Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and even if there is valid parental consent, (...) the presence of Body Dysmorphic Disorder means that cosmetic surgery will fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion. (shrink)

This article is concerned with "all-or-nothing" approaches to female genital cosmetic surgeries, those that overemphasize either women's autonomy to defend total accessibility or the oppressive social context affecting women to defend the total banning of the procedures. By contrast, the author takes both phenomena into consideration. The author argues identifying patterns of false consciousness and weighing those against harm done to a patient provides a moral basis for a doctor to possibly deny their consent at face value. (...) This also requires a shift in understanding the doctor–patient relationship as a first step toward a feminist model for women's healthcare. (shrink)

In the UK, female genital mutilation is unlawful, not only when performed on minors, but also when performed on adult women. The aim of our paper is to examine several arguments which have been advanced in support of this ban and to assess whether they are sufficient to justify banning female genital mutilation for competent, consenting women. We proceed by comparing female genital mutilation, which is banned, with cosmetic surgery, towards which the (...) law has taken a very permissive stance. We then examine the main arguments for the prohibition of the former, assessing in each case both (a) whether the argument succeeds in justifying the ban and, if so, (b) whether a parallel argument would not also support a ban on the latter. We focus on the following arguments. Female genital mutilation should be unlawful because: (1) no woman could validly consent to it; (2) it is an oppressive and sexist practice; (3) it involves the intentional infliction of injury; (4) it causes offence. Our view is that arguments (3) and (4) are unsound and that, although arguments (1) and (2) may be sound, they support not only a ban on female genital mutilation, but also one on (some types of) costmetic surgery. Hence, we conclude that the present legal situation in the UK is ethically unsustainable in one of the following ways. Either the ban on female genital mutilation is unjustified because arguments (1) and (2) are not in fact successful; or the law's permissive attitude towards cosmetic surgery is unjustified because arguments (1) and (2) are in fact successful and apply equally to female genital mutilation and (certain forms of) cosmetic surgery. The people of the countries where female genital mutilation is practised resent references to ‘barbaric practices imposed on women by male‐dominated primitive societies’, especially when they look at the Western world and see women undergoing their own feminization rites intended to increase sexual desirability: medically dangerous forms of cosmetic plastic surgery, for instance …. (shrink)

The Abagusii are one of the many communities in Kenya that engage in female genital cutting. Locally, the practice is simply known as “circumcision.” Introduced as “female circumcision” to the West, the practice was thought to parallel male circumcision. Both are referred to as tahiri, and both are coming of age rites. However, female circumcision was thought inaccurately to reflect the difference in health outcomes. As presented to the West, FGC results in worse health outcomes for (...) females than circumcision does for males. While male circumcision is credited with lowering HIV transmission, the opposite is true for FGC (UNICEF... (shrink)

Debates about female genital mutilation/cutting have polarized opinion between those who see it as an abuse of women’s health and human rights, to be ‘eradicated’, and those who may or may not oppose the practice, but see a double standard on the part of western campaigners who fail to challenge other unnecessary surgical interventions — such as male circumcision or cosmetic surgery — in their own communities and cultures. This article interrogates these debates about FGM/c in (...) the context of measures to reduce it in the UK over recent decades. It does not suggest that FGM/c is a legitimate practice, seeing it, rather, as an abuse of women’s and children’s rights that should be combated using a combination of measures. However, it argues that reduction strategies are undermined by inconsistencies in the law and the failure to back up the law with research and education. (shrink)

