From clitoridectomies to ‘designer vaginas’: The medical construction of heteronormative female bodies and sexuality through female genital cutting

Abstract

This paper contributes to an ongoing critical discussion of sexuality and female genital cutting (FGC) offered by feminists, human rights activists, and academics. While most research to date focuses on the current practice of FGC in the African context, this limited understanding prohibits consideration of other instances and types of FGC. Three distinct historical and cultural contexts of FGC are addressed in this paper: (1) the practice of medical clitoridectomy in Victorian England and the use of clitoridectomies in North America in the mid twentieth century, (2) the ongoing Western use of genital surgery, and (3) the current trend of elective genital plastic surgery to create “designer vaginas” in the twenty-first century. This discussion reveals how various cultures and people–including women themselves–use FGC to influence and enforce Western medically constructed female embodiment(s) of heteronormative femininity and sexuality.

Keywords:

• Clitoridectomy
• clitoroplasty
• designer vagina
• female genital cutting
• feminizing genitoplasty

Acknowledgement

I would like to thank the reviewers of Sexualities, Evolution & Gender for their helpful comments and suggestions on earlier drafts of this paper.

Notes

 For discussion of these critiques see Genital cutting and transnational sisterhood: Disputing US polemics, edited by S. M. James and C. Robinson.

 Arrogant perception, world travelling and multicultural feminism: The case of female genital surgeries by Isabella Gunning (1992) and Listening to other(ed) voices: Reflections around female genital cutting edited by Stanlie James and Claire Robertson (2002) illustrate both the need for and ways to do this.

 Hanny Lightfoot-Klein (2002) discusses the role of male and female genital cutting as a rite of passage in many African cultures. The age at which FGC is practiced on females depends upon the cultural tradition and practice of each community. In many situations, girls are routinely mutilated before the age of menstruation, often between the ages of four and 13 (Amnesty International 1998; Mayers, 2004; Mitchell, 2004a, 2004b). Olayinka Koso-Thomas (1987, pp. 49–51) notes that female circumcision occurs between the ages of five and 30 years in various ethnic and religious groups, as well as across occupation and educational levels in Africa.

 The academic press and many governments often use “othering” strategies to show the “backwardness” of cultures and people practising FGC within these specific contexts. Western concepts and ideas of freedom and equality are used as a political statement in a bourgeois liberal moral sense in attempts to regulate cultural practices of particular nations and peoples. For further discussion of this influence, see Apffel-Marglin and Sanchez (2002) and Tamir (2000). Gunning provides an excellent detailed discussion of moving beyond the arrogant perception of “othering” by developing and using a “three pronged analysis of: (1) seeing oneself in historical context; (2) seeing oneself as the ‘other’ might see you; and (3) seeing the ‘other’ within her own complex cultural context” to aid in the process of respecting both “independence and interconnectedness” (Gunning, 1992, p. 247).

 BCE stands for “before the common era” and is expected to eventually replace BC, meaning Before Christ (www.religioustolerance.org/ce.htm). Various academics, and historians of non-Christian cultures in particular, prefer the new designation when dating events that occurred beyond the influence of Christian cultures (http://en. wikipedia.org/wiki/Common_Era).

 It must be noted here that clitoridectomy in the West differs from that practiced in Africa outlined by Koso-Thomas (1987, p. 16). In the West, the practice of clitoridectomy is similar to that of excision, with the removal of the clitoral hood as well as the clitoris, while, unlike excision, leaving the labia minora intact. Erlich (in Lionnet, 2004, p. 4) notes “a famous seventeenth-century French surgeon named Dionis is credited with being the first one to recommend excision as a remedy against female lasciviousness”. Levert, as noted by Erlich in Lionnet (1992, p. 9), argues clitoridectomy was first used, in 1822, by Graefe in the USA to treat “masturbatory madness” and is a medicalized form of misogyny that continued into the US until the 1950s. In the Western context, clitoridectomy refers to the removal of the clitoral hood as well as the clitoris, while leaving the labia minora intact.

 A note of thanks to Patrice Miniely for drawing my attention to this information.

 This attitude only applied to middle and upper class women and not to working class or immigrant women, many of whom worked long hours of hard labour.

 Eugenics movements were developing and taking hold in England and Canada during this time period, and influenced the attitudes of many physicians and others had about the role of middle-class women as wives and mothers (McLaren, 1990).

 The purity movement (made up primarily of moral reformers, clergymen, doctors, members of the National Council of Women) focused their campaigns on the sexual immorality, including masturbation, female prostitution, sex outside marriage, male sexual violence against women, and possibly same-gender sex. For a full discussion of the social-purity movements, see Kinsmen (1996).

 For further discussion on the relevance of masturbation during the Victorian era see: Assad, 1979; Dally, 1992; Duffy, 1998; James, 2002; Metzger, 1999; Wallerstein, 1980; Watson, 2002.

 See for example: Coventry, 2000, Dally, 1992, Duffy, 1998, Fausto-Sterling, 2000, Kandela, 1999, Lightfoot-Klein, 2002, and Slack, 1988.

 Brown's popular 1866 book was entitled On the curability of certain forms of insanity, epilepsy, catalepsy, and hysteria in females (Coventry, 2000, p. 56; Hall, 2004).

 For further reading on the work of Sims see McGregor (1990).

