In a series of essays and letters published in 2010, commentators in bioethics debated the ethics of two interventions that aim to prevent or treat a symptom of a genetic condition called congenital adrenal hyperplasia, which can cause “virilization” in affected baby girls—the development of atypical, sometimes masculine‐appearing, genitals. Surgeries are often performed to try to “normalize” both the appearance and the function of affected girls’ genitals, and a drug thought to prevent virilization is sometimes prescribed to pregnant women who (...) are likeliest to be carrying an affected fetus. The CAH debates suggest that there is profound disagreement in the field about whether preventing or treating virilization is an appropriate goal of medicine—or, indeed, parenting. Of course, that disagreement has its roots in ongoing debates about how to understand and react to a range of anatomical and behavioral differences, from short stature to deafness to hyperactivity, as well as ongoing debates about the limits of autonomy—in this case, parental autonomy, which is all the more complex. These issues are at the heart of bioethics. Yet it can be very difficult for us to talk and write respectfully and clearly about them. Here, I recount the debates, show how they lost focus, and attempt to explain why the question about how parents and physicians should respond to atypical genitalia in children is so important and difficult. I argue that it is not a question that should be answered based on a single principle or philosophical commitment. No one principle can do all of the work. For each individual or family that faces it, the question is shaped by details about particular interventions aimed at altering a particular difference and offered in a particular social and family context. Scholars in bioethics who hold an especially strong commitment to any one principle should advocate for their views, but they must also make room for and respect the kind of pragmatic, particularized decision‐making that parents sometimes engage in. (shrink)

Abstract:AbstractDrawing from qualitative data in a Southern African context, this article explores meanings assigned to names for female genitalia to establish whether males and females assign the same meanings to the same vocabulary used in naming or whether they associate the same vocabulary with different meanings. The study illustrates that while males associate the meanings of terms for female genitalia with well-established, stigmatized views of women, female informants associate the same terms with different meanings that provide alternative views (...) about women and, at the same time, appear to be a form of reclamation of Southern African women’s personhood, identity, and agency. Although males, through these vocabulary items, metaphorically associate female genitalia with possession, which discursively constructs women as powerless objects that can be owned and commoditized, females draw from the philosophy of Africana womanism, indicating that even in asymmetrically structured societies, some women subjectively and purposefully construct their own identities as strong, smart, socially conscious, and independent. (shrink)

Very little research has attempted to describe normal human variation in female genitalia, and no studies have compared the visual images that women might use in constructing their ideas of average and acceptable genital morphology to see if there are any systematic differences. The objective of the present work was to determine if visual depictions of the vulva differed according to their source so as to alert medical professionals and their patients to how these depictions might capture variation and (...) thus influence perceptions of ‘normality’. A comparative analysis was conducted by measuring (a) published visual materials from human anatomy textbooks in a university library, (b) feminist publications (print and online) depicting vulval morphology and (c) online pornography, focusing on the most visited and freely accessible sites in the UK. Post hoc tests showed that labial protuberance was significantly less (p<0.001, equivalent to approximately 7 mm) in images from online pornography compared to feminist publications. All five measures taken of vulval features were significantly correlated (p<0.001) in the online pornography sample, indicating a less varied range of differences in organ proportions than the other sources where not all measures were correlated. Women and health professionals should be aware that specific sources of imagery may depict different types of genital morphology and may not accurately reflect true variation in the population, and consultations for genital surgeries should include discussion about the actual and perceived range of variation in female genital morphology. (shrink)

Background. Although genital sensations are an essential aspect of sexual behavior, the cortical somatosensory representation of genitalia in women and men remain poorly known and contradictory results have been reported. Objective. To conduct a systematic review of studies based on electrophysiological and functional neuroimaging studies, with the aim to identify insights brought by modern methods since the early descriptions of the sensory homunculus in the primary somatosensory cortex . Results. The review supports the interpretation that there are two distinct (...) representations of genital sensations in SI, one on the medial surface and the other on the lateral surface. In addition, the review suggests that the secondary somatosensory cortex and the posterior insula support a representation of the affective aspects of genital sensation. Conclusion. In view of the erogenous character of sensations originating in the genitalia, future studies on this topic should systematically assess qualitatively as well as quantitatively the sexually stimulating and/or sexually pleasurable characteristics of sensations felt by subjects in response to experimental stimuli. (shrink)

Summary Transsexuals are individuals who identify as a member of the gender opposite to that which they are born. Many transsexuals report that they have always had a feeling of a mismatch between their inner gender-based ‘‘body image’’ and that of their body’s actual physical form. Often transsexuals undergo gender reassignment surgery to convert their bodies to the sex they feel they should have been born. The vivid sensation of still having a limb although it has been amputated, a phantom (...) limb, was first described by Weir Mitchell over a century ago. The same phenomenon is also occurs after amputation of the penis or a breast. Around 60% of men who have had to have their penis amputated for cancer will experience a phantom penis. It has recently been shown that a significant factor in these phantom sensations is ‘‘cross-activation’’ between the de-afferented cortex and surrounding areas. Despite this it also known that much of our body image is innately ‘‘hard-wired’’ into our brains; congenitally limbless patients can still experience phantom sensations. We hypothesise that, perhaps due to a dissociation during embryological development, the brains of transsexuals are ‘‘hard-wired’’ in manner, which is opposite to that of their biological sex. We go on to predict that male-to-female transsexuals will be much less likely to experience a phantom penis than a ‘‘normal’’ man who has had his penis amputated for another reason. The same will be true of female-to-male transsexuals who have had breast removal surgery. We also predict that some female-to-male transsexuals will have a phantom penis even although there is not one physically there. We believe that this is an easily testable hypothesis, which, if correct, would offer insights into both the basis of transsexuality and provide farther evidence that we have a gender specific body image, with a strong innate component that is ‘‘hard-wired’’ into our brains. This would furnish us with a better understanding the mechanism by which nature and nurture interact to link the brain-based internal body image with external sexual morphology.. (shrink)