Making links between different embodied cultural practices has become increasingly common within the feminist literature on multiculturalism and cultural difference as a means to counter racism and cultural essentialism. The cross-cultural comparison most commonly made in this context is that between ‘African’ practices of female genital cutting (FGC) and ‘western’ body modifications. In this article, I analyse some of the ways in which FGC and other body-altering procedures (such as cosmetic surgery, intersex operations and 19th century (...) American clitoridectomies) are compared within this feminist literature. I identify two main strategies of linking such practices, which I have termed the ‘continuum’ and ‘analogue’ approaches. The continuum approach is employed to imagine FGC alongside other body-altering procedures within a single ‘continuum’, ‘spectrum’ or ‘range’ of cross-cultural body modifications. The analogue approach is used to set up FGC and other body-altering practices as analogous through highlighting cross-cultural similarities, but does not explicitly conceive of them as forming a single continuum. Two key critiques of the continuum and analogue approaches are presented. First, because these models privilege gender and sexuality, they tend to efface the operation of other axes of embodied differentiation, namely race, cultural difference and nation. As such, the continuum and analogue approaches often reproduce problematic relationships between race and gender while failing to address the implicit and problematic role which race, cultural difference and nation continue to play in such models. This erasure of these axes, I contend, is linked to the construction of a ‘western’ empathetic gaze, which is my second key critique. The desire on the part of theorists working in the West to establish cross-cultural ‘empathy’ through models that stress similarity and solidarity conceals the continuing operation of geo-political relations of power and privilege. (shrink)

A UK doctor was recently acquitted of charges of reinstating a variety of female genital mutilation after delivering a child. In this paper, I contend that this incident reflects a broader confusion concerning the ethico-legal status of non-therapeutic genital surgeries for children and adults, which are not derivable from tenets of medical ethics, but rather violate them. I argue that medical professionals have an obligation to announce and address this confusion in order to motivate legislative reform, since (...) the inconsistency of the current law entrenches the underlying sexism and ethnocentrism upon which its sense depends. Without convincing arguments for condoning male circumcision and female cosmetic genital surgery and for treating adult women of colour as lacking the capacity to consent, the current legislation stands in need of urgent revision. (shrink)

Labiaplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and is viewed as a worrying trend. Currently, the main clinical strategy is to reassure adolescents that they are normal by talking about the variation of labia size and appearance and showing pictures demonstrating the wide range of normal female genital appearance. For the most part, policy documents recommend against (...) labiaplasty in adolescents, claiming that it is medically non-essential surgery. In this paper, we contrast findings from our interviews with clinicians with the existing literature and policy documents and we point out areas needing more thought. This is qualitative research using semi-structured interviews. We set out to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labiaplasty. We interviewed clinicians who are likely to be approached by under-eighteens requesting labiaplasty. We use interpretive content analysis and thematic analysis to analyse the data. Our findings support the emphasis on education and reassurance as the first step for all patients, but other issues that have not figured previously in the literature that would alter clinical strategies for managing patients emerge as well. Key findings are that reassurance does not always work and that the distinction between functional and appearance concerns is not a solid foundation in itself for deciding whether surgery is ethically appropriate. We conclude that the distinction between functional and appearance concerns is not ethically relevant. It is open to different interpretations and is not regarded by all clinicians as the definitive factor in relation to surgery. The focus of clinicians should be on relieving distress whatever the cause. Appearance reasons may sometimes justify surgery but, also, functional reasons may sometimes not be sufficient justification for surgery. (shrink)

Recalcitrant disputes among health care providers and patients or their families may signal deep cultural differences about what interventions are needed or about clinicians’s professional duties. These issues arose in relation to a mother’s request for hymenoplasty or revirgination for her minor daughter to enable an overseas, forced marriage and protect her from an honor killing. The American College of Obstetrics and Gynecology committee recommends against members performing a hymenoplasty or other female genital cosmetic surgeries due to (...) a lack of data concerning their safety and efficacy. A key issue in such cases is how to determine what is in the minor’s best interest and the scope of health care moral or professional’s duties. The Best Interests Standard can serve as a powerful moral tool for resolving cross-cultural disputes and identifying needed policy. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (“children”). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or “endosex” females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians (...) may not perform any nonvoluntary genital cutting or surgery, from “cosmetic” labiaplasty to medicalized ritual “pricking” of the vulva, insofar as the procedure is not strictly necessary to protect the child’s physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit–risk calculations, but on a fundamental concern to respect the child’s privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter’s sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians’ widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

