Zero Tolerance for Genital Mutilation: a Review of Moral Justifications

To summarize and critically evaluate the moral principles invoked in support of zero tolerance laws and policies for medically unnecessary female genital cutting (FGC).

Recent Findings

Most of the moral reasons that are typically invoked to justify such laws and policies appear to lead to a dilemma. Either these reasons entail that several common Western practices that are widely regarded to be morally permissible and are currently treated as legal—such as intersex “normalization” surgery, female genital “cosmetic” surgery performed on adolescent girls, or infant male circumcision—are in fact morally impermissible and should be discouraged if not legally forbidden; or the reasons are being applied in a biased and prejudicial manner that is itself unethical, as well as inconsistent with Western constitutional requirements of equal treatment of individuals before the law.

Summary

In the recent literature, only one principle has been defended that appears capable of justifying a zero tolerance stance toward medically unnecessary FGC without relying on, exhibiting, or perpetuating unjust cultural or moral double standards. This principle holds that, in countries whose ethicolegal traditions are shaped by a foundational concern for individual rights, respect for bodily integrity, and personal autonomy over sexual boundaries, all non-consenting persons have an inviolable moral right against any medically unnecessary (or medically deferrable) interference with their genitals or other private anatomy. In such countries, therefore, all non-consenting persons, regardless of age, race, ethnicity, parental religion, assigned sex, gender identity, or other individual or group-based features, should be protected from medically unnecessary genital cutting, regardless of the severity of the cutting or the expected level of benefit or harm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic €32.70 /Month

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Rent this article via DeepDyve

Similar content being viewed by others

Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations

Article 12 November 2020

Rethinking the Anti-FGM Zero-Tolerance Policy: from Intellectual Concerns to Empirical Challenges

Article Open access 12 December 2020

Medicalized Female Genital Mutilation/Cutting: Contentious Practices and Persistent Debates

Article Open access 21 February 2018

Explore related subjects

Change history

Notes

According to a recent consensus statement by the Brussels Collaboration on Bodily Integrity, “an intervention to alter a bodily state is medically necessary when (1) the bodily state poses a serious, time-sensitive threat to the person’s well-being, typically due to a functional impairment in an associated somatic process, and (2) the intervention, as performed without delay, is the least harmful feasible means of changing the bodily state to one that alleviates the threat. ‘Medically necessary’ is therefore different from ‘medically beneficial’—a weaker standard—which requires only that the expected health-related benefits outweigh the expected health-related harms. The latter ratio is often contested as it depends on the specific weights assigned to the potential outcomes of the intervention, given, among other things, (a) the subjective value to the individual of the body parts that may be affected, (b) the individual’s tolerance for different kinds or degrees of risk to which those body parts may be exposed, and (c) any preferences the individual may have for alternative (e.g., less invasive or risky) means of pursuing the intended health-related benefits” [3••] (p. 18). Definition based on [4].

Transgender women and girls can be harmed in particular ways by the pre-emptive removal of their penile foreskins through circumcision [56]. For example, the penile foreskin, which amounts to between 30 and 50 square centimeters of highly sensitive, erogenous tissue in the fully developed organ [11, 57, 100,101,102], can be used in the construction of a neovagina if the individual decides to pursue certain gender-affirming procedures, thereby reducing the need for extensive skin grafts from other parts of the body, such as the thigh [103].

Referring to the current UK anti-FGM law, which is similar to the one in Australia, Arianne Shahvisi has recently argued that the law “codifies the idea that women of particular cultures are not as capable of making their own decisions as are other women, let alone as capable as men. For, if a woman requests a labiaplasty (say) from a private cosmetic surgeon in the UK, her ethnicity will likely be used to determine her consent status, and in turn whether or not the procedure can occur legally. The current law enforces differential access to [genital cutting] procedures on the basis of race” [109] (p. 105).

For a selection of arguments in this vein, see these references: [5, 36, 61, 67, 70, 82, 85, 86, 109,110,111,112,113].

