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Genital cutting as “research” at Cornell University

Jill

UPDATE: In the comments, many people have pointed out that these surgeries appear to have been done on intersex children. I have updated the post to reflect that.
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Several readers have sent on this story out of Cornell University (trigger warning on that link and the rest of this post), where a pediatric urologist is performing “nerve-sparing” genital surgery on young children who are deemed to have over-sized clitorises. He basically removes large portions of the clitoral shaft, leaving the glans, and then performs annual follow-up exams which involve stimulating the childrens’ clitorises, labia and inner thighs with a vibrator and asking them if they feel anything.

Um.

There are, of course, legitimate reasons to use vibrating tools to test sensitivity in patients who have undergone procedures which may cause nerve damage. But a few things are off here. First, why are we decreasing the size of a child’s clitoris without their consent? Yes, we are talking about clitorises which deviate significantly from the average size; but unless there is some actual physical problem, I have a hard time understanding why doctors should cut away at healthy tissue — at the risk of decreasing genital sensation — just so that a child’s genitalia fits the doctor’s aesthetic sensibilities. If the child in question is an adult and can consent to this kind of medical procedure, then that’s their business. But if we’re concerned about psychosocial harm, I’d say it’s a better idea to quit demonizing certain bodies as aberrations and embrace the fact that human beings have variable physical traits. And unless the body part that is deemed “abnormal” is creating physical problems like pain or discomfort, we should probably leave it alone until the person whose body is in question can decide what they would like to do.

In any case, we definitely should not be having children go to the doctor’s office, lay down and have their clitorises stimulated with a vibrator. Talk about potential for psychosocial damage.

For further reading, I would recommend Dan Savage’s take, and this piece at the Bioethics Forum.

37 thoughts on Genital cutting as “research” at Cornell University

  1. Helen G’s got a good post up about this that makes clear that these were overwhelmingly intersexed girls.

    http://birdofparadox.wordpress.com/2010/06/18/we-need-to-talk-about-igm/

    So I think it’s not just about doctors’ aesthetic principles about genital size (though it is that), it also emerges out of a fairly established paradigm of non-consensually “correcting” intersexed infants “for their own good” (ie to forcibly produce the normative boundaries of the sex binary).

  2. I read that story (and several associated articles) yesterday. I got the impression that Poppas was actually going to the girls’ houses to do his follow-up exam, rather than having them come to a dr. office. All I could think of while reading it is: those girls are never going to feel safe in their own homes or around their parents again (the parents are always in the room), and frankly it looks like sexual assault to me. I say, if it looks like a duck and quacks like a duck…call it a duck.
    So, how exactly is the Review Board going to explain allowing one of their “doctors” to sexually assault six year old girls in the name of “research”?

  3. I have read several articles on this case already, and my conclusion is that I have to agree 100% with Bookewyrme here: this is sexual assault at the hands of a doctor, approved by the ethics committee. If these girls will still feel safe with their parents, they probably won’t with doctors.

  5. This does sound horribly like the reports of mutilation carried out on intersex children because their doctors/their parents thought their bodies weren’t “shaped right”.

    (The next paragraph may be triggering: apologies.)

    Mutilation of intersex children into “appropriate” bodies has included the surgical creation of vaginas in children born without that opening, and parents instructed to ensure that the artificial vagina didn’t close up by, basically, fucking the child nightly with a dildo.

    The claimed motivation behind mutilating children with intersex genitalia while they are babies is so that the surgery to make them “look normal” will all take place before they can remember it. But that claimed motivation dissolves like a shadow of a lie when doctors start proposing “aftercare” involving what is effectively sexual molestation with a claimed “clinical” basis.

    I really prefer not to read Dan Savage. I think he’s a stopped clock with regard to sexism (and far worse with regard to racism). He occasionally is right, but only by accident.

  6. I am currently reading Age of Sex Crime, and when I got to the section on “gynecological fetishes,” I was a little suspicious of her claim that gynecology is often fueled by an obsession with sex crime, and vice versa.

    And then I read something like this.

  7. @ Jesurgislac–

    I think that is *exactly* what it is, dressed up as something slightly different. Same animal to a different degree. I’ve read cases of children being assumed intersex because of an “overly large” clitoris.

    Husband tells me he was not subject to full IRB review because clinicians conducting reviews of patients/*experimental new surgical techniques* are not considered to be “conducting research” in the full sense of the world, e.g. human clinical trials. Apparently this would not have made it past a full IRB review.

  8. Sorry, I accidentally deleted “and operated upon” after “assumed intersex” above.

    Sigh…my bad. It’s what I get for commenting when half brain dead!

  9. “In any case, we definitely should not be having girls go to the doctor’s office, lay down and have their clitorises stimulated with a vibrator. Talk about potential for psychosocial damage.”