In the history of zoology the English anatomist Morrison Watson (1845–1885) is considered to be the discoverer of the masculinized sexual organs of the spotted hyena. Beginning in 1877, Watson had published a series of anatomical studies on the spotted hyena (Watson, 1877, 1878, 1881, Watson and Young, 1879), in which he, in which he for the first time made public the anatomical peculiarities of the female spotted hyena’s genitalia. This scientific achievement is well documented. But now we can (...) also state that a hundred years before Watson the Dutch amateur zoologist Robert Jacob Gordon (1743–1795), while serving in the Scots Brigades at the Cape of Good Hope, had already made the same discovery and merely unfortunate personal circumstances prevented publication. During his stay at the Cape, Gordon had studied spotted hyenas intensively and recorded his observations in accurate drawings and comments. These drawings have been preserved as part of a large collection of animal drawings entitled Gordon Atlas. With his discovery, Gordon actually was the first to provide empirical evidence of a “curious and inexplicable case of dimorphism” (Darwin on a beetle) in mammalians, long before Étienne Geoffrey Saint-Hilaire (Cours de l’histoire naturelle des mammifères, 1829) started examining masculinized sexual organs in the mole or Darwin recognized the importance of sexual dimorphism (Descent of Man, 1871). In this paper we reproduce for the first time all hyena drawings from the Gordon Atlas, including Gordon’s handwritten notes in the margins in the original Dutch and in translation. Additionally, we briefly delineate the knowledge about the South African spotted hyena in Gordon’s time and indicate that we doubt Watson’s explanation for the age-old confusion about the hyena. (shrink)

Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries have potentially (...) lifelong consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult. (shrink)

Feminism is the movement to end women’s oppression. One possible way to understand ‘woman’ in this claim is to take it as a sex term: ‘woman’ picks out human females and being a human female depends on various anatomical features (like genitalia). Historically many feminists have understood ‘woman’ differently: not as a sex term, but as a gender term that depends on social and cultural factors (like social position). In so doing, they distinguished sex (being female or male) from (...) gender (being a woman or a man), although most ordinary language users appear to treat the two interchangeably. More recently this distinction has come under sustained attack and many view it nowadays with (at least some) suspicion. This entry (around 12 000 words in length) outlines and discusses distinctly feminist debates on sex and gender. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the implications for autonomy theory (...) of these understandings of the relation between culture, FGC, and women’s agency. I review the range of worldwide FGC practices – including “corrective” surgery for “ambiguous genitalia” in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value‐neutral accounts of autonomy nor restrictive, value‐saturated accounts adequately explain women’s agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy‐disabling cultural alienation, promote autonomy‐within‐culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence. (shrink)

This article discusses the ethics of the use of preimplantation genetic diagnosis to prevent the birth of children with intersex conditions/disorders of sex development , such as congenital adrenal hyperplasia and androgen insensitivity syndrome . While pediatric surgeries performed on children with ambiguous genitalia have been the topic of intense bioethical controversy, there has been almost no discussion to date of the ethics of the use of PGD to reduce the prevalence of these conditions. I suggest that PGD for (...) those conditions that involve serious medical risks for those born with them is morally permissible and that PGD for other “cosmetic” variations in sexual anatomy is more defensible than might first appear. However, importantly, the arguments that establish the latter claim have radical and disturbing implications for our attitude toward diversity more generally. (shrink)

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the (...) history of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

This paper is interested in the relationship between evolutionary thinking and moral behavior and commitments, ethics. There is a traditional way of forging or conceiving of the relationship. This is traditional evolutionary ethics, known as Social Darwinism. Many think that this position is morally pernicious, a redescription of the worst aspects of modern, laissez-faire capitalism in fancy biological language. It is argued that, in fact, there is much more to be said for Social Darwinism than many think. In respects, it (...) could be and was an enlightened position to take; but it flounders on the matter of justification. Universally, the appeal is to progress—evolution is progressive and, hence, morally we should aid its success. I argue, however, that this progressive nature of evolution is far from obvious and, hence, traditional social Darwinism fails. There is another way to do things. This is to argue that the search for justification is mistaken. Ethics just is. It is an adaptation for humans living socially and has exactly the same status as other adaptations, like hands and teeth and genitalia. As such, ethics is something with no standing beyond what it is. However, if we all thought that this was so, we would stop being moral. So part of the experience of ethics is that it is more than it is. We think that it has an objective referent. In short, ethics is an illusion put in place by our genes to make us good social cooperators. (shrink)

This paper is interested in the relationship between evolutionary thinking and moral behavior and commitments, ethics. There is a traditional way of forging or conceiving of the relationship. This is traditional evolutionary ethics, known as Social Darwinism. Many think that this position is morally pernicious, a redescription of the worst aspects of modern, laissez-faire capitalism in fancy biological language. It is argued that, in fact, there is much more to be said for Social Darwinism than many think. In respects, it (...) could be and was an enlightened position to take; but it flounders on the matter of justification. Universally, the appeal is to progress—evolution is progressive and, hence, morally we should aid its success. I argue, however, that this progressive nature of evolution is far from obvious and, hence, traditional social Darwinism fails. There is another way to do things. This is to argue that the search for justification is mistaken. Ethics just is. It is an adaptation for humans living socially and has exactly the same status as other adaptations, like hands and teeth and genitalia. As such, ethics is something with no standing beyond what it is. However, if we all thought that this was so, we would stop being moral. So part of the experience of ethics is that it is more than it is. We think that it has an objective referent. In short, ethics is an illusion put in place by our genes to make us good social cooperators. (shrink)

In 1979, Lewontin and I borrowed the archi- tectural term “spandrel” (using the pendentives of San Marco in Venice as an example) to designate the class of forms and spaces that arise as necessary byproducts of another decision in design, and not as adaptations for direct utility in them- selves. This proposal has generated a large literature featur- ing two critiques: (i) the terminological claim that the span- drels of San Marco are not true spandrels at all and (ii) the (...) conceptual claim that they are adaptations and not byprod- ucts. The features of the San Marco pendentives that we explicitly defined as spandrel-properties—their necessary number (four) and shape (roughly triangular)—are inevitable architectural byproducts, whatever the structural attributes of the pendentives themselves. The term spandrel may be extended from its particular architectural use for two- dimensional byproducts to the generality of “spaces left over,” a definition that properly includes the San Marco pendentives. Evolutionary biology needs such an explicit term for features arising as byproducts, rather than adaptations, whatever their subsequent exaptive utility. The concept of biological span- drels—including the examples here given of masculinized genitalia in female hyenas, exaptive use of an umbilicus as a brooding chamber by snails, the shoulder hump of the giant Irish deer, and several key features of human mentality— anchors the critique of overreliance upon adaptive scenarios in evolutionary explanation. Causes of historical origin must always be separated from current utilities; their conf lation has seriously hampered the evolutionary analysis of form in the history of life. (shrink)