This paper addresses two related topics: 1. The disanalogies between elective cosmetic practices and sex reassignment surgery. Why does it seem necessary for me – an aging professional woman – to ignore the blandishments of hairdressers wielding dyes and dermatologists wielding acids and scalpels? Why does it not seem equally necessary for a transgendered person to repudiate sex reassignment procedures? 2. The role of the body in identity and agency. How do phenomenological insights regarding the constitution of selfhood (...) in relation to the interplay between the body image and corporeal know-how contribute to an account of the agency of transgendered individuals? Studying several paintings by contemporary feminist artist Jenny Saville has advanced my thinking on these topics. Saville’s imagery is an invaluable aid to reflection on these issues because she uses her painterly technique, which critics often dub “virtuoso,” to represent lived human bodies. In her work, viewers encounter representations of subjectivized, agentic corporeity, as distinct from inert, objectified flesh. Moreover, her sympathetic engagement with nonconformist, devalued bodies helps to reconfigure the standard gestalts of the human body that viewers typically carry with them and thus to convert fear and/or disgust into appreciation and understanding. In this paper, I consider three of Saville’s paintings. Plan, Saville’s self-portrait as a nude female whose body has been prepped for liposuction, conveys the pathos of this procedure. Matrix is a nude portrait of self-described “gender variant visual artist” Del LaGrace Volcano. In the words of one critic Saville’s depiction of Volcano’s nude intersexed body “restores beauty to the primitive [female] genital organ.” Passage, another nude portrait of an intersexed individual, is an image of vibrant sexuality despite the presumptively jarring juxtaposition of breasts and a penis. I argue that conceiving the agentic subject as a rational deliberative capability that uses a conjoined body as the instrument of its will makes it impossible to theorize the agency of transgendered people. In contrast, when agentic subjects are understood as embodied subjects and embodiment is understood as a dimension of practical intelligence, the agency of transgendered individuals is intelligible. (shrink)

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

Western feminists, physicians, and ethicists condemn the traditional genital surgeries performed on women in some non‐Western cultures. But coming to moral judgment is not the end of the story; we must also decide what to do about our judgments. We must learn to work respectfully with, not independently of, local resources for cultural self‐examination and change.

Western media coverage of female genital modifications in Africa has been hyperbolic and one-sided, presenting them uniformly as mutilation and ignoring the cultural complexities that underlie these practices. Even if we ultimately decide that female genital modifications should be abandoned, the debate around them should be grounded in a better account of the facts.

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the implications for (...) autonomy theory of these understandings of the relation between culture, FGC, and women’s agency. I review the range of worldwide FGC practices – including “corrective” surgery for “ambiguous genitalia” in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value‐neutral accounts of autonomy nor restrictive, value‐saturated accounts adequately explain women’s agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy‐disabling cultural alienation, promote autonomy‐within‐culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty (...) and blepharoplasty in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

The principle of respect for autonomy in clinical ethics is frequently linked to bioethics’ neglect of community-level ethical considerations. I argue that the latter is not an inevitable consequence of the former; rather, that neglect results from a common interpretation of respect for autonomy in solely synchronic and individual terms. A relational understanding of autonomy reveals the way in which respect inescapably involves diachronic and social dimensions. When these are acknowledged, the association between respect for autonomy and liberal individualism is (...) weakened. Such respect has more in common with communitarian approaches, and it need not conflict with the incorporation of collective-level values into ethical deliberation. (shrink)

Through illustrating the similarities between embodied practices rooted in different cultural contexts (such as `African' female genital cutting and `Western' cosmetic surgery), feminist theorists seek to reveal the instability of essentialist binaries which distinguish various groups as culturally, ethnically and morally `different'. They also aim to query how the term `culture' is employed differentially on the basis of embodied axes such as race and nation. However, in emphasizing overarching commonalities between practices, feminist cross-cultural comparisons risk collapsing (...) into economies of sameness that elide the complex relations of power through which such practices have been constituted. They can also fix the imagined subjects of these practices in troubling ways. Using the ubiquitous `African' female genital cutting and `Western' cosmetic surgery binary as an example, this article explores the difference it might make to address culturally essentialist constructions of embodied practice with a focus on relationality rather than commonality. As a means to reorient feminist cross-cultural approaches which depend on assertions of similarity or sameness, it argues for the theoretical and pedagogical utility of thinking through relational webs. (shrink)

It is suggested that the practice of attempting to normalise children with Down 's syndrome by subjecting them to major facial plastic surgery has no therapeutic benefit, and should be seen as mutilating surgery comparable to female circumcision.