    Actually, historian Rachel Maines did research on the history of the vibrator after seeing one in a Sears Roebuck catalog from the early 1900s, and as it turns out, women actually once did go to the doctor’s office, lay down, and have their clitorises stimulated with a vibrator — to cure “hysteria.” Regression much?

  10. You can oppose clitoroplasty without accusing the doctor of being sexually inappropriate with his patients. He didn’t invent feminizing genital surgery or clitoroplasty. That’s been the standard of care for girls with ambiguous genitalia for decades, for better or worse.

    All this doctor is doing is writing about a particular surgical technique that he thinks preserves the nerves that supply the clitoris.

    I went back and read the original paper. The doctor wasn’t “stimulating their clitorises with a vibrator.” He was using a standard piece of medical equipment called a biothesiometer that delivers a calibrated dose of vibration to test the patient’s sensory thresholds.

    There’s nothing sexual about it. Doctors use biothesiometers all the time on various parts of the body to check nerve function. They’re popular tools in diabetic foot care. Nobody would say that a podiatrist uses “a vibrator” to stimulate the feet of patients with diabetes. They’d say that the podiatrist touched the device to the foot and dialed up the intensity until the patient said “Yes, I can feel that” and then moved on to take the next reading.

  11. Lindsay Beyerstein,

    “He was using a standard piece of medical equipment called a biothesiometer that delivers a calibrated dose of vibration to test the patient’s sensory thresholds.”

    Semantics aren’t really a great defense, here. You can describe it any way you like, but the basic problem is that he was doing WRONG.

    Using the correct medical implements doesn’t earn a free pass or brownie points when you’re doing something harmful and/or unethical.

    It doesn’t matter if his intent is sexual or not, it matters how *they* view it. It matters what impact it will have on his victims. If your first awareness of your clitoris comes not from self exploration but from having it first cut and then touched and evaluated annually by a stranger without your consent while your parents stood by watching, I just don’t think it’s a stretch to say that might really fuck with your head and influence your future sex life.

    Even if we assume that this sort of contact has no lasting negative impact, how do we explain it to these girls? “He has to touch you every year because you had an operation when you were a baby. Why did you have an operation? Because your clitoris looked abnormal and had to be fixed.”

    Sure. No harmful messages there.

  12. @ Lindsay, just because something is “standard care” does not mean we should accept or support it. This is clearly an inappropriate procedure. The man is cutting clitoral tissue off and then annually examining the genitals of children, all for the purpose of making them look a certain way. Not to mention, there is evidence to show that genital surgeries on children (intersexed or not) is harmful. And, really, it’s just plain wrong that these children are being subject to a non-necessary and often harmful procedure without their consent. Furthermore, as a doctor, this jackass should be committed to evidence-based practices and helping people. Clearly, that is not the case here.

    “There’s nothing sexual about it.” Really? The sole purpose of the clitoris seems to be sexual pleasure. It does not have another function. Cosmetically altering a clitoris to make it look more “normal” or “aesthetically pleasing” (and likely interfering with the child’s later sexual functioning) is clearly sexually motivated in some way.

  13. Hi!

    As some other commenters have pointed out, the procedure was performed on intersex people. The articles you linked to are misleading on this aspect and, thus, have caused most people to not know the targetted children are intersex.

    Could I convince you to change your post to consider that information? Two good links explaining are http://birdofparadox.wordpress.com/2010/06/18/we-need-to-talk-about-igm/ and http://scienceblogs.com/pharyngula/2010/06/what_is_the_right_size_for_a_c.php

    Thank you!

  14. Ah hah. Finally found the link to the article I read yesterday. It is Alice Dreger’s article in Psychology Today where she talks further about this. I should note, I think it only really makes sense if you’ve already read the Bioethics piece by Dreger and Federer. In the article, while she doesn’t specifically mention intersex, she does make a point that this particular surgery/research/whatever it claims to be is fueled by homophobia and heteronormative ideas. Anyway, it is further enlightening.

    http://www.psychologytoday.com/blog/fetishes-i-dont-get/201006/can-you-hear-us-now

  15. I think Lindsay has a point. You can believe that the procedure was wrong without calling these doctors pedophiles with lab coats who used vibrators on kids for their own sexual pleasure, instrad of doctors who used medical equipment to test nerve response in a manner that could be potentially psychologically harmful.

  17. There’s nothing sexual about it. Doctors use biothesiometers all the time on various parts of the body to check nerve function. They’re popular tools in diabetic foot care. Nobody would say that a podiatrist uses “a vibrator” to stimulate the feet of patients with diabetes. They’d say that the podiatrist touched the device to the foot and dialed up the intensity until the patient said “Yes, I can feel that” and then moved on to take the next reading.