Vitiligo is a progressive and multifactorial condition of skin, mucosa, and hair depigmentation. Loss of functional melanocytes leads to the appearance of white macules on the skin, often affecting the lips and genitalia. The impact extends to psychological stress, decreased quality of life, and risk of psychiatric morbidity. Various therapeutic strategies have been designed to inhibit the immune response in vitiligo to reduce melanocyte damage while increasing melanocyte repopulation. There is no standardized method of evaluating treatment outcomes in vitiligo (...) patients. Herbal medicines several studies have shown that GB also has many benefits for health and healing skin diseases, one of which is used in treating vitiligo. Therefore, this study aimed to evaluate the potential of Ginkgo biloba extract as a therapeutic supplement in enhancing the positive effects of desoxymethasone on vitiligo. Using a double-blind randomized control trial clinical trial research design, 26 subjects were divided into treatment and control groups. The control group received standard vitiligo therapy with topical desoxymethasone and placebo, while the treatment group received topical desoxymethasone plus Ginkgo biloba extract. Melanin index, VASI score, MDA, TNF-α, CD8 expression, and caspase 3 were measured before and after treatment. The results showed that the administration of Ginkgo biloba extract had a significant effect in reducing MDA, TNF-α, CD8 expression, and caspase 3 levels, and improving melanin index and erythema in vitiligo patients who received topical desoxymethasone therapy. These findings demonstrate the positive potential of Ginkgo biloba extract as an adjunct to vitiligo therapy, resulting in favorable clinical and molecular impacts in patients undergoing combination treatments. (shrink)

This study reviews various discourses around female sexual mutilation from the perspective of the human and social sciences, and also current debates between supporters of the cultural argument and those defending the universality of human rights. An aside about the Dogon myth of world order recorded by Marcel Griaule in Dieu d’eau or Aristotle’s philosophical discourse in the Reproduction of Animals is required in order to widen the debate and see its importance as regards the dignity of the human person. (...) In Aristotle woman is a freak accident, she interrupts the circle that goes from man to man so that he can start off again. Woman is a "catastrophe" necessary to the exercise of the male genitalia; her body is naturally mutilated and incomplete. In the Dogon myth the clitoris rises up like a termite-hill, it is oversized and must be knocked down, that is, excised. Between excessive size, monstrousness and ugliness come discourses which have since time immemorial accompanied and justified wounding the female genitals. But today a medical type of discourse, which is widely accepted, is aiming to repair excised genitalia and give back to women the happiness of a recovered body. Thus we may ask what "woman’s dignity" consists of and whether it is the same as the "dignity of the human person". (shrink)

Recent events in the United States and beyond have brought debates over the practice of female genital cutting back into public, academic, and policy discourses.1 In April 2017, Jumana Nagarwala, a Michigan-based emergency medicine physician from a small Shia sect known as the Dawoodi Bohra, was charged with performing female genital mutilation. The procedure is prohibited by federal law and defined as the circumcision, excision, or infibulation of the whole or any part of the female genitalia under the age (...) of 18. Nagarwala argues that she did not mutilate, but rather performed a variation of a religious ritual, termed Khatna, which involves the nicking... (shrink)

One of two commentaries on “Normalizing Atypical Genitalia: How a Heated Debate Went Astray,” by Josephine Johnston, from the November‐December 2012 issue.

As Freud convincingly shows, civilised political life is a source of constant uneasiness. Desire propels the subject towards an end that remains unfulfilled and pleasure is reduced to a transition from one moment of displeasure to another. Freud conceives pleasure as suppression of an absence, as the result of a process. Marcuse in his turn showed that excessive pleasure works as a counterbalance for displeasure, the repression of sexual impulse and the hypertrophy of the genitalia producing intense pleasure. A (...) post-Freudian theory of pleasure would complement Marcuse’s materialist critique of psychoanalysis by learning to conceive pure pleasure (with Aristotle’s Nichomachean Ethics) in a non-metaphysical way, segregated from the notion of superfluity. (shrink)

The corpse of a high-ranking male official was unearthed in the 1975, and important archaeologic discoveries were claimed. The exact year of his funeral was 167 BC. Autopsy revealed that the man had peptic ulcer disease. His naked body exposing genitalia and post-dissection stitches, with the dissected-out intestines and brain lying alongside, is now exhibited in a formalin-impregnated viewing glass tank in a museum .Meanwhile a 2000-year-old clothed female corpse is on display in another museum. In 1971, workers in (...) …. (shrink)

This article discusses how careproviders of all types can help people with differences of sexual development (DSD): people with ambiguous genitalia, who used to be referred to as intersexed. Careproviders may be in a unique position to benefit these people by offering to discuss difficult issues that concern them, even when the discussions are brief. Specific interventions include learning about people with DSD, whether through the literature or in the clinic; treating them with optimal respect; raising difficult topics such (...) as sex, fertility, and social stigma; encouraging them and helping them to meet others with DSD; and sharing the strengths that we can see that they have. We have come far, but have a long way to go. (shrink)

The hymen is a structure of the female genitalia that is poorly understood even by many medical professionals. Despite the significant anatomical variation in the hymen and no guarantee that rupture or bleeding will occur at first coitus, it has come to hold major cultural significance around the world as a perceived biological indicator of virginity. The persistence of such myths around the hymen causes real harm, including the increase in so-called revirgination surgical procedures.

One of two commentaries on "Normalizing Atypical Genitalia: How a Heated Debate Went Astray," by Josephine Johnston.