Why do physicians who've taken the Hippocratic Oath willingly cut into seemingly healthy patients? How do you measure the success of surgery aimed at making someone happier by altering his or her body? Sander L. Gilman explores such questions in Creating Beauty to Cure the Soul, a cultural history of the connections between beauty of body and happiness of mind. Following these themes through an impressive range of historical moments and players, Gilman traces how aesthetic alterations of the body (...) have been used to "cure" dissatisfied states of mind. In his exploration of the striking parallels between the development of cosmetic surgery and the field of psychiatry, Gilman entertains an array of philosophical and psychological questions that underlie the more practical decisions rountinely made by doctors and potential patients considering these types of surgery. While surveying and incorporating the relevant theories of Sigmund Freud, Alfred Adler, Karl Menninger, Paul Schilder, contemporary feminist critics, and others, Gilman considers the highly unstable nature of cultural notions of health, happiness, and beauty. He reveals how ideas of race and gender structured early understandings of aesthetic surgery in discussions of both the "abnormality" of the Jewish nose and the historical requirement that healthy and virtuous females look "normal," thereby enabling them to achieve invisibility. Reflecting upon historically widespread prejudices, Gilman describes the persecutions, harrassment, attacks, and even murders that continue to result from bodily difference and he encourages readers to question the cultural assumptions that underlie the increasing acceptability of this surgical form of psychotherapy. Synthesizing a vast body of related literature and containing a comprehensive bibliography, Creating Beauty to Cure the Soul will appeal to a broad audience, including those interested in the histories of medicine and psychiatry, and in philosophy, cultural studies, Jewish cultural studies, and race and ethnicity. (shrink)

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these (...) appeals to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices. (shrink)

By modifying the body in meaningful ways, human beings establish their identity and social status. Lip plugs, ear plugs, penis sheaths, cosmetics, ornaments, scarification, body piercings, and genital modifications encode and transmit messages about age, sex, social status, health, and attractiveness from one individual to another. Through sociocultural sexual selection, male genital modification plays an important role as a sociosexual signal in both male competition and female mate choice. The reliability of the signal correlates with the cost (...) of acquiring the trait. Women use a variety of cues to assess male quality. Male genital modification is one way that some women assess their mates. Extreme male genital modifications not only honestly advertise status, sexual potency, and ability to provide sexual satisfaction, they may provide a reliable index of male-female cooperation through the male’s commitment to endure pain and risk. (shrink)

This article explores the unusually high levels of cosmetic surgery in South Korea – for both women and men. We argue that existing explanations, which draw on feminist and postcolonial positions, presenting cosmetic surgery as pertinent only to female and non-western bodies found lacking by patriarchal and racist/imperialist economies, miss important cultural influences. In particular, focus on western cultural hegemony misses the influence in Korea of national identity discourses and traditional Korean beliefs and practices such (...) as physiognomy. We show how these beliefs provide a more ‘gendered’ as opposed to feminist analysis, which allows space for discussion of men’s surgeries. Finally, we critique the accepted notion of the ‘western body’, especially its position in some literature as a more unobtainable ideal for non-western than for western women. We argue that this body has little in common with actual western women’s bodies, and more in common with a globalized image, embodying idealized elements from many different cultures. (shrink)

Very little research has attempted to describe normal human variation in female genitalia, and no studies have compared the visual images that women might use in constructing their ideas of average and acceptable genital morphology to see if there are any systematic differences. The objective of the present work was to determine if visual depictions of the vulva differed according to their source so as to alert medical professionals and their patients to how these depictions might capture variation (...) and thus influence perceptions of ‘normality’. A comparative analysis was conducted by measuring (a) published visual materials from human anatomy textbooks in a university library, (b) feminist publications (print and online) depicting vulval morphology and (c) online pornography, focusing on the most visited and freely accessible sites in the UK. Post hoc tests showed that labial protuberance was significantly less (p<0.001, equivalent to approximately 7 mm) in images from online pornography compared to feminist publications. All five measures taken of vulval features were significantly correlated (p<0.001) in the online pornography sample, indicating a less varied range of differences in organ proportions than the other sources where not all measures were correlated. Women and health professionals should be aware that specific sources of imagery may depict different types of genital morphology and may not accurately reflect true variation in the population, and consultations for genital surgeries should include discussion about the actual and perceived range of variation in female genital morphology. (shrink)