    I doubt he’s guilty of sexual assault in intent terms. I think it’s wrong to say that there’s nothing sexual about it.

    There’s a difference between using an instrument to examine a patient’s genitalia and using an instrument to examine another body part, e.g. a foot. The patient feels differently about those body parts, and reacts differently to the two examinations; an ethical, responsible physician needs to acknowledge that and respond accordingly. My ob/gyn understands that my appointments with him are different from my other annual physicals. He’d hopefully exercise additional sensitivity for a prepubescent patient.

    That standard medical instrument was being used to evaluate nerve sensation in a little girl’s clitoris. You can’t pretend that there’s no difference between that examination and an examination on a diabetic retiree’s foot.

    While it is absolutely true that clitoroplasty has gone on for decades, it’s not uncontested. There’s an entire movement built around stopping the incredibly harmful and dangerous practice of genital surgery on children, especially as a form of gender assignment.

    A lot of that activism is built around explaining that the harm goes much deeper than potential damage to nerve tissue. I appreciate that this physician is trying to preserve nerve tissue, but the procedure itself is still harmful and unnecessary. And the way you’re analyzing this practice–in a way that doesn’t take the patients into account at all–normalizes that harm.

  18. I’m not saying we should support genital surgery. However, if we want to oppose it, we need to understand what’s actually happening. This isn’t the work of some isolated mad scientist.

    By performing clitoroplasties, Dr. Dix Poppas is practicing mainstream medicine. Maybe mainstream medicine is wrong and needs to change. However, he’s not experimenting on these girls by doing the surgery. (I don’t even think he invented the surgical technique that he wrote about in the paper. He just wrote up his case files from a series of patients that he treated using that technique.) This is an important distinction because there are two separate questions here: 1) Should this surgery be done in the first place?; 2) Did Dr. Poppas behave in a malicious and unprofessional manner?

    The appropriate target is medical profession and not this one doctor.

    You can argue that the surgery is misguided without accusing the doctor of sexually molesting children. When a doctor does a pelvic exam, it’s never a sexual act–unless the doctor does something inappropriate to sexualize the encounter (e.g., making suggestive comments, touching the patient in other ways that have nothing to do with the exam, etc.). There are rapists who use health care as cover. They are criminals. You trivialize the problem by referring to any test or procedure that might not be in the patient’s best interest as “rape.”

    Nobody is alleging that Dr. Poppas, or his patients, or the parents who were in the room, got any sexual gratification from these tests. There is no evidence that he acted with any ulterior motive.

    What I really object to is the demonization of Dr. Poppas for the nerve testing. People with a ideological axe to grind are describing something very ordinary in the most lurid and sensational terms to smear this doctor. “Oooh, vibrators, the pervert! Get the pitchforks.”

    The fact that he tested his patients for nerve damage after he performed the surgery does not make him a sexual abuser. Would you condemn a surgeon for using a biothesiometer to test vibration-perception in children’s genitals after nerve-sparing cancer surgery? Of course not, because it simply makes sense to do post-operative tests to make sure that the procedure worked as advertised and whether any complications developed. This is not research on human subjects, this is just the ordinary practice of medicine. If a surgery carries a risk of complications, it’s the doctor’s job to check for them and tell you what s/he found.

  19. Er…..

    Errr, no.

    While I understand, if do not completely agree, with where you are coming from with the nerve testing argument—

    This is human subject RESEARCH. It, and other things like it, needs to be redefined as such, not only so that these things do not happen & are subject to IRB review (which yes, I know, is a pain in the butt, that is kind of the POINT), but so that primary care physicians and surgeons are enabled to carry out research and obtain good data in their own practices with which to improve patient care.

    Clinical trials are not the only thing that should qualify as the biomedical gathering and evaluation of data on human subjects….invention of the technique or not, he was certainly attempting to perfect & further its use on these girls.

  20. It’s a doctor’s job to do no harm.

    Can you really make a good faith argument that pathologizing, cutting, then repeatedly examining and handling a child’s genitals does not constitute harm?

    We’re not talking about cancer. We’re not talking about a life saving procedure. We’re talking about cosmetic genital surgery on patients who can’t consent.

    “You can argue that the surgery is misguided without accusing the doctor of sexually molesting children.”

    I would argue that a child having their genitals probed by a stranger against their will isn’t really obligated to give a good goddamn what that person’s motivation is, and may not be able to make distinctions with regards to intent.

    I would argue that any doctor who thinks this is a perfectly reasonable course of treatment should have their head examined.

    What is your position, that if and when these children are traumatized by the surgery and the exams, we say “Oh, pish. Don’t be silly! It’s just a legitimate medical procedure done with the appropriate instruments! Your lingering feelings of unease and violation are all in your head!”?

