| Clitoridectomy | |
|---|---|
| Other names | Clitorectomy |
| Specialty | Gynecology |
Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. [1] It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. Commonly, non-medical removal of the clitoris is performed during female genital mutilation. [2]
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 a clitoris size 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 Müllerian agenesis. Treatments on children raise human rights concerns. [6]
Clitoridectomy surgical techniques are used to remove an invasive malignancy that extends to the clitoris. Standard surgical procedures are followed in these cases. This includes evaluation and biopsy. Other factors that will affect the technique selected are age, other existing medical conditions, and obesity. Other considerations are the probability of extended hospital care and the development of infection at the surgical site. [3] The surgery proceeds with the use of general anesthesia, and prior to the vulvectomy/clitoridectomy an inguinal lymphadenectomy is first done. The extent of the surgical site extends one to two centimeters beyond the boundaries of malignancy. Superficial lymph nodes may also need to be removed. If the malignancy is present in muscular tissue in the region, it is also removed. In some cases, the surgeon is able to preserve the clitoris though the malignancy may be extensive. The cancerous tissue is removed and the incision is closed. [3]
Post operative care may employ the use of suction drainage to allow the deeper tissues to heal toward the surface. Follow up after surgery includes the stripping of the drainage device to prevent blockage. A typical hospital stay can be up to two weeks. The site of the surgery is left unbandaged to allow for frequent examination. [3] Complications can be the development of lymphedema though not removing the saphenous vein during the surgery will help prevent this. In some instances, foot elevation, diuretic medication and compression stockings can reduce the build up of fluid. [3]
In a clitoridectomy for infants with a clitoromegaly, the clitoris is often reduced instead of removed. The surgeon cuts the shaft of the elongated phallus and sews the glans and preserved nerves back onto the stump. In a less common surgery called clitoral recession, the surgeon hides the clitoral shaft under a fold of skin so only the glans remains visible. [7]
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 also have derived from ideas about what a normal female genitalia should look like and the policing of boundaries between the sexes. [8]
In the seventeenth century, anatomists remained divided on whether a clitoris was a normal female organ, with some arguing that it was an abnormality in female development and, if large enough to be visible, it should always be removed at birth. [9] In the 19th century, a clitoridectomy was thought by some to curb female masturbation. [10] 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. [11]
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. [12]
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. [13]
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. [14]
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. [15]
Clitoridectomies are the most common form of female genital mutilation. The World Health Organization (WHO) estimates that clitoridectomies 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. [16]
Clitoridectomy of women with conditions that cause a clitoromegaly is controversial when it takes place during childhood or under duress. Many women that were exposed to such treatment have reported their loss of physical sensation in the affected area, and loss of autonomy. [17] [18] In recent years, multiple human rights institutions have criticized early surgical management of such characteristics. [19] [20] [21]
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 disorder of sex development/intersex variation. [22] [23] In April 2016, the United Nations Special Rapporteur on health, Dainius Pūras, condemned this treatment as a form of genital mutilation "in the absence of symptoms or health issues warranting those procedures." [24]
In amniotes, the clitoris is a female sex organ. In humans, it is the vulva's most erogenous area and generally the primary anatomical source of female sexual pleasure. The clitoris is a complex structure, and its size and sensitivity can vary. The visible portion, the glans, of the clitoris is typically roughly the size and shape of a pea and is estimated to have at least 8,000 nerve endings.
Female genital mutilation (FGM) is the ritual cutting or removal of some or all of the vulva. The practice is found in some countries of Africa, Asia and the Middle East, and within their respective diasporas. As of 2023, UNICEF estimates that "at least 200 million girls... in 31 countries"—including Indonesia, Iraq, Yemen, and 27 African countries including Egypt—had been subjected to one or more types of FGM.
Genital modifications are forms of body modifications applied to the human sexual organs, such as piercings, circumcision, or labiaplasty. The term genital mutilation is generally used for genital modifications that diminish the recipient's quality of life and result in adverse health outcomes, whether physical or mental.
