06/18/10-by Bridgette P. LaVictoire
Pediatric urologist Doctor Dix Poppas has been engaged in the clitoridectomies of infant girls with the consent of their parents because these little girls have overly large clitorises. Some of the girls that he has mutilated have been as young as three years of age. According to Dr. Poppas, these girls will have “normal appearing vagina” after the surgery. Of course, by “vagina” he means vulva since the vagina is the internal portion of a woman’s reproductive anatomy, not the exterior. He has been working on this research at Cornell University, and the girls that he has been experimenting upon suffer from a form of intersexuality known as adrenal hyperplasia. It is not uncommon for many intersexed children to be ‘fixed’ by doctors and parents irregardless of the consequences of their actions. While Dr. Poppas maintains that these girls will have normal functionality with clitoraplasty, that surgery is not a total guarantee of success, and even transwomen who undergo the procedure can end up with insensitive clitorises. The length of time between the clitoridectomy and the clitoraplasty can reduce that surgery’s chance of success to near zero.
Making the surgery more problematic is that Dr. Poppas has been excising portions of these girl’s clitoral shafts. Many women masturbate by rubbing the shaft of the clitoris rather than through the touching of the clitoral glans. The glans of most women is so sensitive that it can cause pain if directly touched. Alice Dreger and Ellen K. Feder, writing at Bioethics Forum, make it abundantly clear that the procedures pursued by Poppas are problematic. According to them,
We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm.
But we are not writing today to again bring attention to the surgeries themselves. Rather, we are writing to express our shock and concern over the follow-up examination techniques described in the 2007 article by Yang, Felsen, and Poppas. Indeed, when a colleague first alerted us to these follow-up exams – which involve Poppas stimulating the girls’ clitorises with vibrators while the girls, aged six and older, are conscious – we were so stunned that we did not believe it until we looked up his publications ourselves.
Here more specifically is, apparently, what is happening: At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.
Much of what Dr. Poppas is doing amounts to child molestation. The follow ups can be just as, or even more traumatic than the initial surgery, which is not done with the child’s consent and is done in order to push a specific, and often unrealistic standard of how a woman’s vulva should look. This is a standard which has lead to women getting their genitals modified in such a way to make them look smaller and less adult.
One time I asked a surgeon who does these surgeries if he had any idea how women actually reach orgasm. What did he actually know, scientifically, about the functional physiology of the adult clitoris? He looked at me blankly, and then said, “But we’re working on children.” As if they were never going to grow up.
Odds on are that this man thought that women achieved orgasm only through the vaginal walls and the ‘G-Spot’ and did not need to have a clitoris at all.
So why the heck do Poppas and other surgeons do these surgeries? They believe it is necessary to ensure “normal” sexual development…. Many of us happen to think “normal” sexual development is actually likely to be thwarted by having parts of your genitals taken away without your consent, and thwarted by follow-up exams like the ones we are describing. Ellen and I have gotten to know hundreds of adults born with sex anomalies who went through these medical scenes growing up. Many have told us that the genital displays involved in the follow-up exams were more traumatic than any other part of the experience. Indeed, when I once asked a group of women with androgen insensitivity syndrome what they wanted me to work on primarily in my advocacy work, they said stopping the exams, particularly those in which med students, residents, and fellows parade through to check out the surgeon’s handiwork.
A great deal of research has been done on this particular subject over the years, and it has been shown that the surgeries that Dr. Poppas is forcing these girls to undergo can often lead to more problems physically than the supposed psychological problems that they will have from possessing an overly large clitoris. The ultimate result of this entire procedure is that it likely will cause these girls major physical and psychological problems down the road that would not occur if society simply took pressure off of women and men that forces women to have often tiny little clitorises and labia. These procedures are also endemic of the major problems that occur from the callous mutilation of many intersexed individuals who are often forced in infancy into a gender assignment which may not be proper for them.