A Review of Female Genital Cutting (FGC) in the Dawoodi Bohra Community:

Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed?

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.

Commentary on "From the War on Terror to the Moral Crusade Against Female Genital Mutilation: Anti-Muslim Racism and Femonationalism in the United States"

I am a practicing urologist with expertise in female genital cutting. In this commentary, I respond to Dr Dina Bader's article "From the War on Terror to the Moral Crusade Against Female Genital Mutilation." I outline the current climate around genital cutting, the various actors shaping female genital cutting (FGC) legislation, and public perceptions surrounding the issue. I conclude that legislative changes sweeping across the United States to ban FGC have a variety of motivations. Some are to lift politicians' profiles; some are to prevent destination FGC cutting domestically. The possibility of increased racial profiling or increased Islamophobia is perhaps underrecognized by liberals, and perhaps a discreet and intentional agenda for conservative lawmakers. The effect of this legislation also increases attention on the genital alteration of all children, male, female, and intersex, which could be the greatest benefit of all.