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Current critiques of the WHO policy on female genital mutilation

Abstract

In recent years, the dominant Western discourse on “female genital mutilation” (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called “the standard tale” of FGM (also termed “female genital cutting” [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO’s terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.

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Fig. 1: Differences of sex development resulting from androgen insensitivity, ranging from characteristically male genitalia (left) to characteristically female genitalia (right) [147].

Notes

  1. 1.

    According to the Brussels Collaboration on Bodily Integrity [1], “an intervention to alter a bodily state is medically necessary when (a) the bodily state poses a serious, time-sensitive threat to the person’s well-being, typically due to a functional impairment in an associated somatic process, and (b) the intervention, as performed without delay, is the least harmful feasible means of changing the bodily state to one that alleviates the threat.” Definition based on [2].

  2. 2.

    There is now growing recognition that some people born with penises may not identify as boys/men, such as transgender women and some genderqueer individuals. At the same time, “the potential harms of neonatal or early-childhood [penile] circumcision for trans women who elect a penile inversion surgery—as a part of gender-affirming care, for example—has yet to receive much attention … the preemptive removal of a large proportion of sensitive, elastic genital tissue from the penis that could otherwise have been used in the construction of a neovagina—i.e., the penile foreskin—is undoubtedly of relevance to the welfare interests of such women” [7].

  3. 3.

    Please note that, due to a lack of space, in-text references have been condensed and pared down as much as possible. For the accepted version of the manuscript (pre-copy editing) with more exhaustive citations, see https://www.academia.edu/42281793.

  4. 4.

    As a reviewer notes, tattoos and piercings are often restricted for minors, at least in many Western legal jurisdictions, with the exception of ear piercing, which is usually allowed. One possibility, of course, is that ear piercing should not be allowed in such jurisdictions, at least in very young children who cannot provide their own informed consent, so as to bring it in line with other medically unnecessary skin-breaking procedures that might be imposed on pre-autonomous individuals. But even if one thinks that infant ear piercing (for example) should be permitted if the parents give their permission, there could still be reason to oppose medically unnecessary procedures affecting the genitals in particular due to their widely perceived special or “private” significance in many cultures [38]. We expand on this view in the concluding section.

  5. 5.

    Similar feelings and associated sexual harms, including decreased sexual satisfaction, have been documented among men, for instance, who were circumcised as children—that is, without their consent—as opposed to in adulthood, with their consent [49]. As a reviewer notes, some studies suggest that removal of the penile foreskin does not detectably affect certain quantitative somatosensory outcomes based on testing of the penile glans [50]. However, similar tests reliably show that the foreskin is, itself, the most sensitive part of the penis to light touch [51, 52], so its removal necessary changes the sensory profile of the organ in a way that may be regretted [53]. Like the clitoral prepuce, the penile prepuce (foreskin) covers, protects, and lubricates the clitoropenile glans [54, 55]; and like the female genital labia, the foreskin can be manually or orally manipulated during sex, masturbation, or foreplay, eliciting particular subjective sensations that are not possible if this tissue is removed [41, 56, 57]. Insofar as a person positively values the specific sensations afforded by manipulation of the labia or foreskin, the sheer state of being genitally intact, or having a choice about the matter, the nonvoluntary removal of these tissues would necessarily harm the person, even in the absence of surgical complications or other (further) effects on genital sensation or function [42, 58].

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Earp, B.D., Johnsdotter, S. Current critiques of the WHO policy on female genital mutilation. Int J Impot Res 33, 196–209 (2021). https://doi.org/10.1038/s41443-020-0302-0

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