Ironically, advocates of “selective zero tolerance” do not criticize the performance of medically unnecessary female genital cutting when it is done for ostensibly “cosmetic” reasons by medical professionals in a clinical environment (“FGCS”), while at the same time, they categorically oppose the performance of medically unnecessary female genital cutting when it is done for “cultural” reasons (“FGM”) even when it is done by medical professionals in a clinical environment (that is, they oppose the so-called “medicalization” of non-Western-associated FGC, arguing instead that it must be stopped altogether) [16, 117]. However, it is hard to see why Western-style “cosmetic” practices should not be regarded as just as “cultural” as non-Western-associated FGC practices. For as Alice Edwards argues, “any woman’s choice to have a procedure on her genitals cannot be separated from the culture in which this decision is made” [118] (p. 27). As such, “highly restrictive esthetic ideals, widespread anatomical ignorance about the range of ‘normal’ appearances for the vulva, marketing campaigns designed to prey on bodily insecurities, and normatively questionable social pressures undoubtedly [play] a role in motivating requests” for FGCS in Western countries [4] (p. 62). In short, “the rationale [for cutting] cannot be separated from cultural associations” irrespective of the culture in which it occurs [118] (p. 27).

For an extensive recent discussion, see Earp and Johnsdotter [114•]. Only a brief outline can be given here.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mathews B. Female genital mutilation: Australian law, policy and practical challenges for doctors. Med J Australia. 2011;194(3):139–41. PubMedGoogle Scholar
  2. Shweder RA. “What about female genital mutilation?” and why understanding culture matters in the first place. In: Shweder RA, Minow M, Markus HR, editors. Engaging cultural differences: the multicultural challenge in liberal democracies. New York: Russell Sage Foundation Press; 2002. p. 216–51.
  3. •• BCBI. Medically unnecessary genital cutting and the rights of the child: moving toward consensus. Am J Bioeth. 2019;19(10):17–28. International consensus statement by more than 90 experts in law, medicine, ethics, and other fields arguing that cutting any person's genitals without their own informed consent is a violation of their right to bodily integrity, unless they are non-autonomous and the cutting is medically necessary (and so cannot be delayed).Google Scholar
  4. Earp BD. The child’s right to bodily integrity. In: Edmonds D, editor. Ethics and the contemporary world. Abingdon and New York: Routledge; 2019. p. 217–35. Google Scholar
  5. Shahvisi A, Earp BD. The law and ethics of female genital cutting. In: Creighton SM, Liao L-M, editors. Female genital cosmetic surgery: solution to what problem? Cambridge: Cambridge University Press; 2019. p. 58–71. Google Scholar
  6. • Bootwala. A review of female genital cutting (FGC) in the Dawoodi Bohra community: parts 1, 2, and 3. Curr Sex Health Rep. 2019;11(3):212–35. Exhaustive historical, sociological, and medical review of FGC practices among the Dawoodi Bohra (the community at the center of recent legal cases in the US and Australia).
  7. Wahlberg A, Påfs J, Jordal M. Pricking in the African diaspora: current evidence and recurrent debates. Curr Sex Health Rep. 2019;5(1):1–7. Google Scholar
  8. Kiefel C, Bell J, Gageler J, Nettle J, Gordon J, Edelman J. The Queen v A2 the Queen v Magennis; the Queen v Vaziri. 2019. Google Scholar
  9. Hoeben C, Ward J, Adams J. A2 v R; Magennis v R; Vaziri v R. 2018. Available from: https://www.caselaw.nsw.gov.au/decision/5b68d25ce4b0b9ab4020e71c
  10. Rogers J. The first case addressing female genital mutilation in Australia: Where is the harm? Alt Law J. 2016;41(4):235–8.
  11. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Brit J Urol. 1996;77(2):291–5. CASPubMedGoogle Scholar
  12. Fahmy MAB. Nonaesthetic circumcision scarring. In: Fahmy MAB, editor. Complications in male circumcision. Amsterdam: Elsevier; 2019. p. 99–134. Google Scholar