In lieu of an abstract, here is a brief excerpt of the content:preface “Africa Reconfigured,” the cluster in this issue on recent scholarly and creative work on Africa, displays a variety of cultural, artistic, and linguistic approaches to decolonizing gender. Originating in disparate fields, each article in this cluster presents examples of how new meanings of gender are produced that defy dominant definitions. Xavier Livermon examines the cultural and political context of postapartheid South Africa, arguing that redefinitions of “tradition”—not just (...) legal rights—have led Black South Africans to “queer” marriage practices. Busi Makoni pushes the boundaries of feminist linguistics to consider how young women creatively relate to the prevailing lexicon of body parts in southern African languages and, in doing so, how they challenge normative gender identities. Cheryl Toman offers an account of writer, playwright, and performer Werewere Liking’s distinctive lifelong fusing of performance art and social activism in Côte d’Ivoire and Mali and how Liking’s plays, prose, and poetry enact decolonization in unique ways. Nigerian artist Peju Alatise, whose work is featured in our art spread, presents an array of ideas, materials, and genealogies that deeply question European and US aesthetics, as the art essay by Moyo Okediji explains. Concluding “Africa Reconfigured” are critical perspectives on Euro-American gender orders found in Olumide Popoola’s except from a novel and the poems by Gabeba Baderoon. Two articles in the second half of this issue reconsider a specific moment of US women’s history: women’s liberation in the 1960s and early 1970s. Sara M. Evans challenges the stereotyping of the women’s liberation movement as white, middle class, and antisex, arguing that this is a myth fostered by academic theory, the movement’s opponents, and the mistaken notion that women ’s liberation rejected its New Left roots. Complementing Evans’s argument, Agatha Beins addresses the issue of racism in that same historical moment of women’s liberation in the United States by revisiting images 8Preface of revolutionary women of color in US feminist periodicals of the time, arguing that we have to understand the use of these images in the context of mainstream and New Left portrayals that demeaned feminism as being not serious about politics. Also in this issue is Mark Schuller ’s analysis of gender-based violence in Haiti in the aftermath of the earthquake of 2010, in which he examines how international humanitarian organizations are not always fully aware of how structural violence operates in the country. In our forum “Teaching about Ferguson,” Feminist Studies offers our readers reflections on the pedagogical challenges and opportunities in taking up the issue of state-sanctioned violence against people of color in the United States. All the articles and essays in this issue emphasize that the specificities of transnational, historical, and political contexts—rather than abstract invocations of globalization —are essential for understanding the changing meanings of gender identities and hierarchies as well as the political goals of women ’s organizations. The first article in our cluster on “Africa Reconfigured” takes on a popular Western assumption about South Africa, which is that the constitutional changes that acknowledged and legalized same-sex partnerships replaced intolerant “traditional” practices among Black South Africans. Xavier Livermon challenges this assumption by demonstrating how Black South Africans engage tradition in creative nonheteronormative ways. He closely follows how Black South Africans redefine autochthonous cultural practices in order to create new meanings and practices for marriage. Just as the very definitions of gender have been continuously in flux, so have the definitions of marriage, and Livermon demonstrates how marriage and long-standing coupling practices have become queered and reconstituted in contemporary Black South Africa. In line with Livermon’s interest in redefinitions of sexuality and gender in a postapartheid context, Busi Makoni explores the relationship between the naming of genitalia and gender positionings. Studying both men’s and women’s uses of the lexicon for body parts in multiple Southern African languages, Makoni concludes that women engage in a process of dis-identification with, and reappropriation of, socially inscribed language for their bodies. Women use the same name labels, but assign them completely different meanings, thereby creating counternarratives of feminine identity. Preface 9 The ability to create new meanings permeates the art... (shrink)

The reference to the vagina as “it” or “down there” is symptomatic of two larger cultural problems: not naming the vagina when speaking about the vagina, and conflating the vagina with the external female genitalia. The euphemisms and obfuscating language have implications both for lay understandings of female bodies and for the practice of health care. Granting and using a name gives both the named and the namer power and legitimacy.

The imaginal discs of Drosophila melanogaster, which form the adult epidermal structures, are a good experimental model for studying morphogenesis. The genital disc forms the terminalia, which are the most sexually dimorphic structures of the fly. Both sexes of Drosophila have a single genital disc formed by three primordia. The female genital primordium is derived from 8th abdominal segment and is located anteriorly, the anal primordium (10 and 11th abdominal segments) is located posteriorly, and the male genital primordium from the (...) 9th abdominal segment lies between them. In both sexes, only two of these three primordia develop to form the adult terminalia. The anal primordium develops in both sexes but, depending on the genetic sex, will form either male or female analia. However, only one of the genital primordia develops in each sex, forming either the male or the female genitalia. This depends on the genetic sex of the fly. Therefore, the genital disc is a very good experimental model of how the sex‐determination and homeotic genes — which determine cell identity — interact to direct the development of a population of cells into male or female terminalia. It has been proposed that the sexually dimorphic development of the genital disc is the result of an integrated genetic input, made up by the sex‐determination gene doublesex and the homeotic gene Abdominal‐B. This input acts by modulating the response to Hedgehog, Wingless, and Decapentaplegic morphogenetic signals. BioEssays 23:698–707, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Since the late 1980s, intersex adults and activists have critiqued the clinical recommendations defined in the 1950s to treat children born with ‘ambiguous genitalia’ with normalising medicine. While their struggles continue, in particular to halt the practice of genital surgery in early infancy, some European surgeons travel to African countries to transfer standards of care that have become highly controversial in the North, including in the medical community. Simple disapproval of these tours as ‘surgical safaris’ forecloses the possibility of (...) analysing more complex situations in which the so-called transfer of competence involves surgeons who promote ‘less cutting and more talking’. Such is the case – and the interest – of the surgical missions in West Africa in which I conducted recent fieldwork, accompanying a team of paediatric surgeons from a European university hospital collaborating with a renowned international NGO. This article analyses the ways in which a variation of sex development called hypospadias is framed and managed in this context through what I call a surgical script for hypospadias. I examine the conditions of (im-)possibility for Northern surgeons to operationalise, and sometimes revise, this script at the missions (but also closer to home). I discuss what the surgeons do in practice to reflect critically on the normative work of the surgical script for hypospadias as a social script on morphological ideals of sex, gender and reproductive heterosexuality. I consider in what sense genital surgery can be said to (re-)construct ‘normal’-looking genitalia, but also, fundamentally, the very idea of genitalia. (shrink)

In this critical, feminist account of the management of intersex conditions under 2006's controversial “Disorders of Sex Development” (DSD) treatment model, I argue that like the “Optimal Gender of Rearing” (OGR) treatment model it replaced, DSD aims at securing a cisgendered future for the intersex patient, referring to a normalized trajectory of development across the lifespan in which multiple sexed, gendered, and sexual characteristics remain in “coherent” alignment. I argue this by critically analyzing two ways that intersex management has changed (...) between OGR and DSD: 1) regarding sex‐assignment recommendations for three patient populations and, 2) with the prenatal treatment of pregnant individuals at risk of conceiving a fetus with congenital adrenal hyperplasia with the steroid hormone dexamethasone. I conclude that like OGR before it, DSD also unjustifiably presumes that typical genitalia are necessary for cisgendered development. However, unlike OGR, it appeals to the empirically inadequate, theoretically suspect, and biologically determinist model of gender development known as brain‐organization theory. Given this, I conclude that the treatment of intersex people under DSD continues to be driven by problematically heterosexist and transphobic assumptions regarding the value and normalcy of cisgendered life, while practically and discursively constituting it as such. (shrink)

