults–we can never know that. Our job is to help young people develop strong self-esteem, and self worth. These tools will allow kids to decide, at maturity, how their body should look and who should be allowed to touch them.
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* Dr. Poppas is Chief of the Institute for Pediatric Urology at the Komansky Center for Children’s Health of New York -Presbyterian Hospital Weill Cornell Medical Center (whew, that’s a mouthful!)
**Not to mention the other follow up procedure: stroking the child’s clitoris with a moistened q-tip–checking to see that she feels stimulated
Sources
What is CAH?
Female Genital Mutilation at Cornell University
American Academy of Pediatrics policy statement on female genital cutting
Genital Mutilation of young girls