  13. Fahmy MAB. Functions of the prepuce. In: Normal and abnormal prepuce. Cham: Springer International Publishing; 2020. p. 67–85. Google Scholar
  14. Foster EA. Female circumcision vs. designer vaginas: surgical genital practices and the discursive reproduction of state boundaries. In: Dickinson J, editor. Body/State. London: Routledge; 2016. p. 17–30. Google Scholar
  15. Edmonds A. Can medicine be aesthetic? Disentangling beauty and health in elective surgeries. Med Anthropol Q. 2013;27(2):233–52. PubMedGoogle Scholar
  16. Askew I, Chaiban T, Kalasa B, Sen P. A repeat call for complete abandonment of FGM. J Med Ethics. 2016;42(9):619–20. PubMedGoogle Scholar
  17. Kelly B, Foster C. Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? BJOG. 2012;119(4):389–92. CASPubMedGoogle Scholar
  18. Boddy J. The normal and the aberrant in female genital cutting: shifting paradigms. Hau J Ethnogr Theor. 2016;6(2):41–69. Google Scholar
  19. Boddy J. Paradoxes of ‘modern’ female bodies: female genital cosmetic surgeries (FGCS) and FGM/C. In: 2nd international expert meeting on female genital mutilation/cutting. Montreal, Canada; 2018.
  20. Ford K-K. “First, do no harm”: the fiction of legal parental consent to genital-normalizing surgery on intersexed infants. Yale L Pol’y Rev. 2001;19(2):469–88. Google Scholar
  21. Garland J, Slokenberga S. Protecting the rights of children with intersex conditions from nonconsensual gender-conforming medical interventions: the view from Europe. Med Law Rev. 2018;27(3):482–508. Google Scholar
  22. Dreger AD, Herndon AM. Progress and politics in the intersex rights movement: feminist theory in action. GLQ J Lesb Gay Stud. 2009;15(2):199–224. Google Scholar
  23. Karkazis K. Fixing sex: intersex, medical authority, and lived experience. Durham: Duke University Press; 2008. Google Scholar
  24. Reis E. Bodies in doubt: an American history of intersex. Baltimore: JHU Press; 2009. Google Scholar
  25. Reis E. Did bioethics matter? A history of autonomy, consent, and intersex genital surgery. Med Law Rev. 2019;27(4):658–74. PubMedGoogle Scholar
  26. Reis-Dennis S, Reis E. Are physicians blameworthy for iatrogenic harm resulting from unnecessary genital surgeries? AMA J Ethics. 2017;19(8):825–33. PubMedGoogle Scholar
  27. Jones M. Intersex genital mutilation – a Western version of FGM. Int J Child Rts. 2017;25(2):396–411. Google Scholar
  28. Ehrenreich N, Barr M. Intersex surgery, female genital cutting, and the selective condemnation of cultural practices. Harv CR-CL L Rev. 2005;40(1):71–140. Google Scholar
  29. Liao L-M, Hegarty P, Creighton SM, Lundberg T, Roen K. Clitoral surgery on minors: an interview study with clinical experts of differences of sex development. BMJ Open. 2019;9(6):e025821. PubMedPubMed CentralGoogle Scholar
  30. Hurwitz RS. Feminizing surgery for disorders of sex development: evolution, complications, and outcomes. Curr Urol Rep. 2011 Apr 1;12(2):166–72. PubMedGoogle Scholar
  31. Kudela G, Gawlik A, Koszutski T. Early feminizing genitoplasty in girls with congenital adrenal hyperplasia (CAH)—analysis of unified surgical management. Int J Enviro Res Pub Health. 2020;17(11):3852. Google Scholar
  32. Schober JM. Feminizing genitoplasty: a synopsis of issues relating to genital surgery in intersex individuals. J Pediatr Endocrinol Metab. 2004;17(5):697–704. PubMedGoogle Scholar
  33. • Garland F, Travis M. Legislating intersex equality: building the resilience of intersex people through law. Legal Stud. 2018;38(4):587–606. Review of recent legal developments concerning intersex people, arguing that “prevention of non-therapeutic medical interventions on the bodies of children [is the] key method to achieving equality for intersex embodied people.”
  34. Earp BD, Shahvisi A, Reis-Dennis S, Reis E. Is female genital 'mutilation' good for one's health? Nurs Ethics; in press.
  35. Gardner M, Sandberg DE. Navigating surgical decision making in disorders of sex development (DSD). Front Pediatr. 2018;6(339):1–9. Google Scholar