Medically unnecessary penile circumcision (MUPC) performed on a non-consenting child has been the subject of increasing critical attention in recent years. This paper provides a behind-the-scenes narrative of the politics of ethical policymaking in the United Kingdom in this area including a discussion about some potential barriers to reform. After a brief overview of ethical guidance for medically unnecessary surgical procedures on children in general and on their genitalia in particular, the paper takes a closer look at three contemporary (...) documents released by UK medical bodies and highlights the unique ethical and safeguarding contradictions in this area. The outcomes of initiatives aimed at engaging constructively with the medical bodies and encouraging wider debate are then described, along with some of the main obstacles to engagement and counter-arguments employed. MUPC is subsequently discussed in a wider societal context, highlighting why serious safeguarding concerns have been raised about what many people believe to be a harmful, preventable practice hiding ‘in plain sight’. The paper ends by calling for UK MUPC guidance to be made consistent with the body of guidance that UK doctors are expected to follow. (shrink)

Technological advances in the field of medicine and health sciences not only manipulate the normal human body and sex but also provide for surgical and hormonal management of hermaphroditism. Consequently, sex assignment surgery has not only become a standard care for babies born with genital abnormalities in the West but even in some Muslim states. On the positive side, it goes a long way in saving children born with abnormal genitalia from numerous legal interdictions of the pre-sex corrective surgery. (...) Nevertheless, the larger ethical and legal questions that medical management of genital abnormality raises to some extent have not been adequately appreciated by contemporary Muslim responses. This article, therefore, in principle argues against surgical management of intersexuality during early infancy from the Islamic legal perspective. (shrink)

This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn (...) to the status of the genitals as ‘intimate’ anatomy—a status that is not fully erased by being in a medical context. In this editorial, we draw on the work of Talia Mae Bettcher on ‘intimate agency’ to explore why unconsented interventions into the genitalia may constitute a distinctive sort of personal violation compared to unconsented contact with various other parts of the human body. In their feature article, Marit van der Pijl and colleagues1 argue it is unethical for healthcare providers to perform unconsented episiotomies on persons in labour. In particular, they suggest that, outside of certain rare emergencies in which, for example, the person giving birth is incapacitated1 and the procedure cannot be delayed until consent becomes possible without introducing a significant risk of serious harm (call these ‘medically necessary’2 procedures), ‘presumed consent’ is the incorrect standard to apply. Instead, they stress that, especially when a proposed intervention involves a person’s genital, sexual or reproductive organs, the need to obtain their explicit consent in advance of proceeding must be honoured. As the authors note, the broader social significance of our genitalia—widely regarded as ‘private’ anatomy—is not erased by being in a medical context (see also 2–4). Boundaries must still be observed. Ethically, this ‘leaves a very small margin for error because invasion of these body parts …. (shrink)

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show (...) how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of “normal” male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. (shrink)

In contrast to Aristotle's male oriented explanation of procreation the Galenic was 'feminist' inasmuch as both sexes were presented as contributing equally in conception and accordingly both had to experience pleasure... Anatomically, the two sexes were presented in Galenic accounts as complementary, the difference being that the man's genitalia were on the outside and the woman's on the inside. The clitoris was likened to the penis and the ovaries considered 'testicles' or 'stones' that produced seed. The male seed was, (...) it is true, depicted by Galenists as superior in having 'spiritual' qualities lacking in the female, but Galen's reproductive schema was far more egalitarian than Aristotle's. (shrink)

The treatment of the goatherd Melanthius in these lines received remarkably little animadversion from earlier commentators . In contrast, the late Manuel Fernandez-Galiano devoted an extremely full note to the passage. One may wonder, however, whether he was right to base it on the automatic assumption that what we have depicted here is an act of murder. He himself admits that we are not ‘told exactly at what moment the unfortunate Melanthius dies’. :πότομος ατη κα δεινοτάτη ποιν, ξ ς εκς (...) κα θανεν τν Μελάνθιον, ε κα ποιητς κα ατ σιγι. Such lack of specificness would be most unlike Homer, and the removal of hands, feet, ears, nose and genitalia would be a remarkably laborious and uneconomical mode of instantly killing someone. Since we are not told that Melanthius dies I infer that he did not, any more than Eurytion did at Od. 21.300–2, in similarly trying circumstances: ‘they cut off his ears and nostrils with the sharp brass; but he, injured in his feelings, went about, enduring that calamity with a frantic mind’, to quote the translation by Buckley for which Housman was so grateful. (shrink)

This study examines the socio-cultural significance of dolls as Roman girls' toys. It focuses on a sample of ivory, bone, and cloth dolls, many of which have ornate hairstyles, molded breasts and, in some cases, delineated genitalia. As the only explicitly gendered toys from the Roman world, these constitute unique bodies of evidence for exploring questions of socialization and identity formation, and assessing ancient ideals. Often treated as relatively straightforward objects that prepared girls for futures as wives and mothers, (...) this study argues instead that they were more complex and conveyed mixed messages to their young owners. By isolating three specific features of the dolls , situating these in their historical and ideological milieux, and linking them with expectations for girls known from literary sources, the dolls' multivalence as artifacts of gender and status is revealed. (shrink)

Purpose: The sensitization which this discussion engenders, has the objective of instituting an ever more formidable resilience in the advocacy against female genital mutilation (FGM) around the globe. Methodology: Besides the expository, analytic and evaluative character of this work, a particular effort is made to unveil the political and epistemological trappings that undergird the condemnable, but on-going practice of female genital mutilation in different parts of the world, especially in the continent of Africa. Findings: Some people point out that the (...) word "cutting" is less judgmental and relates better to terms used in many local languages. However, many women's health and human rights organizations use the word "mutilation," not only to describe the practice, but also to point out the violation of women's human rights. Unique Contribution to theory, practice and policy (recommendation): Ritual circumcision of young males and females is a practice seen in many cultures across the world, including sub-Saharan and North Africa, the Muslim Middle East, the Jewish diaspora, Aboriginal Australia, the Pacific Islands, Southeast Asia, etc. This work discuses female circumcision as “female genital mutilation” and rejects the view proposed by some that its practice is culturally and ethically relative. All three terms, female genital cutting (FGC), female circumcision, or female genital mutilation (FGM) describe the procedure that cuts away part or all of the external female genitalia and are used to describe the same thing, that is, mutilation. Some people fear that parents may resent the implication that they are "mutilating" their daughters by participating in this largely cultural event, and so reject the term FGM in favour of FGC. (shrink)

A reply by the author of “Normalizing Atypical Genitalia: How a Heated Debate Went Astray,” to “The Battle Lines of Sexual Politics and Medical Morality,” by John D. Lantos, and “More Rhetoric Than Argument?” by Ellen K. Feder, Alice Dreger, and Anne Tamar‐Mattis.