  21. You can argue that the surgery is misguided without accusing the doctor of sexually molesting children.

    I think I see where you’re coming from. You mean that we don’t know one way or another whether Doctor Poppas’s motivation in cutting into baby genitals, and then using a vibrator to “test the sensitivity” of what remains when the child was old enough to communicate, was because he thought he had a right, in a scientific kind of way, to decide what a girl’s genitals should look like, or because he got a kick out of mutilating and then arousing little girls. We just don’t know, and I would absolutely agree that if Poppas were treated as a criminal, he would have a right in court to be tried only for the crime of scientific experimentation on a non-consenting subject, if there was no evidence that he was motivated by sexual desire towards the bodies of little girls.

    But this is not “misguided”. This is evil.

    People with a ideological axe to grind are describing something very ordinary in the most lurid and sensational terms to smear this doctor.

    Why yes, I do have “an ideological axe to grind”. Two, in fact. My ideological axe says that women are human beings, not animals to be chopped to fit a man’s ideas of what their genitals should look like. My ideological axe of ageism says that because babies and small children cannot give meaningful consent, no unnecessary procedures such as mutilating their genitals ought to be performed on them. Intersex children are vulnerable to this. We ought not as a society to allow parents to be shamed into allowing this kind of operation to be performed: we ought to accept that everyone’s born different.

    How is it “smearing” to point out exactly what a doctor is doing? It may be considered “normal” and “mainstream” to mutilate children in this way. But that doesn’t make it right.

  22. Has anyone who’s actually a doctor critiqued this article? I understand all the fury over clitoroplasty, but I would very much like to see a medical professional’s take on this since my understanding is that the patients had an adrenal condition that had other physical manifestations. If it’s as described it’s horrible, but I have the impression there’s more to it.

  23. Ellid: It’s not any more ok to unnecessarily cut the genitals of people with adrenal conditions any more than it is to cut the genitals of people our society deems “normal”.

    No amount of attempts at medical justification changes this. Substantive critique of infant genital cutting of intersex people is long-standing from both within and without the medical community, and there’s no excuse for any doctor or ethics board to be ignorant of it.

  24. I feel queasy just reading the OP. The problem isn’t one doctor — the problem is the system that makes this entire procedure conscionable. Can it be smash the heterobinarynormativemisogynistageist paradigm tiem?

  25. Lindsay, as an ethicist and a psychoanalyst, I have to disagree pretty strongly with you on pretty much all of the points you’ve made about this case.

    You can oppose clitoroplasty without accusing the doctor of being sexually inappropriate with his patients. He didn’t invent feminizing genital surgery or clitoroplasty. That’s been the standard of care for girls with ambiguous genitalia for decades, for better or worse.

    What you’re avoiding here is that doctors are not objective people who drew their place in life by lot. You have to work to enter a specialty and you have to work to develop enough of a patient base to do research (which is exactly what he’s doing, even if he’s managed to dodge the IRB). Something lead this man who pursue gynecology in general and clitoroplasty in specific. At many points in the arc of his career he could have asked himself “is this right?” By not only performing the procedure, but by doing so so many times that he is doing research on the subject, he grants the procedure and it’s social context his support and approval. He could have delivered babies, he could have repaired torn ACLs, he could have done almost anything. He chose this. If what he does is sexually inappropriate (and I’ll explain why it is) then it doesn’t really matter how widespread similar behaviors are and saying “this is the standard” is obfuscatory at best.

    All this doctor is doing is writing about a particular surgical technique that he thinks preserves the nerves that supply the clitoris.

    No, he is pursuing a particular line of interest which involves altering the genitals of healthy children in order to make them more pleasing to their future partners and studying the effects of his procedure on their future sexual responsiveness. Doing heart research means studying circulation. Doing genital research means studying sex. The purposes of the organ cannot be separated from the meaning of the research.

    I went back and read the original paper. The doctor wasn’t “stimulating their clitorises with a vibrator.” He was using a standard piece of medical equipment called a biothesiometer that delivers a calibrated dose of vibration to test the patient’s sensory thresholds.

    There’s nothing sexual about it.

    There is nothing sexual about the instrument in general, but in this case we are definitely talking about sexuality. What purposes to the nerves in the clitoris serve? Why is there such a density of nerve endings there? Why have some human cultures traditionally removed that organ? Why would you want to preserve the nerves during clitoroplasty.

    The answer is sex. What you have here is a doctor who has developed a procedure to make children appear physically as girls. This procedure requires the cutting away of clitoral tissue. The doctor identified a particular problem with this procedure: that sensitivity might be adversely impacted. That sensitivity is explicitly and solely sexual. He has decided to test sensitivity in these children over time using a vibrating device that is standard in the medical industry. Anyone who has had a vibrating device applied to their genitals can tell you that it is arousing. When you say “sensitivity thresholds” in this context you mean sexual sensitivity. This isn’t an accident, it is exactly what the doctor in this case is interested in.