  36. Oba AA. Female circumcision as female genital mutilation: human rights or cultural imperialism? Glob Jurist. 2008;8(3):1–38. Google Scholar
  37. Manderson L. Local rites and body politics: tensions between cultural diversity and human rights. Int Feminist J Pol. 2004;6(2):285–307.
  38. Jacobson D, Glazer E, Mason R, Duplessis D, Blom K, Mont JD, et al. The lived experience of female genital cutting (FGC) in Somali-Canadian women’s daily lives. PLoS One. 2018;13(11):e0206886. PubMedPubMed CentralGoogle Scholar
  39. Callahan D. The WHO definition of “health”. Hastings Cent Stud. 1973;1(3):77–87. CASPubMedGoogle Scholar
  40. Earp BD. Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines. Front Pediatr. 2015;3(18):1–6. Google Scholar
  41. Sommerville M. The ethical canary: science, society, and the human spirit. Montreal: McGill-Queen’s University Press; 2004. Google Scholar
  42. Saalihal-Munajjid M. Medical benefits of female circumcision. Islam Question & Answer. 2020; Available from: https://islamqa.info/en/answers/45528/medical-benefits-of-female-circumcision.
  43. Mohamed Ali SEK. Safe female circumcision. Khartoum: Khartoum University; 2009. Available from: http://umatia.org/2011/safecircumcision.htmlGoogle Scholar
  44. Bhalla N. Female circumcision in Sri Lanka is “just a nick,” not mutilation: supporters. Jakarta Globe. 2017; Available from: https://jakartaglobe.id/news/female-circumcision-sri-lanka-just-nick-not-mutilation-supporters.
  45. Hussein A. Female circumcision: an Islamic practice brings untold benefits to women. Daily Mirror. 2018; Available from: http://www.dailymirror.lk/opinion/Female-Circumcision-An-Islamic-practice-brings-untold-benefits-to-women/172-155646.
  46. Gollaher DL. From ritual to science: the medical transformation of circumcision in America. J Soc Hist. 1994;28(1):5–36. Google Scholar
  47. Hodges F. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC, Milos MF, editors. Sexual mutilations. New York: Springer US; 1997. p. 17–40. Google Scholar
  48. Doğan G. The effect of religious beliefs on the publication productivity of countries in circumcision: a comprehensive bibliometric view. J Relig Health. 2020; online ahead of print.
  49. Solomon LM, Noll RC. Male versus female genital alteration: differences in legal, medical, and socioethical responses. Gender Med. 2007;4(2):89–96. Google Scholar
  50. • Johnsdotter S. Girls and boys as victims: asymmetries and dynamics in European public discourses on genital modifications in children. In: Fusaschi M, Cavatorta G, editors. FGM/C: from medicine to critical anthropology. Turin: Meti Edizioni; 2018. p. 31–50. Nuanced study of the inconsistent discourses concerning male and female genital cutting in a European context.Google Scholar
  51. Newland L. Female circumcision: Muslim identities and zero tolerance policies in rural West Java. Women's Stud Int Forum. 2006;29(4):394–404. Google Scholar
  52. Leonard L. “We did it for pleasure only.” Hearing alternative tales of female circumcision. Qual Inq. 2000;6(2):212–28. Google Scholar
  53. Earp BD, Darby R. Circumcision, sexual experience, and harm. U Penn J Int Law. 2017;37(2-online):1–57. Google Scholar
  54. Ahmadu FS. Equality, not special protection: multiculturalism, feminism, and female circumcision in Western liberal democracies. In: Cassaniti J, Menon U, editors. Universalism without uniformity: explorations in mind and culture. Chicago: University of Chicago Press; 2017. p. 214–36. Google Scholar
  55. • Lunde IB, Hauge M-I, Johansen REB, Sagbakken M. ‘Why did I circumcise him?’ Unexpected comparisons to male circumcision in a qualitative study on female genital cutting among Kurdish–Norwegians. Ethnicities. 2020; online ahead of print. Important empirical study exploring the relationship between male and female genital cutting in the minds of Kurdish-Norwegians.
  56. Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis. Bioethics. 2020; online ahead of print.
  57. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999;83(S1):34–44. PubMedGoogle Scholar
