Female Genital Mutilation at Cornell University

While the whole world was debating the American Academy of Pediatrics’ position on “female genital cutting”—the AAP was against it before they were for it, and now, after an outcry, they’re against it again—Alice Dreger and Ellen Feder have been raising the alarm about “medical research” currently being conducted at Cornell University. A pediatric urologist at Cornell—Dix Poppas—has been operating on little girls with what he judges to be oversized clitorises, cutting away important clitoral tissues, and then stitching the glans to what remains of the shaft. Poppas claims that, unlike past clitoral-reduction procedures, his procedure is “nerve sparing.”

First big problem: “nerve-sparing” surgeries don’t always work. And the chunks of these girls’ clitorises that the doctor is cutting away—large pieces of their clitoral shafts—may be just as important as the clitoral glans. Dreger:

To shorten these clitorises, Poppas is saving the glans (tip) but cutting out parts of the shaft. Bo Laurent has pointed out that Masters and Johnsons showed that many women masturbate by rubbing the shafts of their clitorises. (Think about it: the clit is the homologue of the penis. How do men masturbate?) Many women seem to find their clitoral glans almost too sensitive. Poppas’s patients are loosing the option of touching parts of their shafts, because he’s throwing them out (after the cut-away parts have been sent to pathology to see if he accidentally took out a nerve).

There’s lots to be outraged about here: there’s nothing wrong with these girls and their healthy, functional-if-larger-than-average clitorises; there’s no need to operate on these girls; and surgically altering a girl’s clitoris because it’s “too big” has been found to do lasting physical and psychological harm. But what’s most outrageous is how Poppas is “proving” that his surgery “spares nerves.” Dreger and Feder:

But we are not writing today to again bring attention to the surgeries themselves. Rather, we are writing to express our shock and concern over the follow-up examination techniques described in the 2007 article by Yang, Felsen, and Poppas. Indeed, when a colleague first alerted us to these follow-up exams—which involve Poppas stimulating the girls’ clitorises with vibrators while the girls, aged six and older, are conscious—we were so stunned that we did not believe it until we looked up his publications ourselves.

Here more specifically is, apparently, what is happening: At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, 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…. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls….

Although we have tried, we have been unable to locate any other pediatric urologist who uses these techniques. Indeed, we doubt many would, because we think most would—as we do—find this technique to be impossible to justify as being in these girls’ best interests. We understand that these tests might produce generalized knowledge that shows whether Poppas’s techniques are better than some other surgeons’, but it isn’t clear to us how this kind of genital touching post-operatively is in individual patients’ best interests. If the testing shows a girl has lost sensation through the surgery, her lost clitoral tissue cannot be put back. However, the tests would seem to expose the girls to significant risk of psychological harm.

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.”

The 2007 article documenting Poppas’s research is here.

Now more from Dreger’s post at Psychology Today:

So why the heck do Poppas and other surgeons do these surgeries? They believe it is necessary to ensure “normal” sexual development…. Many of us happen to think “normal” sexual development is actually likely to be thwarted by having parts of your genitals taken away without your consent, and thwarted by follow-up exams like the ones we are describing. Ellen and I have gotten to know hundreds of adults born with sex anomalies who went through these medical scenes growing up. Many have told us that the genital displays involved in the follow-up exams were more traumatic than any other part of the experience. Indeed, when I once asked a group of women with androgen insensitivity syndrome what they wanted me to work on primarily in my advocacy work, they said stopping the exams, particularly those in which med students, residents, and fellows parade through to check out the surgeon’s handiwork.

There’s so much to be angry about I hardly know where to start. Applying a vibrator a girl’s clitoris after it’s been surgically shortened may demonstrate that she still has “sensation” in what’s been left behind—that she still has a few nerve endings that function—but that’s not proof that she hasn’t been physically or emotionally harmed by the surgery and those traumatic follow-up “procedures.” These post-op visits with the doctor and his vibrator do the girls no good—what can the doctor do if a girl reports no sensation? reassemble her clit?—and retaining sensation isn’t proof that these girls will grow up to be healthy, sexually functional adults. All of the tissues that make up the clitoris—the glans, the stem, the erectile tissues—are important to sexual response, orgasm, and fulfillment, not just the part of the clitoris that’s “normally” exposed.

There’s another disturbing reason this surgery is being performed: girls with large clitorises are more likely to identify as lesbians when they grow up. Needless to say (or maybe not-so-needless): carving up a girl’s clitoris does nothing to change the underlying hormonal and genetic factors that contribute to lesbian orientation and identity. Big clits don’t make lesbians—lesbians sometimes make big clits. These surgeries are partly motivated by out-and-out homophobia, by the belief that “fixing” a large clit somehow prevents lesbianism. (Larger penises correlate positively with gayness in males but no one is out there shortening boys’ penises.)

Please go and read Dreger and Feder’s piece—”Bad Vibrations“—at the Bioethics Forum. And read Dreger’s post at her own blog.

And if you’re reading this and you’re a student at Cornell: female genital mutilation is being practiced on your campus. What are you going to do about it?