Introducción: La ablación o mutilación genital femenina incluye una amplia variedad de prácticas que suponen la extirpación total o parcial de los genitales externos o su alteración por razones que no son de índole médica. Causa daños irreversibles y pone en peligro la salud, e incluso la vida de la mujer o niña afectada. Objetivo: Caracterizar la mutilación genital femenina y sus complicaciones a largo plazo en la comunidad de Fajikunda, Gambia, entre marzo y septiembre de 2012. Método: Se realizó (...) un estudio descriptivo prospectivo a 117 mujeres que asistieron al centro de salud por cualquier motivo que requiriera examen ginecológico y se estudiaron las variables grupo de edades, tipo de mutilación, grupo étnico y complicaciones. Resultados: Del total, 98 mujeres eran de 45 años de edad o menos; la clitoridectomía fue la práctica más frecuente; la inflamación pélvica crónica y el dolor en los genitales fueron las complicaciones a largo plazo que mayor asociación estadística demostraron con relación a la mutilación. La anorgasmia presentó una alta incidencia en la población estudiada. Conclusiones: La prevalencia de la mutilación genital femenina en Fajikunda es aproximadamente la misma que en Gambia, la tipo I es la más practicada y generalmente en jóvenes de la etnia Mandinga. Introduction: The ablation or female genital mutilation includes a wide variety of practices dealing with total or partial extirpation of the external genitalia or its alterations for reasons other than of medical nature. It causes irreversible damages and puts in danger the health or even the life of the woman or child involved. Objective: The aim of the present study is to characterize female genital mutilation and its long-term complications in Fajikunda community, Gambia, between March and September 2012. Method: A descriptive prospective study was performed to 117 women that attended the health unit for reasons requiring gynecological examination and the variables age group, mutilation type, ethnic group and complications were studied. Results: Of the total, 98 women were 45 years old or less; the clitoridectomy was the most frequent practice; cronical pelvic and genital pains were the long-term complications that showed a major statistical association with relation to mutilation. Conclusions: The prevalence of female genital mutilation in Fajikunda is approximately the same as in Gambia, the type I is the most performed and generally within young women belonging to Mandinga ethnic group. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Promoting Health and Social Progress by Accepting and Depathologizing Benign Intersex TraitsHida ViloriaI was born with ambiguous genitalia and it was a doctor who, by honoring my bodily integrity and not “fixing” me, gave me the greatest gift I’ve ever received. Because my body and its sexual traits are a positive, fundamental part of my experience and identity as a human being, I know that having my genitals (...) removed or altered according to someone else’s vision would have deeply damaged me, both physically and psychologically.The doctor who protected my autonomy was, unsurprisingly, my father. I say “unsurprisingly” because in my experience parents are typically more protective of their children than doctors are of their patients. Also, doctors do not discuss cases with other doctors in the same way they do with laypeople, as doctors know more about medical issues such as the risks involved in infant genital surgery.Other than having clitoromegaly (a large clitoris), my reproductive anatomy is typically female, and so I was assigned female and raised as such without incident. My parents didn’t discuss my intersex traits with me, and I grew up thinking of myself and being accepted as, a girl.When I began menstruating, my father told me I’d need to take pills to “grow taller.” I thought this unusual, as I wasn’t short, and later overheard my mother arguing with him, saying that the pills were “experimental”. I was reminded of this discussion years later, when she told me that the pills had actually been hormones to make my breasts grow. I never took them though as she convinced my father not to make me.Article 7 of The International Covenant on Civil and Political Rights states that, “No one shall be subjected without his free consent to medical or scientific experimentation,” and I’m grateful to both my parents for protecting my civil rights as they protected my health.Due to my Catholic upbringing and schooling, I had no opportunity to compare my genitals to other girls’, and it wasn’t until the age of twelve that I realized, while perusing magazines with friends, that I have atypical sex anatomy. Contrary to common speculation however, this awareness didn’t make me question being female. I simply assumed there must be some genital variation in humans.I feel my parents made the wisest decision possible by registering me as one of the two accepted, available genders but allowing me to live, physically and behaviorally, as who I am. Despite not having developed a stereotypically curvaceous female figure, I was popular and excelled in typically feminine social activities, as well as sports and academics. For example, I was one of four girls selected out of one hundred twenty–five that competed for a spot on my high school cheerleading [End Page 114] squad when I tried out to help a friend who needed a tryout partner.Other than escaping IGM (Intersex Genital Mutilation) and estrogen therapy, I’ve had only a few experiences pertaining to my medical care around being intersex. These experiences fall into two categories: seeing medical doctors who treated me the same after discovering that I have ambiguous genitalia, and seeing ones who didn’t. I feel incredibly blessed that my experiences in the former category vastly outweigh the latter.My first experience came at the age of twenty, when a gynecologist asked me if my clitoris had always been as large as it is. I responded that it had, and she said, while looking at me disapprovingly, that she’d like to do some tests. When I asked her what they were for though, she wouldn’t respond directly. She said I’d reported having some upper lip hair, and acne, on my intake forms. I replied that neither were above average, and asked if there were health issues I should be concerned about. She reluctantly said no. I asked what reason there was then for undergoing tests because of the size of my clitoris.She finally responded, “It’s just not normal.”Fortunately, I’d had positive reactions to my sex traits from the people I’d dated. For example, the first... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing at the Intersections: Navigating Life as a Black Intersex ManSean Saifa WallAs I sit down to write this narrative, my mind is reflecting on the past year. This year has seen numerous protests against state–sanctioned violence with the declaration that “Black Lives Matter”. As a Black intersex man, I have witnessed the impact of state–sanctioned violence on my family and my community, both from the police state and (...) medical community. I charge the police state and the medical community with state– sanctioned violence: Each targets non–normative bodies—the former through incarceration and execution, and the latter by means of surgical and hormonal intervention. As a Black intersex man, I stand at the intersection bearing witness to how this violence has incarcerated my friends and loved ones as well as being subjected to medically unnecessary surgical intervention. Although this is where I stand now, both socially and politically, I have not always existed here.I was born in the winter of 1978 at Columbia–Presbyterian Hospital in New York City. I was the youngest of five children and one of three children in my family who were born with an intersex trait now known as androgen insensitivity syndrome (AIS). At the time, AIS was referred to as “testicular [End Page 117] feminization syndrome.” Upon receiving my medical records years later at the age of twenty–five, I noticed scribbling and a barrage of notes indicating the process by which the doctors assigned my gender as female. Although I had ambiguous genitalia, which caused some initial confusion among the doctors, XY chromosomes were not enough for me to be raised as male. My mother was told I would be raised as a girl and, according to the medical records, “function as such.”Unlike my sisters who were also born with AIS, my mom was not swayed by the surgical recommendations doctors made about my body. As a matter of protocol, my sisters’ gonads were removed in infancy, however, my mom made the decision that my testes would remain with me until they had to be removed.Because of intense pain in my groin area, my testicles were removed when I was thirteen years old. The pain that I felt following the surgery was perhaps the worst pain that I have experienced in my entire life. After surgery, my pediatrician prescribed estrogen and Provera as a hormonal replacement regimen. Fatty deposits changed the shape and contours of my face. Once robust and chiseled thighs now harbored cellulite. The beginnings of facial hair and prominent body hair became wispy and nonexistent. What was hard and defined became soft.At no point did anyone ask me what I wanted to do with my body.I actually missed the effects of my natural testosterone such as a deepening voice, increased hair and muscle mass; when I asked if I could take both testosterone and estrogen after surgery, my mother remarked, “You would look too weird.”The hormone therapy was coupled with intense social conditioning. I feel as if the social conditioning for young women raised with AIS is suffocating. When doctors prescribed hormones for me to take, my mother constantly reminded me how “beautiful” the little yellow pills would make me. As a means of reassurance, my pediatrician told my mom that “a lot of fashion models” have AIS and that I would most certainly be beautiful. In our dominant US culture, gender norms can already be oppressive, but for women with AIS, there is the impact of gender norms and the underlying fear that women with AIS are not really women since they have XY chromosomes. I did not succumb to the pressure to be more feminine, but actually gravitated toward masculinity. Before transitioning to live as a man, I considered myself a butch woman. When I came out of the closet at fourteen years old and presented as a masculine young woman, I never felt safe. Because I dated women who were more feminine than I, my relationship with these women seemed threatening to men who repeatedly reminded me through harassment and threats that “I was not a man.” Of course, I wasn’t trying to be a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Truth in WritingAmandaAn excerpt from my journal during a dark period in my life reads:I am a survivor of sexual mutilation, of coerced gender roles, and of perpetual lies all in the name of normalization. Sometimes I have a hard time even thinking about the true extent of what all happened. It’s like my mind doesn’t have that type of scope, like when I think about the word (...) “eternity.”I wrote this after combing through old medical records, reading comments like “her introitus has healed nicely and looks normal, but my exam suggests that her vagina is shortened,” and “reduction clitoroplasty... removal of testes.” The records go on to say that my “external genitalia is quite satisfactory,” and “on perineal exam, her neovaginal orifice is quite compliant and easily accepts my second and third digits.”My journal continues:I chose this fake hole when I was a teenager because I didn’t know there was another option. I was told from day one to be a female, to be heteronormative, to act like all the other girls, and the only way I could fully accomplish this is by looking the part. A fake hole would be necessary, I thought, to go along with the rest of the lies. Sometimes I think about how the doctors told me to lie about my surgeries and my scars. Sometimes I wonder what my parents would have told the world if I had died during one of surgeries. Maybe they would have said “we were just trying to make her fuckable.”My strength is growing from the stories and experiences I write and share. My journal started about four years ago, when I was in my early 20s, near the beginning of medical school. My initial purpose in writing the journal was to help sort through my feelings and experiences related to a newly discovered sexuality and a changing gender identity. Medical school was thousands of miles away from my previous life, my family, and my friends. Away from my old social network, I was free to self–discover on my own terms. In the first journal entry, I lay out reasons why I decided to get in contact with a therapist, something I had not done previously. Some of the reasons were fairly standard reasons one seeks out a therapist, such as moving away from home. But the fundamental reasons I sought out a therapist, and why I chose to journal, had to do with exploring feelings after my first sexual encounter with a woman, and then [End Page 98] accepting my intersexuality. My relationship with that therapist did not last, but the journaling did.In the beginning of the journal, I write:I am from a small, religious, white, non–diverse, family oriented suburb of Milwaukee. I was raised to be the picture–perfect daughter in a household that did not talk about feelings, sex, cultural or religious differences, etc. My brother and I also never talked about personal issues (and still don’t), which is quite remarkable since we are twins, and have grown up doing most everything together, from sharing birthday parties, to being locker buddies... [When my mother told me about having Androgen Insensitivity Syndrome (AIS)] knowing this little fact about my body kept me wanting to become as perfectly female in all ways possible.Growing up without being able to talk about having AIS was stifling to say the least. Closing communication implied great shame, and with the shame came even greater repression. My skate-boarding, baseball card collecting, and model car building interests disappeared after learning about my AIS, which I believe was when I was 12 years old, but I cannot remember exactly. Granted, it’s tough to say whether my interests just changed as I grew older, but I do remember having a fear of portraying any masculine tendencies that other girls in my town weren’t displaying (for example, playing soccer was okay, but I had to shave my legs). I also had crafted some pretty good covers for my AIS, including stories about when I first had my (fake) period, or how I acted fearful about a... (shrink)

