Clinical, Ethical, and Legal Considerations Raised by Self-Reported Genital Mutilation Following Voluntary Cosmetic Labiaplasty

An increasing number of women are undergoing female genital cosmetic surgery (FGCS). Labiaplasty, the most commonly performed FGCS, consists of a surgical procedure to decrease the inner labia size so that no or less tissue protrudes beyond the outer labia. Anatomically, it is similar to female genital mutilation/cutting (FGM/C) Type 2a. Thus, what are the differences and similarities between FGCS and FGM/C? Even though FGCS is not recommended by most scientific societies, it is considered legal, contrary to FGM/C. Most women seeking FGCS have physiologic (neither diseased nor anatomically atypical) genitalia and are reassured by counseling. We recommend counseling, history taking, screening for relevant conditions, and, if surgery is pursued, medical care by a specialist. We present the cases of three patients who reported feeling genitally mutilated after having willingly undergone FGCS. This feeling led these women to seek care at an outpatient clinic that receives migrants, refugees, second-generation, or naturalized patients originating mainly from African countries having experienced FGM/C. We discuss clinical implications, health insurance coverage, legal, ethical, and social implications. Multiple unresolved issues must be carefully addressed by scientific societies, legislators, and anti-FGM/C advocates to ensure equal treatment of all individuals in relation to genital cutting or surgery. Genital modifications experienced as harmful, or that are performed without informed consent, should be studied in relationship to one another and evaluated with consistent principles, regardless of the skin color of the individuals concerned, their cultural, ethnic, or religious background, or the name given to the genital modification they underwent.

Daughter circumcision and maternal life satisfaction: a cultural moderation effect revealed across two multicountry studies

INTRODUCTION

The present paper assessed the relationship between maternal life satisfaction (MLS) and the intergenerational transmission of female genital cutting (FGC, female circumcision). It was hypothesised that the association would be more strongly positive in countries in which FGC is more prevalent (ie, culturally normative), suggesting a practice that is socially reinforcing within sociocultural contexts in which it is common.

METHODS

Across two studies with more than 85 000 participants in 15 African and Asian countries, mothers completed surveys reporting on their own FGC experiences and those of their daughters' and on their educational history and socioeconomic status.

RESULTS

The association between MLS and daughter circumcision was weak but positive for the full sample. Contrary to predictions, in countries in which FGC is uncommon, it was more positively associated with MLS, and in countries in which it is common, it was weakly or negatively associated with MLS.

CONCLUSION

Results are contrary to the notion that the intergenerational transmission of FGC is a function of happiness deriving from its cultural normativity. They suggest, instead, a diversity of social motives depending on cultural context. Customised messaging to reduce the intergenerational transmission of FGC is discussed.

Reconsidering the role of patriarchy in upholding female genital modifications: analysis of contemporary and pre-industrial societies

According to the World Health Organization (WHO), customary female genital modification practices common in parts of Africa, South and Southeast Asia, and the Middle East are inherently patriarchal: they reflect deep-rooted inequality between the sexes characterized by male dominance and constitute an extreme form of discrimination against women. However, scholars have noted that while many societies have genital modification rites only for boys, with no equivalent rite for girls, the inverse does not hold. Rather, almost all societies that practice ritual female genital modification also practice ritual male genital modification, often for comparable reasons on children of similar ages, with the female rites led by women and the male rites led by men. In contrast, then, to the situation for boys in various cultures, girls are not singled out for genital modification on account of their sex or gender; nor do the social meanings of the female rites necessarily reflect a lower status. In some cases, the women's rite serves to promote female within-sex bonding and network building-as the men's rite typically does for males-thereby counterbalancing gendered asymmetries in political power and weakening male dominance in certain spheres. In such cases, and to that extent, the female rites can be described as counter-patriarchal. Selective efforts to discourage female genital modifications may thus inadvertently undermine women-centered communal networks while leaving male bonding rites intact. Scholars and activists should not rely on misleading generalizations from the WHO about the relationship between genital cutting and the social positioning of women as compared to men. To illustrate the complexity of this relationship, we compare patterns of practice across contemporary societies while also highlighting anthropological data regarding pre-industrial societies. Regarding the latter, we find no association between the presence of a female initiation rite and a key aspect of patriarchy as it is classically understood, namely, social endorsement of a gendered double-standard regarding premarital sexual activity. We situate this finding within the broader literature and discuss potential implications.

Is Circumcision "Necessary" in Islam? A Philosophical Argument Based on Peer Disagreement

In recent years, there has been a resurgence in debates on the ethics of child genital cutting practices, both female and male, including within a Muslim context. Opponents of female genital cutting sometimes assert that the practice is not mentioned explicitly in the Qur'an as a way of implying that it does not have any religious standing within Islam. However, neither is male genital cutting mentioned explicitly in the Qur'an, and yet most people accept that it is a Muslim religious practice. Both practices, however, are mentioned in secondary sources of Islamic jurisprudence, with disagreement among religious authorities about the status or authenticity of some of these sources. This paper considers the religious status of both female and male genital cutting practices within Islam and employs a philosophical argument based on "peer disagreement" to ask whether either practice is necessary (i.e., religiously required) for a devout Muslim to endorse.