Clitoridectomy

A clitoridectomy is often done to remove malignancy or necrosis of the clitoris. This is sometimes done along with a radical complete vulvectomy. Surgery may also become necessary due to therapeutic radiation treatments to the pelvic area.[3]

Removal of the clitoris may be due to malignancy or trauma.[3][4]

Female infants born with a 46,XX genotype but have genitalia affected by congenital adrenal hyperplasia and are treated surgically with vaginoplasty that often reduces the size of the clitoris without its total removal. The atypical size of the clitoris is due to an endocrine imbalance in utero.[1][5] Other reasons for the surgery include issues involving a microphallus and those who have Mayer-Rokitansky-Kustner disorder. Treatments on children raise human rights concerns.

While much feminist scholarship has described clitoridectomy as a practice aimed at controlling women's sexuality, the historic emergence of the practice in ancient European and Middle Eastern cultures may have possibly derived from ideas about intersex people and the policing of boundaries between the sexes. In the seventeenth century, anatomists remained divided on whether a clitoris was a normal female organ, with some arguing that only intersex people had one and that, if large enough to be visible, it should always be removed at birth.[7] In the 19th century, a clitoridectomy was thought by some to curb female masturbation.[8] Isaac Baker Brown (1812–1873), an English gynaecologist who was president of the Medical Society of London believed that the "unnatural irritation" of the clitoris caused epilepsy, hysteria, and mania, and he worked "to remove [it] whenever he had the opportunity of doing so", according to his obituary in the Medical Times and Gazette. Peter Lewis Allen writes that Brown's views caused outrage, and he died penniless after being expelled from the Obstetrical Society.[9]

Occasionally, in American and English medicine of the nineteenth century, circumcision was done as a cure for insanity. Some believed that mental and emotional disorders were related to female reproductive organs and that removing the clitoris would cure the neurosis. This treatment was discontinued in 1867.[10]

Aesthetics may determine clitoral norms. A lack of ambiguity of the genitalia is seen as necessary in the assignment of a sex to infants and therefore whether a child's genitalia is normal, but what is ambiguous or normal can vary from person to person.[11]

Sexual behavior is another reason for clitoridectomies. Author Sarah Rodriguez stated that the history of medical textbooks has indirectly created accepted ideas about the female body. Medical and gynecological textbooks are also at fault in the way that the clitoris is described in comparison to a male's penis. The importance and originality of a female's clitoris is underscored because it is seen as "a less significant organ, since anatomy texts compared the penis and the clitoris in only one direction." Rodriguez said that a male's penis created the framework of the sexual organ.[12]

Not all historical examples of clitoral surgeries should be assumed to be clitoridectomy (removal of the clitoris). In the nineteen thirties, the French psychoanalyst Marie Bonaparte studied African clitoral surgical practices and showed that these often involved removal of the clitoral hood, not the clitoris. She also had a surgery done to her own clitoris by the Viennese surgeon Dr Halban, which entailed cutting the suspensory ligament of the clitoris to permit it to sit closer to her vaginal opening. These sorts of clitoral surgeries, contrary to reducing women's sexual pleasure, actually appear aimed at making coitus more pleasurable for women, though it is unclear if that is ever their actual outcome.[13]

Clitoridectomies are the most common form of female genital mutilation. The World Health Organization (WHO) estimates that clitordectomies have been performed on 200 million girls and women that are currently alive. The regions that most clitoridectomies take place are Asia, the Middle East and west, north and east Africa. The practice also exists in migrants originating from these regions. Most of the surgeries are for cultural or religious reasons.[14]

Clitoridectomy of women with intersex conditions is controversial when it takes place during childhood or under duress. Intersex women exposed to such treatment have spoken of their loss of physical sensation, and loss of autonomy.[15][16] In recent years, multiple human rights institutions have criticized early surgical management of such characteristics.[17][18][19]

In 2013, it was disclosed in a medical journal that four unnamed elite female athletes from developing countries were subjected to gonadectomies and partial clitoridectomies after testosterone testing revealed that they had an intersex condition.[20][21] In April 2016, the United Nations Special Rapporteur on health, Dainius Pūras, condemned this treatment as a form of female genital mutilation "in the absence of symptoms or health issues warranting those procedures."[22]