Medical anatomy is one of the key sites of the scientific production, reproduction and maintenance of sex and gender. Our Human Anatomies Project explores the construction, reconstruction and maintenance of difference in genital anatomies, focusing especially on the clitoris. This article focuses on representations of human genitalia in the form of cyberanatomies - video, CD-ROM and internetbased renderings of human bodies. In cyberspace as elsewhere, the biomedical expert remains the proper and dominant mediator between humans and their own bodies, (...) despite the democratization of knowledges supposedly possible through the Internet. Special attention is given to the specific sites of production and distribution of these different cyberanatomies. Through our review of the globalization of cyberanatomies, we have come to witness the very sedimentation of sex/gender/sexuality in new arenas of representations of human bodies. Western biomedical imperialism and globalization of a standardized (American) body are taken up as core theoretical concerns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Difficult Road to Deciding on CircumcisionAnonymous TwoAnonymous TwoWhen I got my results back from my noninvasive prenatal testing, NIPT and found out I was going to have a little boy, one of my first thoughts was, "I don't want to circumcise him," which sounds silly because I just found out the gender of my baby and my first thought is about his genitalia. The idea of growing (...) and carrying this perfect little baby for nine months and then hurting him was unthinkable to me. I simply did not want to hurt him. The idea of it made me feel sick. Anytime the subject came up, I would protectively put my hand over my belly. And I do admit there were a lot of times I wished I was having a girl so I didn't have to deal with the circumcision debate.There was a lot of conversation between myself and my husband about it. My husband was adamant about getting it done. He referred to uncircumcised penises as "snake penises" and said our son will be made fun of for being different. He said it would be easier for him to clean and when he's old, he won't have to worry about infection. I would counter with, "well what if he falls in love with a girl from a culture that doesn't circumcise? She will think his penis is weird." The more we talked about it, the more ridiculous it felt thinking that far in advance and all these hypothetical situations he might get in over his penis. My parents wanted it done for religious reasons, but that wasn't a factor for me. My mom kept saying it's in the Bible and it needs to be done. My boss is Jewish and she joked that I could just convert to Judaism and the choice would be taken away from me so I didn't have to stress over it. Everything I read on my mommy groups and sites like Reddit called male circumcision child abuse and stated how barbaric it was. Terms like "genital mutilation" were thrown around a lot, and I didn't want to be part of a group that was seemingly looked down upon by so many.I spent my whole pregnancy saying how much I did not want to circumcise my baby. About a week after he was born and we were starting to get settled, my husband started to call around trying to get him an appointment for circumcision. It was unusual to do it this way, as typically it's done when babies are still in the hospital. But the hospital wasn't doing circumcisions because it was elective, and they weren't doing elective procedures because of COVID. At his first doctor's appointment, I talked to our pediatrician about it. She is Indian and told me she didn't circumcise her boys and said that it was very normal in many parts of the world to not do it. I would watch her pull back the skin to check it for fibers and think, "Is it really that bad to keep it? It's just skin." Our pediatrician didn't do it, as she doesn't perform procedures in the office, and she gave us some names of doctors that were supposed to be doing it. My husband called them all and none of them were doing circumcisions either. Finally, my husband found a doctor, but he was booked out for almost a month and a half. With no other option, we made the appointment. I was not thrilled about it, and made my husband do all the calls and arrange it because I did not agree with it.What made me change my mind about circumcising him was I didn't want him to be different. My husband assured me this was the best choice and he was very concerned our son would be bullied for being different. I have a good friend that is a nurse in a long term care facility currently. I called her and asked if it was really that bad for old men to care... (shrink)

