GAMS BELGIUM

Surgery, operations, mutilation: understanding and differentiating

Circumcision

When raising the issue of FGM, it is not unusual to also hear male circumcision being brought up. On one hand, some use circumcision to deny the existence of FGM as a form of gender-based violence. Others think the two practices are completely unrelated. This paper wishes to demonstrate that neither of these positions are correct.

Male circumcision, which involves cutting the foreskin, is mainly practised for religious reasons (in Judaism, Islam and Christian Orthodox Churches) or supposedly for hygienic reasons.

As in the case of FGM, circumcision is most often carried out without the consent of the child. In both cases, it is a violation of a child’s bodily integrity. Most types of FGM, such as infibulation, removal of the clitoris and the labia, cannot be compared to circumcision in terms of the tissues cut and the health consequences. However, other practices such as the removal of the clitoral hood can be considered as being quite similar to circumcision.

Cosmetic surgery

We know that girls and women are exposed to numerous images of “what a woman should be”. Society’s norms and expectations include habits and behaviour, but different societies also have different expectations about the anatomy of genital organs, which do not always correspond to real/natural anatomy.

In order to be able to live up to these expectations, women and girls sometimes decide to subject themselves to cosmetic surgery to modify their genitals. These include labioplasty (reduction of outer or inner labia, clitoral-hood reduction), hymenoplasty (reconstruction of the hymen) which allows women to have a “second virginity”, as well as operations to narrow the opening of the vagina.

Episiotomy

Many women go through surgical interventions on their internal and/or external genitalia throughout their lives, often performed during pregnancy and childbirth. Healthcare professionals can decide to carry out these interventions, with or without the consent of the patient, provided they are medically justified. Perinatal statistics comparing European countries show that from country to country there are large differences in the number of interventions such as C-sections and episiotomies carried out; this opens a debate on to what extent are these procedures medically justified.

Intersexuality

Another legal discrepancy arises between FGM and mutilation carriedout on children born intersex. European countries have laws against female genital mutilation, supported by the position of the WHO.14 Nevertheless, in the same states, intersex children may still be subjected to non-consensual surgical operations justified by so-called “sexual ambiguities”.

The term “intersex” describes “human beings whose biological sex cannot be classified as clearly male or female. An intersex person may have the biological attributes of both sexes or lack some of the biological attributes considered necessary to be defined as one or the other sex. Intersex is always congenital and can originate from genetic, chromosomal or hormonal variations. Environmental influences such as endocrine disruptors can also play a role in some intersex differences. The term is not applicable to situations where individuals deliberately alter their own anatomical characteristics” (Organization Intersex International)15.

The general prevalence of intersex persons is estimated to be 1.7%16. This can include diversity in terms of anatomical sex (internal or external genital organs), the sex of the chromosomes or the sexual hormones.