  58. Fahmy MAB. Normal female prepuce. In: Normal and abnormal prepuce. Cham: Springer International Publishing; 2020. p. 75–81. Google Scholar
  59. Fahmy MAB. Embryology of the prepuce. In: Normal and abnormal prepuce. Cham: Springer International Publishing; 2020. p. 29–33. Google Scholar
  60. Fahmy MAB. Anatomy of the prepuce. In: Normal and abnormal prepuce. Cham: Springer International Publishing; 2020. p. 35–57. Google Scholar
  61. Dustin M. Female genital mutilation/cutting in the UK: challenging the inconsistencies. Euro J Women’s Stud. 2010;17(1):7–23. Google Scholar
  62. Svoboda JS. Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting. Glob Disc. 2013;3(2):237–55. Google Scholar
  63. Svoboda JS, Darby R. A rose by any other name? Symmetry and asymmetry in male and female genital cutting. In: Zabus C, editor. Fearful symmetries: essays and testimonies around excision and circumcision. Amsterdam and New York: Rodopi; 2008. p. 251–302. (Matutu; vol. 37).
  64. Svoboda JS, Adler PW, Van Howe RS. Circumcision is unethical and unlawful. J Law Med Ethics. 2016;44(2):263–82. PubMedGoogle Scholar
  65. Svoboda JS, Adler PW, Van Howe RS. Is circumcision unethical and unlawful? A response to Morris et al. J Med Law Ethics. 2019;7(1):72–92. Google Scholar
  66. • Munzer SR. Examining nontherapeutic circumcision. Health Matrix. 2018;28(1):1–77. Law review article by distinguished professor arguing that children have a right-in-trust not to have their genitals surgically interfered with, except for medical necessity, until they have the capacity to make decisions about such surgery for themselves.Google Scholar
  67. Mason C. Exorcising excision: medico-legal issues arising from male and female genital surgery in Australia. J Law Med. 2001;9(1):58–67. CASPubMedGoogle Scholar
  68. Earp BD. In defence of genital autonomy for children. J Med Ethics. 2016;42(3):158–63. PubMedGoogle Scholar
  69. Earp BD. Religious freedom, equal protection, and the child’s (gender neutral) right to bodily integrity. In: Secularism 2019: Reclaiming religious freedom. London: National Secular Society; 2019. Available from: https://youtu.be/GBH0g_Cl7Rk. Google Scholar
  70. Earp BD. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework. Medicolegal Bioeth. 2015;5(1):89–104. Google Scholar
  71. Earp BD. Sex and circumcision. Am J Bioeth. 2015;15(2):43–5. PubMedGoogle Scholar
  72. Earp BD, Steinfeld R. Genital autonomy and sexual well-being. Curr Sex Health Rep. 2018;10(1):7–17. Google Scholar
  73. Earp BD, Steinfeld R. Gender and genital cutting: a new paradigm. In: Barbat TG, editor. Gifted women, fragile men. Brussels: ALDE Group-EU Parliament; 2017. (Euromind Monographs). Available from: http://euromind.global/brian-d-earp-and-rebecca-steinfeld/?lang=en.
  74. Earp BD. Why was the U.S. ban on female genital mutilation ruled unconstitutional, and what does this have to do with male circumcision? Ethics Med Public Health. 2020;15:100533. Google Scholar
  75. Earp BD. Protecting children from medically unnecessary genital cutting without stigmatizing women’s bodies: implications for sexual pleasure and pain. Arch Sex Behav. 2020; online ahead of print.
  76. Earp BD, Darby R. Circumcision, autonomy and public health. Pub Health Ethics. 2019;12(1):64–81. Google Scholar
  77. Earp BD, Shaw DM. Cultural bias in American medicine: the case of infant male circumcision. J Pediatr Ethics. 2017;1(1):8–26. Google Scholar
  78. Darby R. The child’s right to an open future: is the principle applicable to non-therapeutic circumcision? J Med Ethics. 2013;39(7):463–8. PubMedGoogle Scholar
  79. Darby R. Risks, benefits, complications and harms: neglected factors in the current debate on non-therapeutic circumcision. Kennedy Inst Ethics J. 2015;25(1):1–34. PubMedGoogle Scholar
  80. Darby R. Targeting patients who cannot object? Re-examining the case for non-therapeutic infant circumcision. SAGE Open. 2016;6(2):1–16. Google Scholar