    Put another way, this doctor is testing the sexual sensitivity of children so that he can discover how much clitoral tissue can be removed from what places (presumably for the benefit of future sexual partners) without adversely impacting their sexual performance. The question of his research is really “how much can we alter these children so that they will be desirable/”normal” women without impacting their sexual performance?”

    Thats before we speculate as to his motivations for entering this field, designing the study in this way, or not seeking IRB approval even though it wasn’t specifically mandated.

    Doctors use biothesiometers all the time on various parts of the body to check nerve function. They’re popular tools in diabetic foot care. Nobody would say that a podiatrist uses “a vibrator” to stimulate the feet of patients with diabetes. They’d say that the podiatrist touched the device to the foot and dialed up the intensity until the patient said “Yes, I can feel that” and then moved on to take the next reading.

    But a foot and a clitoris are not the same thing. They do not respond to vibration in the same way. They do not have (perhaps with some exceptions) the same psychosexual context or the same levels of sexual arousal.

    When I go to the chiropractor I tend to get a massage after my adjustment. The massage therapist puts lotion on their hands and uses motion to create friction across my upper back in order to reduce the tension in those muscles. Its a nonsexual procedure. Move the same procedure to my genitals, however, and you’re talking about something radically different (and inappropriate) because my back is not the same thing, and does not have the context, as my genitals.

    I’m not saying we should support genital surgery. However, if we want to oppose it, we need to understand what’s actually happening. This isn’t the work of some isolated mad scientist.

    No, but thats something of a strawman, isn’t it?

    He doesn’t have to be an isolated mad scientist for his work to be both sexualized and oppressive. Nor does the fact that what he is doing is not especially unusual somehow inoculate him from suspicion. Also, I’m quite conscious of your use of “if” statements around the opposition of genital alteration without consent.

    By performing clitoroplasties, Dr. Dix Poppas is practicing mainstream medicine. Maybe mainstream medicine is wrong and needs to change. However, he’s not experimenting on these girls by doing the surgery. (I don’t even think he invented the surgical technique that he wrote about in the paper. He just wrote up his case files from a series of patients that he treated using that technique.)

    From an ethical perspective it is irrelevant if he pioneered the technique or not. By systematically cataloging these case studies and doing follow up treatment in a specific and repeated way he was doing research. Thats what research is. Moreover, the research was deemed interesting and important enough to be published in a reputable journal. He might not be “experimenting” on these girls but he is certainly studying the effects of a specific procedure in a specific matter.

    This is an important distinction because there are two separate questions here: 1) Should this surgery be done in the first place?; 2) Did Dr. Poppas behave in a malicious and unprofessional manner?

    Those aren’t really separate questions. The “everybody else did it” defense works no better in the arena of professional ethics than it did when you were a child. More importantly, the reasons why the surgery should not have been done are tied into the malicious and unprofessional nature of the procedure itself.

    I’ll be blunt: at every step in this process what we are talking about is the abuse of children for the satisfaction of others. If this were something the children in question might want then we could wait until they were able to consent to the clitoroplasty. The fact that these surgeries were done when they were young, too young to be aware, tells us that their needs or desires are being disregarded from the beginning. Instead we have the parent’s desire to have a “normal” child and the doctor’s desire to perform the procedure and thus “cure” a genital abnormality which causes no physical health complications. Beyond that we have all of the cultural and discursive elements of the procedure, why such normality is valued, and what it means to be altering human beings (at the clear risk of their own sexual responsiveness) for the satisfaction of others.

    Those are the macro-level issues. On the micro-level you have a doctor who has chosen not only to go into this field but to routinely observe and stimulate the genitals of children over a long period of time in the name of research. Can we be positive that there is a sexual component to this on his part? No, probably not, but I wouldn’t bet against it. As an analyst, I’d be willing to stake quite a lot on the suspicion that there is a sexual component here for the doctor.

    The appropriate target is medical profession and not this one doctor.

    Both are appropriate targets. You don’t forgive a rapist because of the rape culture, nor do you ignore their one offense in favor of addressing the larger context which fostered it. Both are important and, indeed, challenging the one can be a stepping stone to challenging the other.

    You can argue that the surgery is misguided without accusing the doctor of sexually molesting children.

    You could, but that would require ignoring context, submitting to the falsely objective frame of discussion which allowed for such actions to be justified in the first place, and ignoring the lived experiences of at least some of the children subjected to these procedures.

    When a doctor does a pelvic exam, it’s never a sexual act–unless the doctor does something inappropriate to sexualize the encounter

    Now I’m no expert, but it is my understanding that most pelvic exams are both consensual and do not involved the purposeful and systematic stimulation of erogenous zones.