In female humans and other mammals, the clitoral hood is a fold of skin that surrounds and protects the glans of the clitoris; it also covers the external clitoral shaft, develops as part of the labia minora and is homologous with the foreskin in the male reproductive system. The clitoral hood is composed of mucocutaneous tissues; these tissues are between the mucous membrane and the skin, and they may have immunological importance because they may be a point of entry of mucosal vaccines.
The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The human female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo, which develops into the fetus. The uterus also produces secretions, which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.
Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.
Genital reconstructive surgery may refer to:
Intersex medical interventions (IMI), sometimes known as intersex genital mutilations (IGM), are surgical, hormonal and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. The medical interventions can be for a variety of reasons, due to the enormous variety of the disorders of sex development. Some disorders, such as salt-wasting disorder, can be life-threatening if left untreated.
The history of intersex surgery is intertwined with the development of the specialities of pediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed.
Vulvectomy refers to a gynecological procedure in which the vulva is partly or completely removed. The procedure is usually performed as a last resort in certain cases of cancer, vulvar dysplasia, vulvar intraepithelial neoplasia, or as part of female genital mutilation. Although there may be severe pain in the groin area after the procedure, for a number of weeks, sexual function is generally still possible but limited.
Clitoromegaly is an abnormal enlargement of the clitoris that is mostly congenital; it is otherwise acquired through deliberately induced clitoral enlargement e.g. body modification by use of anabolic steroids, including testosterone. It can happen as part of a gender transition. It is not the same as normal enlargement of the clitoris seen during sexual arousal.
The labia are the major externally visible portions of the vulva. In humans and other primates, there are two pairs of labia: the labia majora are large and thick folds of skin that cover the vulva's other parts while the labia minora are the inner folds of skin between the outer labia that surround and protect the urethral and vaginal openings.
Labiaplasty is a plastic surgery procedure for creating or altering the labia minora and the labia majora, the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range.
Disorders of sex development (DSDs), also known as differences in sex development or variations in sex characteristics (VSC), are congenital conditions affecting the reproductive system, in which development of chromosomal, gonadal, or anatomical sex is atypical.
Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is a plastic surgery procedure for reducing the size and the area of the clitoral hood in order to further expose the glans of the clitoris.
Female genital mutilation (FGM), also known as female circumcision or female genital cutting, includes any procedure involving the removal or injury of part or all of the vulva for non-medical reasons. While the practice is most common in Africa, Asia, and the Middle East, FGM is also widespread in immigrant communities and metropolitan areas in the United States, and was performed by doctors regularly until the 1980s.
Female genital mutilation in Sierra Leone is the common practice of removing all or part of the female's genitalia for cultural and religious initiation purposes, or as a custom to prepare them for marriage. Sierra Leone is one of 28 countries in Africa where female genital mutilation (FGM) is known to be practiced and one of few that has not banned it. It is widespread in part due to it being an initiation rite into the "Bondo," though initiation rite-related FGM was criminalised in 2019. The type most commonly practised in Sierra Leone is Type IIb, removal of part or all of the clitoris and the labia minora. As of 2013, it had a prevalence of 89.6%.
Nigeria has the highest rate of female genital mutilation (FGM) in the world in total numbers. It is usually experienced by girls aged 0 to 15 years old. It involves either partial or complete removal of the vulva or other injury to the female genital organs and has no medical benefit.
Intersex people in the United Kingdom face significant gaps in legal protections, particularly in protection from non-consensual medical interventions, and protection from discrimination. Actions by intersex civil society organisations aim to eliminate unnecessary medical interventions and harmful practices, promote social acceptance, and equality in line with Council of Europe and United Nations demands. Intersex civil society organisations campaign for greater social acceptance, understanding of issues of bodily autonomy, and recognition of the human rights of intersex people.
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