Thread by @briandavidearp

OK folks, time for another thread. This doctor, @DrChaya, is apparently running for Senate against @SenatorCollins (bit.ly/2TsgmSd). I was copied into a thread where someone had drawn a comparison between female & male genital cutting, which @DrChaya, like most people,

found astonishing & offensive, claiming "FGM removes the clitoris." It is understandable why she would think this, because even the @WHO states that at least some forms of FGM involve "partial or total removal of the clitoris."

The @WHO also states that "FGM is rooted in gender inequalities" and "constitutes an extreme form of discrimination against women" (bit.ly/1qUplWF). It also states that, unlike male circumcision, FGM has "no known health benefits." So, the prevailing view in Western

discourses is that FGM is like "cutting off the entire penis" as a way to sexually disable young boys. What most people don't know is the @WHO policy is funded primarily by anti-FGM activist groups, is not written by experts, is incoherent, & gets basic facts wrong. I'll explain.

First, there is *literally no form* of FGM, anywhere in the world, that removes the clitoris. The clitoris is a very large, complex organ that is mostly inside the body, like an iceberg, with a very small portion that protrudes outside. To remove it would require major surgery.

As my brilliant colleague Dr. Jasmine Abdulcadir shows in the below MRI, the most extreme forms of FGM affect the glans of the clitoris, leaving most of its erectile tissues & structures relevant for orgasm intact (bit.ly/2QpBzdK, bit.ly/2Tqgfq2). Moreover,

the @WHO typology for FGM includes more than a dozen distinct procedures (bit.ly/2iI2QaL), several of which do not affect any part of the clitoris, such as FGM Type IIa & some of FGM Type IV. In my own work, I argue it is *morally wrong* to cut the genitals of a child

*regardless* of which exact tissues or structures are affected & *whether or not* they will be able to experience pleasure or orgasm (as most women with FGM can!), simply because the child is defenseless, it is their most private body part, & they are incapable of giving consent.

Even the *risk* of sexual or psychological harm due to a 'ritual nick' (FGM Type IV, which does not remove tissue or typically alter the morphology of the vulva) is *unacceptable* if the child is healthy & cannot evaluate such risk for herself. After all, the knife could slip, or

nerve damage could occur; she might get an infection, etc. Even if these risks could be 'minimized' through medicalization, as is increasingly common in societies that practice FGM - taking their cue from US cutting of boys in hospitals - it is rational to prefer that *no* sharp

object be brought anywhere near one's intimate sexual anatomy unless it is *absolutely medically required* & the cutting cannot be delayed to an age of consent without putting one's life in danger. Of course, these same principles apply to medically unnecessary male circumcision

and to some surgeries, like "feminizing cliteroplasty" performed on children with ambiguous genitalia (see screenshot, from ). But these are accepted practices in Western societies, so we don't tend to think of them as harmful or ethically problematic.

Indeed, @DrChaya herself has performed medically unnecessary circumcisions on non-consenting, healthy patients, & had this done to her sons. So she may be highly motivated to find a clear distinction between this practice and "FGM" which she agrees is morally wrong (see below).

Her main approach is to cite "health benefits." However, removing any tissue from the body will have some "health benefits" because the tissue cannot become infected or have other problems. But surgery is not without risk. Whatever benefits there are must be weighed against risks

& as I pointed out, *every* international pediatric society or comparable medical org apart from @AmerAcadPeds has concluded the benefits of newborn circ do NOT outweigh risks (bit.ly/2AgagNF). Her response was to pull up PubMed & literally count articles that appear to

support circumcision, which is almost the definition of confirmation bias, and, needless to say, not how an MD should evaluate evidence for *any* claim, especially in a polarized literature where the data are regularly 'rigged' by partisan researchers (bit.ly/2ToqJX9).

But there is a deeper problem. If we want to say the sheer existence of "health benefits" (especially when these can be achieved through much less invasive, non-surgical means!) justifies cutting a healthy child's genitals without consent, we create an incentive for defenders

of what they call "female circumcision" to try to find "health benefits" for their *own* culturally favored rituals, which is exactly what some are now doing (see screen shots below, from my discussion here bit.ly/2F78yCl). But this is to miss the point. Genital cutting

is wrong to do to children, not because it does or doesn't confer (contestable) health benefits, but because it affects the most psychosexually significant part of a vulnerable person's body without their consent in a way they may later rationally grow up to resent.

If 'minor' or sterilized forms of FGM *did* have health benefits -- for example, neonatal labiaplasty might reduce the risk of labial cancer -- presumably no Western observer would then say, "Oh, in that case, I guess it's okay to do." See below (from bit.ly/2F78yCl).