  81. •• Möller K. Male and female genital cutting: between the best interests of the child and genital mutilation. Oxf J Leg Stud. 2020;online ahead of print. Perhaps the most significant philosophical and legal discussion addressing male and female genital cutting together from the past 10 years. Argues that that the fundamental wrong of child genital cutting is grounded not in empirical matters pertaining to expected levels of benefit or harm, but rather in the principle of respect for a child's bodily and sexual integrity.
  82. Johnson MT. Male genital mutilation: beyond the tolerable? Ethnicities. 2010;10(2):181–207. Google Scholar
  83. Sarajlic E. Children, culture, and body modification. Kennedy Inst Ethics J. 2020; online ahead of print.
  84. • Townsend KG. The child’s right to genital integrity. Philos Soc Crit. 2020;46(7):878–98. A sustained philosophical defense of the concept of a child’s right to genital integrity.Google Scholar
  85. Tangwa GB. Circumcision: an African point of view. In: Denniston GC, Hodges FM, Milos MF, editors. Male and female circumcision. Boston: Springer; 1999. p. 183–93. Google Scholar
  86. Tangwa GB. Bioethics, biotechnology and culture: a voice from the margins. Dev World Bioeth. 2004;4(2):125–38. PubMedGoogle Scholar
  87. Toubia NF. Evolutionary cultural ethics and the circumcision of children. In: Denniston GC, Hodges FM, Milos MF, editors. Male and female circumcision. Boston, MA: Springer; 1999. p. 1–7. Google Scholar
  88. Lightfoot-Klein H, Chase C, Hammond T, Goldman R. Genital surgeries on children below an age of consent. In: Szuchman LT, Muscarella F, editors. Psychological perspectives on human sexuality. New York: John Wiley & Sons; 2000. p. 440–79. Google Scholar
  89. Davis DS. Male and female genital alteration: a collision course with the law. Health Matrix. 2001;11(1):487–570. CASPubMedGoogle Scholar
  90. Arora KS, Jacobs AJ. Female genital alteration: a compromise solution. J Med Ethics. 2016;42(3):148–54. PubMedGoogle Scholar
  91. Jacobs AJ, Arora KS. Punishment of minor female genital ritual procedures: is the perfect the enemy of the good? Dev World Bioeth. 2017;17(2):134–40. PubMedGoogle Scholar
  92. AAP. Ritual genital cutting of female minors. Pediatr. 2010;125(5):1088–93. Google Scholar
  93. Shweder RA. The goose and the gander: the genital wars. Glob Disc. 2013;3(2):348–66. Google Scholar
  94. Shweder RA. Doctoring the genitals: towards broadening the meaning of social medicine. J Clin Ethics. 2015;26(2):176–9. PubMedGoogle Scholar
  95. Duivenbode R, Padela AI. The problem of female genital cutting: bridging secular and Islamic bioethical perspectives. Persp Biol Med. 2019;62(2):273–300. Google Scholar
  96. Hodson N, Earp BD, Townley L, Bewley S. Defining and regulating the boundaries of sex and sexuality. Med Law Rev. 2019;27(4):541–52. PubMedGoogle Scholar
  97. Dembroff R. Beyond binary: genderqueer as critical gender kind. Philos Imp. 2019; online ahead of print.
  98. Harrison J, Grant J, Herman JL. A gender not listed here: genderqueers, gender rebels, and otherwise in the national transgender discrimination survey. LGBTQ Pol’y J. 2012;2(2011–2012):13–24. Google Scholar
  99. Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G. Non-binary or genderqueer genders. Int Rev Psychiatr. 2016;28(1):95–102. Google Scholar
  100. Earp BD. Infant circumcision and adult penile sensitivity: implications for sexual experience. Trends Urol Men Health. 2016;7(4):17–21. Google Scholar
  101. Werker PMN, Terng ASC, Kon M. The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap. Plast Reconstr Surg. 1998;102(4):1075–82. CASPubMedGoogle Scholar
  102. Kigozi G, Wawer M, Ssettuba A, Kagaayi J, Nalugoda F, Watya S, et al. Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters). AIDS. 2009;23(16):2209–13.
  103. Papadopulos NA, Lellé J-D, Zavlin D, Herschbach P, Henrich G, Kovacs L, et al. Quality of life and patient satisfaction following male-to-female sex reassignment surgery. J Sex Med. 2017;14(5):721–30.
  104. WHO. Manual for early infant male circumcision under local anaesthesia. Geneva, Switzerland: World Health Organization; 2010. Google Scholar