    Also, not to be difficult, but you cannot know what the exam is for the doctor. Their intrapsychic experience is generally not available. You do not (and in most cases cannot) know what gets them off. I know that I have personally encountered at least three physicians professionally who have admitted a degree of sexual gratification as a result of performing gynecological exams even though they didn’t do anything the patient would identify as inappropriate. In the case of the research this post is discussing, there is a doctor who designed a study that explicitly required the sexual stimulation of children in it’s methodology in order to track the effectiveness of an unnecessary procedure. I don’t think it’s inappropriate to question his motives.

    Nobody is alleging that Dr. Poppas, or his patients, or the parents who were in the room, got any sexual gratification from these tests. There is no evidence that he acted with any ulterior motive.

    There are certainly some patients for whom the experience was traumatic. Just because Dr. Poppas was able to resist masturbating in public doesn’t mean that there was no sexual arousal or motivation on his part. Just because he didn’t attempt to bring the children to orgasm doesn’t mean that what he was doing wasn’t potentially problematic. I would argue that, from the very nature of what he is doing, there is something suspicious. Obviously quite a few other people in this thread are made uncomfortable. Some of the patients clearly felt that what was happening was wrong. All of this in the context of follow-up from a medically unnecessary procedure performed in the absence of consent.

    The fact that he tested his patients for nerve damage after he performed the surgery does not make him a sexual abuser. Would you condemn a surgeon for using a biothesiometer to test vibration-perception in children’s genitals after nerve-sparing cancer surgery? Of course not, because it simply makes sense to do post-operative tests to make sure that the procedure worked as advertised and whether any complications developed. This is not research on human subjects, this is just the ordinary practice of medicine. If a surgery carries a risk of complications, it’s the doctor’s job to check for them and tell you what s/he found.

    Dr. Poppas, for his research, performed 51 clitoroplasty procedures for this study. Fifty-one. 51 essentially unnecessary, cosmetic procedures. 51 procedures which he carefully followed in order to publish the results of his study. 51 alterations of a child’s genitalia, with significant risks to future sexual function, in the name of making them look normal. 51 children then exposed to regular observation and stimulation of their genitals in order to find out if he did something wrong or if he worked out the right method so that more people could use it in the future. 51 children who will grow up with the experience of their genitals and sexuality being something which is the object of public observation and control. 51 children who were not allowed to (and indeed could not) decide if their bodies would be altered for the appreciation of others.

    This wasn’t cancer, this wasn’t making the best of a bad situation. This was a decision. Dr. Poppas and the parents of these children decided to risk the complications and subject the children to follow-up because their genitals looked weird. Thats indefensible.

  27. I would also question why Poppas did not follow somewhat standard procedure in any sort of potentially sexually uncomfortable medical situation, and ask a female nurse trained in the technique to preform the vibration test for him.

    No, that would not make the procedure itself OK in the slightest. But it does make you further question the man’s motives, or at least his prudence and medical ethics.

  28. @Ellid – Oh, ok that makes all the difference then, these were obviously ‘abnormal’ kids with ‘unacceptable’ genitalia that needed to be ‘corrected’.

    Or, how about, NO. Every person alive has a right to bodily integrity. Nobody has the right to decide what anybody else’s genitals look like, nobody, the genital mutilation of children without their full consent is absolutely abhorrent. Parents=/=owners. These are young people who will grow up to be adults, they are not show dogs or dolls.

    Tell me this – if you gave birth to a child who was genetically male and his penis was deemed ‘too big’ would you have it shortened? If not, why not?

    @William – thank you

    @Lindsay – I’m sure Dr Poppas loves your shiny white suit of armour and your steed. I can’t unpack and detail the many ways in which you’re missing the point in such a terrible fashion without having a meltdown, but William’s critique of you is note-perfect.

  29. Has anyone who’s actually a doctor critiqued this article? I understand all the fury over clitoroplasty, but I would very much like to see a medical professional’s take on this since my understanding is that the patients had an adrenal condition that had other physical manifestations. If it’s as described it’s horrible, but I have the impression there’s more to it.

    I would point out that while an underlying diagnosis of CAH might, in some of these cases, been the cause of the “abnormal” genitalia thats pretty clearly not the central focus of the study. CAH can be a terrible disease, but cutting off the clitoris doesn’t treat it.

    There certainly is “more to it” in this case because what we’re talking about is an unnecessary procedure that doesn’t treat the underlying disorder and who’s only possible purpose is to normalize the children being treated so that they’ll be more physically appealing to people who see their genitals in the future. Because medicine has defined intersex individuals as intrinsically ill, we get studies like this one which seek to take “sick” individuals and make them “healthy” by means to removing whatever it is about them which deviations too much from the mean. Thats before we get to the deeply problematic “nerve function” testing which looks an awful lot like sexual abuse and seems to have been experienced as such in at least some of these cases.