This article examines the development of koro’s epistemic status as a paradigm for understanding culture-specific disorders in modern psychiatry. Koro entered the DSM-IV as a culture-bound syndrome in 1994, and it refers to a person’s overpowering belief that his (or her) genitalia is retracting and even disappearing. I focus in particular on mental health professionals’ competing views of koro in the 1960s—as an object of psychoanalysis, a Chinese disease, and a condition predisposed by culture. At that critical juncture, transcultural (...) psychiatrists based outside of continental China—namely, Taiwan, Hong Kong, and Singapore—appropriated ideas from traditional Chinese culture to consolidate the clinical diagnosis of koro as culture-bound. This new global meaning of koro was made possible by a cohort of medical experts who encountered the phenomenon and its sufferers in Sinophone (Chinese-speaking) communities, but placed their contributions within the broader contours of the global reach of Anglophone psychiatric science. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Game ChangeMaximo CortezOn November 17, 1983, I was born with a condition called mixed gonadal dysgenesis, and ambiguous genitalia. My gender was not of a big concern at that time. The more urgent matter was that I had a heart murmur, which was repaired when I was twelve months old. [End Page E5]It was not until I turned five, and by issue of the Texas Children’s Protective Services (...) (CPS), that my mother was forced to authorize providers to perform normalization surgeries on me. An anonymous caller tipped the CPS that my mother was raising a boy as a girl. The state intervened and explained to my mother that she would have to consent to these surgeries or else she would lose custody of me. This included a gonadectomy and a clitorectomy. Without any consent, these surgeries were performed “in my best interests.” My mother was an epileptic, Hispanic, Mormon, single parent.I was raised to be a socially acceptable female, though as early as five, I played with “boy” toys and enjoyed TV programs aimed at male youth, like Teenage Mutant Ninja Turtles. It was not until I had those normalization surgeries performed on me that I felt different. I knew that something major had happened to me. I woke up in a hospital bed in a gown. I raised the covers and noticed that I had an “X” carved in my groin area. Doctors mutilated my clitoris by reducing its size, which made me feel alienated and angry that something was wrong with my body.I had a surgery performed on me that was to be kept secret and never talked about. This sense of fear and shame was instilled in me shortly after the surgery. I do not recall any psychological evaluations or counseling to help me cope with such surgeries. Seeing everyone else my age going through puberty during my teenage years, I felt behind. I wasn’t becoming a boy with a deep voice or facial hair. Instead, I visited the doctor’s office with my mom and was told that I would be taking oral estrogen to become a woman. I wasn’t until that moment that I understood I was seeing a doctor to foster the development of female secondary characteristics. I felt betrayed by the medical community and by my own mother.Just a few years later, I saw a urologist to find out whether I was ready for a vaginal construction surgery (vaginoplasty). Thankfully the urologist suggested that I was not ready to move forward with an invasive and irreversible vaginal construction surgery. I never pursued it as an adult, as I have always felt male gendered.Social sexual relationships have always been difficult for me but more so with my attraction to women. I first realized my attraction to women in early middle school. Being raised Mexican and a Mormon and knowing that I was homosexual created a lot of conflict for me. I felt that I was a male–gendered person forced into a castrated, mutilated, and medically created female body. I suffered through depression from an early age and it continues today. My conservative Mormon upbringing brought me much shame. The Mormon religion, as most people understand it, expresses a great intolerance to homosexuals and transgender people. I felt like I was a heterosexual male in a female’s body, but the Mormons would never accept me.My later teenage years and mid–twenties were a dark time in my life. I even attempted suicide in my early twenties. My depression was treated with antidepressants and talk therapy. Once I began testosterone, I gradually stopped taking antidepressants. When I was only on estrogen, I felt very moody, angry, and in an emotional funk. I would cry easily and would become very irritable and emotional without cause. With testosterone therapy, I began to think more clearly, had balanced emotions, and began to think more logically.I began to research intersex online and found a women’s androgen insensitivity (AIS) support group. At one of their national conferences, I met another intersex individual who was raised as a female and who had transitioned to male. Like me... (shrink)