Loose lips mean profits

Once upon a time (as a WW2 poster warned) loose lips sank ships. These days they are being exploited by surgical entrepreneurs to generate profits for their business. An article in the British Medical Journal reports that cosmetic surgeons are using the Internet to entice women to seek female genital cosmetic surgery (FGCS) by picturing the normal female genitals (and especially a "large" labia) as ugly, smelly, difficult to keep clean, prone to irritation and likely to repel men. The article warns that the information on websites is misleading, often erroneous and potentially dangerous, and notes that in 2007 the American College of Obstetricians and Gynecologists issued a statement warning that "these procedures are not medically indicated and the safety and effectiveness of these procedures have not been documented."

Essentially, it is a case of profit-oriented medical business operators creating a demand for unnecessary surgeries by implying that normal genitals are somehow defective, but can be improved (and made more attractive to sexual partners) by a little judicious trimming. It is cynically preying on women's anxieties about their body and fears of rejection.

The article has attracted some commentary, including from bioethicist Brian Earp, who points out that nearly all the objections to FGCS can also be levelled at non-therapeutic circumcision (NTC) of male minors. All over the Internet, pro-circumcision websites warn that the normal penis (and especially one with a "large" foreskin) is ugly, smelly, difficult to keep clean, prone to irritation and likely to repel female sexual partners. Like the surgeons touting FGCS, the medical entrepreneurs who make money from excising (and sometimes then selling) infant foreskins paint lurid scenarios of the disease-risk posed by the unmodified penis, and imply that normal genitals are somehow defective, but can be improved (and made more attractive to sexual partners) by a little judicious trimming. It is cynically preying on men's anxieties about their body and fears of rejection.

The main differences between FGCS and NTC (or should we call it male genital cosmetic surgery?) relate to consent and professional attitudes. In most cases the women seeking FGCS are adults who can give consent, however ill-informed and misled they may be, not children who cannot. To this extent, FGCS is far less ethically objectionable than NTC of male minors: the principle that a person has ownership and control over his or her own body implies that not only that it should protected from interference and damage by others, but that a competent and informed adult can dispose of it in any way that he or she freely chooses.

But even more striking than this is the contrast between the humane concern (shown by the American gynaecologists and the BMJ) at the risks adult women are running, the bad information they are receiving, etc, and the dead silence on the risks and harm being imposed on male infants and boys, as well as the bad information their parents receive when they decide to get them circumcised. Yet while the FGCS racket is a fairly minor branch of medical mayhem, circumcision affects tens of millions of boys each year, and in some African countries (thanks to AIDS control programs) it has become a major industry and an important component of GNP. When scale and ethical/human rights issues are taken into account, it is clear that NTC of boys is a far greater problem than FGCS.

You would not know this from the law in Australia, nor from the policies of the Royal Australasian College of Physicians. In most states, the criminal code prohibits any cutting of the female genitals, unless medically necessary, even if the woman is an adult and requests the procedure. Payments for female circumcision were withdrawn from the Medical Benefits Schedule in 1995, yet Medicare still provides a no-questions-asked rebate for medically unnecessary circumcision of males, most of whom are infants.

To highlight the contrast between this ultra-protective attitude to women and the indifference shown to the welfare of boys, consider the policies of the RACP on female genital mutilation and male circumcision. According to the FGM policy, FGM is an injury to the external genitals; it is usually performed on girls between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; it is wrong because it is performed on minors without consent; it is illegal in all Australian states; and, although it is a practice authorized and recommended by some cultural and religious minorities, it is unacceptable in Australia. Doctors should vigorously oppose any form of FGM and become advocates for girls who are threatened with it, even against their parents and culture of origin.

These are fine sentiments, and one wonders why the same principles are absent from the RACP's policy on circumcision of boys. Yet circumcision is also an injury to the external genitals; it is usually performed between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; and it is performed on minors without consent. Despite all this, and although the RACP states clearly that circumcision is not warranted in Australia as a prophylactic health measure, the operation is OK if a boy's parents prefer him to be circumcised; the practice is not illegal or even regulated anywhere in Australia; and there is no suggestion that doctors should oppose the practice and become advocates for the victims.

Yet if any form of female genital cutting is a violation of a girl's human rights, it follows that any male genital cutting must violate the human rights of boys. A human right is a right that applies to all humans, regardless of gender or age, simply by virtue of their humanity; it has nothing to do with the culture of their parents. For the RACP's position to be logically consistent there are only two possibilities here: either a girl's right not to have any part of her genitals injured by FGM is a not a human right at all, but gender-specific right, applicable only to females; or boys are not human. Neither possibility seems likely, and the truth appears to be that the RACP is in the grip of the prevailing sexist double standard, whereby the slightest nick to the female genitals is an outrage that must be abhorred and opposed, while the most ruthless and brutal circumcision of a boy is a harmless snip that no sane person can really object to.

The authors of the BMJ article deserve full credit for exposing the designer vagina racket; what is needed even more urgently is a similar exposure of the designer penis racket.