  30. Has anyone who’s actually a doctor critiqued this article? I understand all the fury over clitoroplasty, but I would very much like to see a medical professional’s take on this since my understanding is that the patients had an adrenal condition that had other physical manifestations. If it’s as described it’s horrible, but I have the impression there’s more to it.

    I would point out that while an underlying diagnosis of CAH might, in some of these cases, been the cause of the “abnormal” genitalia thats pretty clearly not the central focus of the study. CAH can be a terrible disease, but cutting off the clitoris doesn’t treat it.

    There certainly is “more to it” in this case because what we’re talking about is an unnecessary procedure that doesn’t treat the underlying disorder and who’s only possible purpose is to normalize the children being treated so that they’ll be more physically appealing to people who see their genitals in the future. Because medicine has defined intersex individuals as intrinsically ill, we get studies like this one which seek to take “sick” individuals and make them “healthy” by means to removing whatever it is about them which deviations too much from the mean. Thats before we get to the deeply problematic “nerve function” testing which looks an awful lot like sexual abuse and seems to have been experienced as such in at least some of these cases.

  31. Medicine is unfortunately couched in scientific, empirically skeptical terms. If we can’t eliminate an ethical environment where genital modification of any kind takes place before real consent can happen, why should we impugn attempts (necessarily studies, which, yes, require clitoroplasty – though I think you’d have a hard time proving that these surgeries only occurred at the instar of the study) at integrating techniques to preserve the enervation and function of modified genitals?

    Is the technique of the study questionable? Yeah, but how else do you, if you’re concerned about the outcomes of clitoroplasties, figure out ways to ensure enervation is preserved. I think people are missing the point, these children would have had conventional clitoroplasties with certainly no guarantee of preserving sensation. I think you can hate the parents for making these choices and doctors who insist that these procedures be performed on certain kinds of vulvas, but shaming doctors who are trying to minimize the damage from these procedures is saying that children should be deprived of their clitoral sensation because of their parents’ mistake. Does innovation in clitoroplasty enable further pathologizing “abnormal” looking genitals (if that’s possible)? Absolutely. But stifling technical innovation in the name of fighting a political battle over the use of surgical procedures misses the locus where this battle ought to be fought, medical schools, pediatricians’ offices and parents’ homes, minds, and hearts. Not the bodies of children.

    I appreciate the ideological, or less harshly, abstract argument that people are forwarding about bodily integrity. The problem lies in that parents have all the agency here and these procedures happen in spite of informed consent. Medical ethics dictate that ideally medical professionals show patients, in this case, parents, the options and provide information about the drawbacks to each option and probable outcomes. If parents can only hear that something is wrong with their child and that there are things that can be done to fix it, I think that is their foible and subsequently their child’s problem – they are terrible stewards of their children’s lives. Those parents have already failed at putting their child’s needs first. It isn’t a problem with medicine. The last thing people need is for medicine to become more paternalistic: as feminists we should be sensitive to the idea that procedures shouldn’t be categorically off-limits for relationships between doctors and patients. Moreover, I don’t think people need medicine to get at the idea that being physically intersexed, or otherwise having “abnormal” looking genitals is a pathology. Little boys who have a different foreskin status from their father’s frequently reach this conclusion without the benefit of medicine or doctors and that isn’t even that big of a difference (and can be the source of self-shaming). What is criticized is a cultural problem that has been medicalized: the pathologizing behavior transcends medicine. We need to condemn the parents that have these procedures done and doctors that mislead parents into having them done (although that’s kind of difficult to discern), not doctors that wish to ameliorate outcomes for certain kinds of procedures.

  32. “The problem lies in that parents have all the agency here and these procedures happen in spite of informed consent. Medical ethics dictate that ideally medical professionals show patients, in this case, parents, the options and provide information about the drawbacks to each option and probable outcomes.”

    Medical ethics says, very clearly, “First, do no harm”. Medical ethics dictates that doctors should not either push nor accede to requests to cut out parts of clitorises. Do you think it would be just fine and dandy to start cutting off the feet and ears and nipples of little children, so long as the parents say it’s ok? Why are clitorises exempt? What makes that body part so special that parents and doctors should have the right to “correct” it if they don’t like the look of it?

    Yes, the cosmetic amputation of children’s functional body parts should be categorically off-limits. Straight out. Nothing “abstract” about it. That is a giant bright fucking line right there. There is nothing “abstract” about having parts of your body removed in infancy. This isn’t a theoretical argument. It is happening, right now, and people are being permanently injured from it.

    The ONLY way this will stop is if every pulls their heads out of their arses and says that clearly and straight out, instead of weaselling around about how “well, it’s ok, these kids aren’t actual NORMAL kids, so we can cut out whatever we like to make them conform”.

