I Really Have No Words
It's been a busy week for sex news. The FDA withheld approval of flibanserin, a drug aimed at increasing women's libidos, and a new anti-rape condom that takes its inspiration from the vagina dentata myth was unveiled at the World Cup. But the news I want to focus on this week is an article published in the Hastings Center's Bioethics Forum by Alice Dreger and Ellen K. Feder that highlights a horrifying research study done by a pediatric urologist at Cornell University's Weill Medical College. Actually, "want," is probably not the right word. I don't really want to have to think about this study at all, but I do feel a responsibility to spread the word and help generate a public outcry so that the research in question isn't continued. The study is from 2007, and it's titled "Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability." What is "Nerve sparing ventral clitoroplasty?" you may ask. It's a surgery designed to reduce the size of an "abnormally" large clitoris by removing all or most of the shaft while preserving the glans. What's horrifying about this study, however, is not that it involves unnecessary surgery on the part of the female genitalia most related to orgasm for the majority of women. No, the really awful thing is that the mean age of the patients receiving this surgery in the paper in question was five. I'll try to enumerate here everything wrong with this study, but I recommend reading both the original Bioethics article and Dan Savage's take on the issue.
The study's main author, Dr. Dix Poppas, performed this surgery on 51 patients, ranging in age from 4 months to 24 years. According to the paper, 32 of those patients were under 2 years old, 5 were between the ages of 2 and 5, and 11 were older than 5. Presumably at least one -- the 24-year-old -- was an adult who chose this surgery of her own free will, but most of the patients were children whose doctor and parents decided their clitorises were too large and needed to be reduced. Why exactly? There's absolutely no evidence that a larger-than-average clit is in any way detrimental to the normal development of a child. On the other hand, surgically altering a girl's clitoris often does have a negative impact on normal psychological and sexual development. The entire purpose of this sort of surgery is aesthetic. The idea is to reduce the appearance of "ambiguous" genitalia and make the girls look "normal." The current techniques for this aim to preserve nerve function as much as possible, which is an improvement on older techniques, in which the clitoris was removed entirely, but the fact remains that there is no medical reason for such surgery. The best argument in favor of it is that girls with large clitorises may feel embarrassed by their genitals and have psychological issues. No way in hell does that justify cutting up their genitals while they are too young to understand what's going on or have a say in the matter. Only in a culture where women's sexuality is primarily about their appearance as sexual objects and only secondarily about their identity as sexual beings could such a thing even be considered, let alone actually practiced.
Are you outraged yet? Because it gets worse. In order to test for nerve function post-surgery, Dr. Poppas conducted several tests. The first, which was done on 49 of the patients (two were "lost," to follow up) involved pressing a fingernail against the girl's clitoris until it blanched and determining how long it took for the blood to return. As far as this measure goes, all patients were found to be normal. The second set of tests were conducted on 10 patients over the age of 5 and are even more disturbing. In these tests, which were done between one week and eight years after the surgery and in the presence of a parent, the doctor stimulated the girls' clitorises, labia, vaginal opening, and inner thighs with a q-tip and also with a "medical vibratory device," and asked them to report how strongly they felt the sensations. So after undergoing surgery to reduce their genitals, these girls were subjected to highly invasive follow-up examinations by a male doctor. (The results indicated that nerve function was retained, although there's no reason to assume that basic nerve function and sexual function are one and the same.) There was no control group of girls with "normal" clitorises to compare the results to. Probably because no parent in their right mind would consent to letting a doctor stimulate their pre-pubescent child's genitals with a vibrator in the name of scientific research. How anybody involved thought this was OK and wouldn't cause the girls any (additional) trauma is inconceivable to me.
If these surgeries and the follow up reports had been conducted on adults, then this research would have been reasonable. I still wouldn't think the surgery was medically necessary, but at least the participants would have understood what was going on. But to conduct these experiments on children? I have no words to express how appalling this is. I imagine that the parents involved in this research meant well. After all, the prevalence of circumcision in the US should be enough to convince anyone that parents implicitly trust a doctor's recommendation, even when it comes to something as sensitive as medically unnecessary genital surgery. No doubt they were told that without this surgery their daughters would grow up with severe psychological issues related to their genitals. Probably they had no idea what the normal range of clitoral size even is, and simply trusted the doctor's judgement on what constituted "too much" clitoris. And probably they thought the follow up tests were necessary to be sure that their children would have normal sexual function when they grow up. I think most of the blame here lies with Dr. Poppas, who seems to be conducting these surgeries and experiments out of an arrogant and paternalistic assumption that he knows what is best for these girls. The authors of the bioethics report followed up with the paper's co-authors and found that they were only involved in the review of medical records of the patients to analyze basic background data such as diagnosis and age at surgery. Only Dr. Poppas and his nurse practitioner were involved directly in the post-operative experiments. Another troubling aspect of this research is that Dr. Poppas appears to have conducted these experiments without the supervision of an institutional review board. This is a BIG DEAL. Any research conducted on human beings has to be approved beforehand by an ethics committee and overseen by a review board. If Dr. Poppas conducted experiments on children without following this protocol it is both unethical (duh) and illegal. If a review board did approve this research, then Cornell needs to investigate how this research was allowed. If not, then Dr. Poppas should be disciplined immediately and banned from conducting further research. (Actually, that should happen regardless.)
This whole issue highlights how important a more open, honest, and accepting approach to sexuality is needed in our culture. I can't imagine well-informed parents agreeing to this research, or doctors with a thorough understanding of female sexuality engaging in it. I hope that bringing this study to light, Dreger and Feder manage to ignite enough outrage to stop these studies and to start a more productive conversation on what exactly constitutes "normal," sexually speaking.
Dr. Pisaster has a doctorate in biophysics, not actually anything sexy. She does however enjoy having sex, reading about sex, and talking about sex. Especially when she's had a little whiskey.