Okay, what about the claim that FGM is a form of gender-based discrimination? This is another claim by the @WHO I am astonished gets uncritically repeated. There are *no societies* that single out girls for cutting. As far as anthropologists are aware, virtually every group that

practices ritual female genital cutting ALSO practices male genital cutting, often in parallel ceremonies for similar reasons (bit.ly/2F4Sv7g). Depending on the details of what is done, the male version of the ritual is often *much* more severe, as @Ayaan Hirsi Ali

discusses in this interview (bit.ly/2BW7w88). By far the most deadly form of genital cutting anywhere in the world is "tribal" male circumcision as it is practiced in many of the same regions that practice female genital cutting; among the Xhosa of South Africa,

dozens of boys die each year from their initiation rites, with multiple penile amputations and hospitalizations (bit.ly/2VtYoQV). Extensive, gruesome photographic evidence is available at ulwaluko.co.za - random sub-set below. Among the Xhosa,

as in many groups (Jews, US Americans, some Muslim sects but not others), *only* the boys are subjected to genital cutting, & women openly discriminate against 'uncircumcised' men as undesirable, unworthy of marriage, and so on (see screenshot, from bit.ly/2Qiyufm).

When most Westerners think of "male circumcision," they think of medicalized US newborn circumcision or perhaps Jewish circumcision at a bris; they don't think of "tribal" male circumcision with the highest death rate of any form of genital cutting. Similarly, when they think of

"FGM," they think of the most extreme forms of female genital cutting (FGC) done with non-sterile equipment in rural Africa - because this is the form the Western media focuses on & with which the @WHO brazenly conflates *all* forms of FGC, collapsing multiple distinct practices

with wildly different physical & sexual effects, risk profiles, symbolic meanings, parental intentions, religious significance, and so on, into a single label, falsely implying that *all* are done to "control the sexuality of girls" and have severe adverse health consequences.

It is no surprise, then, that Westerners fail to think of, say, 'sunnah' female circumcision in Malaysia (bit.ly/2F4x6Mj) or khatna among Dawoodi Bohra (bit.ly/2lgnX51), which are often done by doctors w sterile equipment & remove no tissue. But these are still

*wrong* to inflict on a young girl w/o her consent, I claim, for the reasons I have already given. Yet other scholars who work in this area, aware that "zero tolerance" for even 'minor' FGM means male circumcision might also be seen as wrong, are making the opposite argument.

For example, Arora & Jacobs, previously known 4 defending ritual male circ, have recently argued in top-ranked @JME_BMJ that Western countries should allow "de minimis" forms of FGM, as a way of creating a buffer of protection around male circumcision (bit.ly/2F6OZcm).

Their argument was then picked up by @TheEconomist, whose editors argued that, yes, we should allow "minor" FGM to be performed; otherwise, on pain of inconsistency, we might have 2 rethink medically unnecessary male circ, which no one wants to do (econ.st/2COqYFE).

Defenders of "female circumcision" have grown emboldened, setting up professional websites quoting directly from @AmerAcadPeds support for "parental rights" in male circumcision for "religious or cultural" reasons & calling out Western double standards (femalecircumcision.org)

Indeed, the @AmerAcadPeds had previously released a policy in which they, too, defended "ritual nicking" of little girls' vulvas on the grounds that this was "much less extensive" than male circumcision and the latter was also not medically necessary (bit.ly/2LOUZrA).

After outrage & push-back from anti-FGM groups such as the @OrchidProject (bit.ly/2VlUxp4), along with harrowing stories of pain and trauma from women who had been cut as girls, the @AmerAcadPeds quickly "retracted" its policy and affirmed that NO cutting should be done

to a girl without her consent if it is not strictly medically necessary, no matter how minor or sterilized. A more recent development is that a federal judge, Bernard Friedman, ruled that the 1996 US anti-FGM law is *unconstitutional* as I explain here: bit.ly/2TrpsOV.

Friedman rejected the government's "equal protection" argument for upholding the law, stating (a) 'ritual nicking' is already illegal in all 50 states as a form of physical assault & congress does not have authority to rule on state-level crimes, and (b) as laudable as it may be

to try to protect girls from a "particular type of abuse" to which they may be subjected (again, referring in this case to the ritual nick, not "extreme" forms of FGM), a sex-specific law "does not logically further the goal of protecting children on a non-discriminatory basis."

So this is just a heads up to people who want to protect children, including girls, from medically unnecessary genital cutting of all kinds. The strongest argument going forward will shift from the X axis (distinctions based on sex) to the Y axis (distinction based on consent),

as I argue in this talk, which I encourage you to watch (it's about 30 minutes and covers the latest issues prior to the federal FGM ruling) bit.ly/2GRAtaQ.

@threaderapp please unroll