  33. Is the technique of the study questionable? Yeah, but how else do you, if you’re concerned about the outcomes of clitoroplasties, figure out ways to ensure enervation is preserved.

    Even if I accepted the premise that “theres nothing we can do to stop these kinds of procedures so we should take a harm reduction stance” this particular study is deeply flawed in terms of methodology that makes me suspect a disturbing ulterior motive. The “check ups” were done in the home, by the doctor himself rather than a female nurse or tech. They were done using procedures that other professionals (even the repugnantly transphobic Ken Zucker) found inappropriate.

    Also, not to call you out, but if you’re going to use big words you really should run them through google first to make sure you know what you’re saying. “Enervation” means to weaken or debilitate or, in medicine, to remove a nerve. Enervation is what this doctor wanted to avoid doing in his unnecessary genital alterations, so you’re saying the opposite of what I assume you mean.

    But stifling technical innovation in the name of fighting a political battle over the use of surgical procedures misses the locus where this battle ought to be fought, medical schools, pediatricians’ offices and parents’ homes, minds, and hearts. Not the bodies of children.

    I hate to be the bearer of bad news, but the locus of this battle has always (and will always) be on the bodies of children. Indeed, most battles over rights ultimately come down to bodies. Who controls them, who owns them, who gets to decide how they will be used by whom and why. In this case, the battle is being fought through a body at the very moment someone judges the child’s genitals. From the act of observation on, the body is the central battleground regardless of what determination is made regarding normalcy and desired outcomes.

    Still, you’re missing a fundamental point. The only problem with this study isn’t that it involves a procedure which, on it’s own, many would consider child abuse. Another problem is that the way in which the study was conducted looks very much like an old pervert sexually stimulating children under the guise of medicine. A study designed in such a way that other people within the industry find it problematic is not mere “technical innovation.” That this doctor’s work might lead to some kind of innovation neither excuses nor banishes the possibility that the design of his study involves what is likely molestation.

    Medical ethics dictate that ideally medical professionals show patients, in this case, parents, the options and provide information about the drawbacks to each option and probable outcomes. If parents can only hear that something is wrong with their child and that there are things that can be done to fix it, I think that is their foible and subsequently their child’s problem – they are terrible stewards of their children’s lives. Those parents have already failed at putting their child’s needs first. It isn’t a problem with medicine.

    It is certainly a problem with medicine. The fact that a doctor is willing to perform the procedure is a problem. It is a sign of the arrogance and judgment which permeates the field that such an argument can even be made.

    The last thing people need is for medicine to become more paternalistic: as feminists we should be sensitive to the idea that procedures shouldn’t be categorically off-limits for relationships between doctors and patients.

    Hey, I agree, but the argument you’re making is a strawman. We’re talking about children who were unable to give consent. Allowing parents to own the bodies of children in the same way we allow adults to own their own bodies is paternalistic. Parents are stewards, not owners. They watch and protect, they do not possess. If an adult wants a clitoroplasty they should be free to have one because it is their body. Parents do not get the same right for the body of their child.

    We need to condemn the parents that have these procedures done and doctors that mislead parents into having them done (although that’s kind of difficult to discern), not doctors that wish to ameliorate outcomes for certain kinds of procedures.

    They are interrelated. By offering the procedure, by improving it, a doctor is giving the procedure their explicit approval. The doctors who perform clitoroplasty on children do not enter the operating room with a single tear running down a stoic face, steeling themselves by quietly repeating “this shouldn’t be done, but if it is I will strive to do it with as little damage as possible.” They do what they do because they think it is right, because they’re fixing an “anomaly” because medicine, in many cases, defines illness as “deviation from an abstract mean.” Sex is no different. You have male, female, and disorder. Doctors fix disorders, the logical conclusion is that someone will be made male or female. Its what medicine has been doing to intersex people (generally as children and against their wills) for as long as they’ve had the power to cosmetically alter genitals.

    Put another way: I really don’t care how artfully you’ve applied lipstick to this pig, you’re still knee-deep in slop and its still a pig.

  34. I agree with everything William has said. I’d go further, though, in terms of the doctor’s complicity with this massive abuse.

    When you remove the logistical barriers to evil, you facilitate evil. When you resolve the minor moral problems that flank a major crime, you facilitate rationalization. This man’s practice isn’t just mutilation; it’s legitimizing mutilation. By solving the wrong problem, he’s made it that much harder to talk about the real one.

  35. Piny: Can I just say that I’m so jealous that you were able to say (and say better) in five lines what its taken me several long posts to meander around to?

  37. Pingback: Interesting posts, weekend of … missed weekends « Feminists with Female Sexual Dysfunction

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