Few parents-to-be consider that their child may be born with ambiguous sex. Still, parents of a newborn child with ambiguous sex are expected to make a far-reaching decision for the child: should the child be operated upon so that it has either female or male genitals? The aim of this article is to examine, phenomenologically, why parents decide to have their children undergo genital surgery when it is not necessary for the child’s physiological functions. Drawing on phenomenological (...) work by Maurice Merleau-Ponty, Simone de Beauvoir and Sara Ahmed, we examine parents’ frustration when their child’s sex is ambiguous and their experiences of the practice of medical sex assignment. We also examine parental identity work when the child has been assigned a sex and the interaction between parents and medical professionals when parents make decisions regarding surgery on their child. Furthermore, we provide a critical perspective on the surgical practice. (shrink)

Male-to-female transsexualism manifests itself in the form of a discrepancy between the male sex assigned at birth and the subjective experience of belonging to the female gender, which in many cases also involves a somatic transition by cross-sex hormone treatment and genital surgery. Until now, no studies related to MtF transsexualism have been carried out within the framework of a phenomenological/existential approach. This paradigm would make it possible to better articulate the transsexual experience beyond the simplistic (...) diagnostic criteria by which it is currently defined. In this study, I will reread MtF transsexualism in the light of Ludwig Binswanger’s theories on Mannerism and Jean Paul Sartre’s remarks on the self and the body. I will do this largely by focusing on first-hand accounts of the MtF transsexual’s experience, in other words from a first-person viewpoint. Finally, I will present some considerations on the meaning of psychological intervention in this field. (shrink)

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality (...) and reproduction to show how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of “normal” male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. (shrink)

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

The market for cosmetic surgery tourism is growing with an increase in people travelling abroad for cosmetic surgery. While the reasons for seeking cosmetic surgery abroad may vary the most common reason is financial, but does cheaper surgery abroad carry greater risks? We explore the risks of poorly regulated cosmetic surgery to society generally before discussing how harm might be magnified in the context of cosmetic tourism, where the demand for (...) cheaper surgery drives the market and makes surgery accessible for increasing numbers of people. This contributes to the normalisation of surgical enhancement, creating unhealthy cultural pressure to undergo invasive and risky procedures in the name of beauty. In addressing the harms of poorly regulated surgery, a number of organisations purport to provide a register of safe and ethical plastic surgeons, yet this arguably achieves little and in the absence of improved regulation the risks are likely to grow as the global market expands to meet demand. While the evidence suggests that global regulation is needed, the paper concludes that since a global regulatory response is unlikely, more robust domestic regulation may be the best approach. While domestic regulation may increase the drive towards foreign providers it may also have a symbolic effect which will reduce this drive by making people more aware of the dangers of surgery, both to society and individual physical wellbeing. (shrink)

One of the most challenging issues in cross-cultural bioethics concerns the long-standing socio-cultural practice of female genital circumcision, which is prevalent in many African countries and the Middle East as well as in some Asian and Western countries. It is commonly assumed that FGC, in all its versions, constitutes a gross violation of the universal human rights of health, physical integrity, and individual autonomy and hence should be abolished. This article, however, suggests a mediating approach according to which (...) one form of FGC, the removal of the clitoris foreskin, can be made compatible with the high demands of universal human rights. The argument presupposes the idea that human rights are not absolutist by nature but can be framed in a meaningful, culturally sensitive way. It proposes important limiting conditions that must be met for the practice of FGC to be considered in accordance with the human rights agenda. (shrink)