  105. WHO. Eliminating female genital mutilation: an interagency statement. Geneva, Switzerland: World Health Organization; 2008. Google Scholar
  106. WHO. Traditional male circumcision among young people. Geneva, Switzerland: World Health Organization; 2009. Google Scholar
  107. Carpenter M. Joint statement on the international classification of diseases 11. Intersex Human Rights Australia. 2019; Available from: https://ihra.org.au/35299/joint-statement-icd-11/.
  108. Macklin R. Not all cultural traditions deserve respect. J Med Ethics. 2016;42(3):155–5.
  109. Shahvisi A. Why UK doctors should be troubled by female genital mutilation legislation. Clin Ethics. 2017;12(2):102–8. Google Scholar
  110. • Onsongo N. Female genital cutting (FGC): who defines whose culture as unethical? IJFAB. 2017;10(2):105–23. African feminist critique of common Western claims about non-Western FGC.Google Scholar
  111. Obiora LA. Bridges and barricades: rethinking polemics and intransigence in the campaign against female circumcision. Case Western Res Law Rev. 1996;47:275–378. Google Scholar
  112. Njambi WN. Dualisms and female bodies in representations of African female circumcision: a feminist critique. Feminist Theor. 2004;5(3):281–303. Google Scholar
  113. van Bavel H. FGM: zero tolerance to what? SOAS blog (University of London). 2018. Available from: https://www.soas.ac.uk/blogs/study/fgm-zero-tolerance/
  114. • Earp BD, Johnsdotter S. Current critiques of the WHO policy on female genital mutilation. IJIR. 2020;online ahead of print. Current overview of the main scholarly criticisms of the WHO policy on "FGM."
  115. Earp BD. Mutilation or enhancement? What is morally at stake in body alterations: Practical Ethics (University of Oxford); 2019. Available from: http://blog.practicalethics.ox.ac.uk/2019/12/mutilation-or-enhancement-what-is-morally-at-stake-in-body-alterations/
  116. • La Barbera MC. Ban without prosecution, conviction without punishment, and circumcision without cutting: a critical appraisal of anti-FGM laws in Europe. Glob Jurist. 2017;17(2):20160012. Wide ranging study of the ethical and legal inconsistencies surrounding anti-FGM laws in Europe.Google Scholar
  117. Shell-Duncan B. The medicalization of female “circumcision”: harm reduction or promotion of a dangerous practice? Soc Sci Med. 2001;52(7):1013–28. CASPubMedGoogle Scholar
  118. Edwards A. What is the dynamic between the ‘cosmetic versus cultural surgery’ discourse and efforts to end FGM in the UK? Oxford Brookes University; 2013.
  119. Fish M, Shahvisi A, Gwaambuka T, Tangwa GB, Ncayiyana DJ, Earp BD. A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision of African men. Dev World Bioeth. 2020; in press.
  120. Darby R. Moral hypocrisy or intellectual inconsistency? A historical perspective on our habit of placing male and female genital cutting in separate ethical boxes. Kennedy Inst Ethics J. 2016;26(2):155–63. PubMedGoogle Scholar
  121. Earp BD. Does female genital mutilation have health benefits? The problem with medicalizing morality: Practical Ethics (University of Oxford); 2017. Available from: http://blog.practicalethics.ox.ac.uk/2017/08/does-female-genital-mutilation-have-health-benefits-the-problem-with-medicalizing-morality/
  122. Bell K. Genital cutting and Western discourses on sexuality. Med Anthropol Q. 2005;19(2):125–48. PubMedGoogle Scholar
  123. Carpenter M. The human rights of intersex people: addressing harmful practices and rhetoric of change. Reprod Health Matters. 2016;24(47):74–84. PubMedGoogle Scholar
  124. Svoboda JS. Circumcision of male infants as a human rights violation. J Med Ethics. 2013;39(7):469–74. PubMedGoogle Scholar
  125. WHO. Ending violence and discrimination against lesbian, gay, bisexual, transgender, and intersex people. Geneva: World Health Organization; 2015. Google Scholar
  126. AAP. Diagnosis, management, and treatment of female genital mutilation or cutting in girls. Pediatrics. 2020;146(2) online ahead of print.