 Clitoridectomy, along with lobotomy and eclectic-shock treatments, were a standard practice for treating lesbians in the 1900s. See Chase (2002a), Monette and Boullata (1995), and Wescott (1997) for further discussion.

 Anne Fausto-Sterling's estimation of 1.7% includes children who are determined to have primary and secondary sexual characteristics that are neither clearly female nor male (2000, p. 53). This calculation includes an average of a wide variety of populations, with the number not being uniform throughout the world.

 According to its website, www.medhelp.org/www/ais/01_INTRO. HTM the AISSG is a consortium of worldwide support groups that owe their origins to the UK-based group which was started in 1988 and was formalized in 1993. The ISNA was founded by Cheryl Chase in 1999 (Coventry, 2000).

 Academic conferences and publications include: the 2001 North American Society of Pediatric and Adolescent Gynaecology annual meeting (Intersex Initiative, 2004), the First World Congress: Hormonal and Genetic Basis of Sexual Differentiation Disorders 2002 conference (Chase, 2002b), the November 2001 meeting of the Paediatric Urology Club of Australia in Melbourne (Jones, 2002), and The Journal of Clinical Ethics (Holmes, 2002, p. 166). Cull (2002) also notes two UK conferences in 2000 that included the experience and knowledge of intersexuals. Popular publications include those by: Baird, 2001, Bornstein, 1994, 1998, Feinberg, 1993, 1997, 1998, and Wilchens, 1997.

 For a more detailed discussion of Money's controversial theory and the damaging effects of this model see: Butler, 2004, Chase, 2002a, Colapinto, 2000, Diamond, 1982, Fausto-Sterling, 2000, and Unger and Crawford, 1992. Or visit the Intersex Society of North America website, which was founded in 1993, as a non-profit organization working to end secrecy, shame, and unwanted genital surgeries for children born with atypical sex anatomy (http://www.isna.org).

 Kate Haas (2004, pp. 54–67) notes that Colombia is the only country to have specific provisions protecting a child's right to bodily integrity and that this decision has opened up a worldwide medical, ethical, and legal debate regarding intersex genital surgery.

 Many intersexuals and advocates argue that having a range of measurement of any type is unreasonable because normalizing genital and reproductive anatomy removes diversity and awareness of diversity (Intersex Society of North America, 2005; Morris, 2004).

 Children born with genitalia larger than 0.85 cm and smaller than 2 cm are considered to be in “phallic limbo” (Fausto-Sterling, 2000, p. 60). Coventry (2000, p. 56) notes that clitoroplasty was coined in the 1970s to distance the new surgical techniques from the negative perceptions of the previous medical clitoridectomies. Chase (2002a, p. 132) argues that clitoroplasty is described as a “simple cosmetic procedure in order to differentiate it from the now infamous clitoridectomy”.

 Coventry (2000, p. 56) notes that it is difficult to gather statistics on the occurrence of this type of surgery, yet she notes that one can deduce the numbers who will undergo clitoroplasty by using the data regarding the number of babies born each year in the USA, and the number born with conditions that produce an enlarged clitoris.

 Butler (2004), Fausto-Sterling (2000), and Holmes (2002) address the role of physicians in escalating the sense of crisis and emergency in parents regarding their intersexed children. Chase (2002a, p. 130) notes that medical professionals consider intersex status to be so “incompatible with emotional health that misrepresentation, concealment of facts, and outright lying (both to parents and later to the intersex person) are unabashedly advocated in professional and medical literature”.

 The diagnosis of intersex and the solution of surgery are presented to parents of children born with ambiguous genitalia as an emergency that needs correcting as soon as possible. For further discussion see Dreger (1998) and Fausto-Sterling (2000).

 Cheryl Chase (2002a, p. 140) argues that “attempts to link the two forms of genital cutting have met with multiform resistance”, and that by examining the ways in which the “two are connected exposes some of the complex interactions between ideologies of race, gender, colonialism, and science that effectively silence and render invisible intersex experience in first-world contexts”.

 According to Fausto-Sterling (2000, p. 107) and Chase (2002a, pp. 135–139), this movement is made up of transgender community and intersexual/hermaphrodite community. For more information visit the website of the Intersex Society of North America. Morris (2004) notes at least 3000 support groups and patient advocacy groups on the Internet.

 Rodney Hunt's analysis of the American Academy of Paediatrics literature indicates that the genitalia of Americans are to conform to the idealized standards outlined by Fausto-Sterling; boys and girls are expected, through their corrective surgery, to fulfill their feminine and masculine hetero psychosexual roles.

 Books like Femalia (Blank, 1993), The cunt coloring book (Corinne, 2001), and Sex for one (Dodson, 1996), celebrate the diversity of female genitalia by showcasing images, through photographs and sketches in their works.

 Dr Matlock's website (www.drmatlock.com) boasts of treating patients from 35 American states and 20 countries by mid-March 2001. Jo Revill (2003) of The Observer, reports that more than 100 women had been to private clinics around the UK to undergo surgery in the previous year.

 The “Toronto Trim” costs about $3,300 CDN, takes approximately 2 hours, and heals in about 6 weeks (Newland, 2003).

 While feminists such as Bornstein (1994, 1998), Butler (1991, 2004), Fausto-Sterling (2000), Feinberg (1993, 1997, 1998), and Wilchens (1997) argue gender is never fixed but, rather, fluid and ever changing, most societies still believe in two-sex or gender system that is to be perpetuated at all costs.