Female genital mutilation is the removal or restructuring of healthy genital tissue. Under natural law, mutilation is an intrinsic evil and a grave violation of human dignity. If mutilation alleviates a threat to a person’s well-being, it may sometimes be permissible, but healthy genitals pose no such threat. The purported social benefits of FGM, such as decreased promiscuity, do not justify the practice, because there is no causal relationship between mutilation and virtue. In terms of autonomy, victims (...) are usually children and unable to consent. Parental rights and the rights of religion do not override children’s inherent rights to physical integrity and safety. Current support for minimal forms of FGM in an attempt to reduce the incidence of severe forms will instead prolong the practice and increase the number of victims. Finally, FGM differs from male circumcision in that it destroys the function and integrity of the organs themselves and promotes profound gender inequality. (shrink)

Leading feminist scholars have been brought together for the first time in this comprehensive volume to reveal the complexity of feminist engagements with the exponentially growing cosmetic surgery phenomenon. Offering a diversity of theoretical, methodological and political approaches Cosmetic Surgery: A Feminist Primer presents not only the latest, cutting-edge research in this field but a challenging and unique approach to the issue that will be of key interest to researchers across the social sciences and humanities.

Recently, there has been a shift in attitude among some feminists towards the practice of cosmetic surgery away from that of outright rejection. Kathy Davis, for instance, offers a guarded `defence' of the practice as a strategy that enables women to exercise a degree of control over their lives in circumstances where there are very few other opportunities for self-realization. Others, such as Kathryn Morgan, Anne Balsamo and Orlan, though highly critical of the current practice of cosmetic (...) surgery, go even further than Davis in advocating its redeployment as a tool to subvert the dominant patriarchal ideals of feminine beauty. In this article I critically appraise this `rehabilitation' of cosmetic surgery, arguing, in the case of Davis, that she leaves unchallenged the social structures of inequality responsible for women's dissatisfaction with their bodies. The proposal to use cosmetic surgery as a tool of political critique is equally problematic insofar as it shares with the cosmetic industry its instrumentalization of the body as mere matter, which is almost infinitely transformable, and also effaces the economic inequalities within which such body transformations occur. (shrink)

Hymenoplasty is a practice that must be judged from within its cultural confines and not only from outside. It offers women who have grown up within the sexual norms of a Western society the chance to return to their parental culture, with its female-specific virginity expectations. Hymenoplasty allows women to be sexually active prior to marriage, which equalizes the discrepancy between gender norms on premarital sexual experience. Caution is needed when comparing hymenoplasty to female genital mutilation. However, (...) comparing hymenoplasty to other cosmetic genital modification procedures raises unique ethical, social, and medical quandaries that highlight the importance of patient’s autonomy. (shrink)

In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values (...) that conflict with the doctor's ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large. (shrink)

Herbert, Dilinie This article reports on the experiences of Female Genital Mutilation/Cutting for women living in countries where it is widespread and for those who migrate to Western countries. It explores the attitudes that shape the ongoing practice of FGM/C and the role of female hierarchy in sustaining these customs in practising communities. In particular, it investigates the dialogue between health professionals in Western countries like Australia and women presenting for antenatal care. This includes conversations around de-infibulation.

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of (...) class='Hi'>female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work. (shrink)

ABSTRACT The Universal Draft Declaration on Bioethics and Human Rights seeks to provide moral direction to nations and their citizens on a series of bioethical concerns. In articulating principles, it ranks respect for human rights, human dignity and fundamental freedoms ahead of respect for cultural diversity and pluralism. This ranking is controversial because it entails the rejection of the popular theory, conventionalist ethical relativism. If consistently defended, this theory also undercuts other United Nations activities that assume member states and people (...) around the world can reach trans‐cultural judgments having moral authority about health, pollution, aggression, rights, slavery, and so on. To illustrate problems with conventionalist ethical relativism and the importance of rejecting it for reasons of health, human rights, human dignity and fundamental freedoms, the widespread practice of female genital circumcision or cutting is discussed. These surgeries are virtually a test case for conventionalist ethical relativism since they are widely supported within these cultures as religious and health practices and widely condemned outside them, including by the United Nations. (shrink)