  127. Brusa M, Barilan YM. Cultural circumcision in EU public hospitals - an ethical discussion. Bioethics. 2009;23(8):470–82. PubMedGoogle Scholar
  128. Earp BD, Hendry J, Thomson M. Reason and paradox in medical and family law: shaping children’s bodies. Med Law Rev. 2017;25(4):604–27. PubMedGoogle Scholar
  129. Clarence-Smith WG. Islam and female genital cutting in Southeast Asia: the weight of the past. Finn J Ethn Migr. 2008;3(4):14–22. Google Scholar
  130. Duivenbode R. Reflecting on the language we use. Islamic Horizons. 2018:54–5.
  131. Barstow DG. Female genital mutilation: the penultimate gender abuse. Child Abuse Negl. 1999;23(5):501–10. CASPubMedGoogle Scholar
  132. Abdulcadir J, Ahmadu FS, Essen B, Gruenbaum E, Johnsdotter S, Johnson MC, et al. Seven things to know about female genital surgeries in Africa. Hast Cent Rep. 2012;42(6):19–27. Google Scholar
  133. Ahmadu F. Male and female circumcision among the Mandinka of the Gambia: understanding the dynamics of traditional dual-sex systems in a contemporary African society. Saarbrücken: LAP LAMBERT Academic Publishing; 2016. Google Scholar
  134. Andro A, Lesclingand M, Grieve M, Reeve P. Female genital mutilation. Overview and current knowledge. Population. 2016;71(2):215–96. Google Scholar
  135. Merli C. Sunat for girls in southern Thailand: its relation to traditional midwifery, male circumcision and other obstetrical practices. Finn J Ethn Migr. 2008;3(2):32–41. Google Scholar
  136. Merli C. Male and female genital cutting among southern Thailand’s Muslims: rituals, biomedical practice and local discourses. Cult Health Sex. 2010;12(7):725–38. PubMedGoogle Scholar
  137. Douglas M, Nyembezi A. Challenges facing traditional male circumcision in the eastern cape. Hum Sci Res Council. 2015:1–47.
  138. Wilcken A, Keil T, Dick B. Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications. Bull WHO. 2010;88:907–14. PubMedPubMed CentralGoogle Scholar
  139. Banwari M. Dangerous to mix: culture and politics in a traditional circumcision in South Africa. Afr Health Sci. 2015;15(1):283–7. PubMedPubMed CentralGoogle Scholar
  140. Schlegel A, Barry H. Pain, fear, and circumcision in boys’ adolescent initiation ceremonies. Cross-Cult Res. 2017;1(1):1–29. Google Scholar
  141. Boyle GJ, Ramos S. Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: a retrospective cohort study. Ann Med Surg (Lond). 2019;42:19–22. Google Scholar
  142. DeLaet DL. Framing male circumcision as a human rights issue? Contributions to the debate over the universality of human rights. J Hum Rts. 2009;8(4):405–26. Google Scholar
  143. Rashid AK, Patil SS, Valimalar AS. The practice of female genital mutilation among the rural Malays in North Malaysia. Int J Third World Med. 2010;9(1):1–8. Google Scholar
  144. Rashid A, Iguchi Y. Female genital cutting in Malaysia: a mixed-methods study. BMJ Open. 2019;9(4):e025078. PubMedPubMed CentralGoogle Scholar
  145. Ahmadu FS. Rites and wrongs: an insider/outsider reflects on power and excision. In: Shell-Duncan B, Hernlund Y, editors. Female “circumcision” in Africa: culture, controversy, and change. Boulder: Lynne Rienner Publishers; 2000. p. 283–315. Google Scholar
  146. Moxon S. Only male genital modification is “control” - the female form is competition by women. New Male Stud. 2017;6(2):126–66. Google Scholar
  147. Fox M, Thomson M. Foreskin is a feminist issue. Australian Feminist Stud. 2009;24(60):195–210. Google Scholar
  148. Fox M, Thomson M. HIV/AIDS and male circumcision: discourses of race and masculinity. In: Fineman MA, Thomson M, editors. Exploring masculinities. Farnham: Ashgate; 2016. p. 97–113. Google Scholar
  149. Hodges FM. The antimasturbation crusade in antebellum American medicine. J Sex Med. 2005;2(5):722–31.
  150. Earp BD, Yuter J. Is circumcision wrong? Letter. 2019; Available from: https://letter.wiki//conversation/127.

Author information

Authors and Affiliations

  1. Yale University and the Hastings Center, 2 Hillhouse Avenue, New Haven, CT, USA Brian D. Earp
  1. Brian D. Earp