The metaphor of inscription on the body and the constitution of the body through those inscriptions have been widely used in recent attempts to theorize the body. Michel Foucault calls the body the ‘inscribed surface of events’ (Foucault, 1984: 83) and Elizabeth Grosz argues that the ‘female (or male) body can no longer be regarded as a fixed, concrete substance, a pre-cultural given. It has a determinate form only by being socially inscribed’ (Grosz, 1987: 2). The body becomes plastic, (...) inscribed with gender and cultural standards. While Foucault assumes the existence of a pre-inscriptive body, many theorists reject that idea and argue that ‘there is no recourse to a body that has not always already been interpreted by cultural meanings’ (Butler, 1990: 8). The constitution of the body rests in its inscription; the body becomes the text which is written upon it and from which it is indistinguishable. Starting from Catherine Belsey's suggestion that to ‘give the metaphor literal significance … is to … isolate it for contemplation’ (Belsey, 1988: 100), I discuss this metaphor of inscription, using cosmetic surgery as one literal example. While some theorists reject the pre-inscriptive body, the popular discourses advocating changing one's body assume unproblematically the existence of a body prior to these ‘elective’ procedures and reinforce the mind/body dualism which recent theory has sought so insistently to reject. I examine how popular discourses of body modification enforce a disciplinary regime (in Foucault's sense) and impose degrees of both literal and figurative inscription. Juxtaposing these two perspectives, I explore how both discourses efface the materiality of the body and the social contexts within which bodies are experienced and constructed. While the rhetoric surrounding cosmetic surgery denies the physical process and the economic constraints, so theories of the body which stress the body's plasticity also deny the materiality of that process and the cultural and social contexts within which the body is always placed. (shrink)

Labioplasty is a surgical procedure performed to alter the size and shape of the labia minora. The reasons for women requesting this procedure remain largely unknown and recently girls and young women under the age of 18 years have been requesting this type of surgery. This paper examines the ethical acceptability of performing this procedure on under 18s. We will first discuss whether labioplasty can be considered to be a therapeutic technique. We will claim that, while it is difficult (...) to offer a definitive definition of what constitutes a therapeutic technique, in our view labioplasty cannot be considered as such. This conclusion has relevance for the ethical acceptability of the procedure, its legal status in regard to the Female Genital Mutilation Act and the debates over who can give consent for it. It will be concluded that in our current state of knowledge, the benefits of labioplasty are far from clear, whereas the harms are demonstrable and therefore this procedure should not be offered to those aged under 18 years. (shrink)

The migratory flows of recent decades that have exercised Europe as a socio-political and economic entity have produced extensive responses and interventions from European gender scholars. One relatively recent phenomenon in this context is the question of reparative surgical interventions, specifically clitoral reconstruction, in cases where women who have migrated to Europe have experienced female genital cutting. Clitoral reconstruction, which this article begins to explore, is recent in part because the related surgery was only established in the (...) 1990s and is to date only practised in a few European countries, and in part because the research with women who ask for and have undergone such surgery has also only recently begun. This article is therefore an initial attempt to map some of the related terrain and to suggest further work that needs to be done in this increasingly important area. (shrink)

There exist a variety of biological variations known as intersex conditions or disorders of sex development, which cause a per­son’s sex as male or female to be uncertain at birth. In the past several decades, cosmetic surgery aimed at “normalizing” the infant’s body has become an increasingly controversial treatment for an infant with an IC or DSD. While ICs and DSDs are not addressed directly by Catholic moral teaching, the Catholic Tradition has a number of tools that (...) can undergird a Catholic response to the suffering of people with ICs and DSDs and support improved medical, pastoral, and spiritual care for them and their families. (shrink)

The Public Policy Advisory Network on Female Genital Surgeries in Africa has written an article expressing concern about the media's inaccurate depiction of this practice and suggesting a more fact‐based approach to reporting on it. I applaud the network for soliciting input from various fields. I cannot agree more that some in the media have misconstrued, exaggerated, and used inflammatory language; words like “torture,” “barbaric,” and “horrific” will likely enrage readers while reinforcing discrimination against women who practice or (...) have undergone genital cutting. The authors also assert that “any genuine public policy debate should be grounded in the best available evidence and begins with fact checking.” Again, I couldn't agree more. My concern is that there is bias in the way some of the data are presented in this article. (shrink)

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by (...) reviewing the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common? (shrink)