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Criminalizing medically unnecessary child genital cutting in Western countries: the terms of the debate and some reasons for caution

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Notes

  1. 1.

    The nuanced distinction between legal prohibition and criminalization, i.e. the decision to enforce a legal prohibition with criminal punishment, is eloquently explained by Merkel and Putzke [3].

  2. 2.

    The practice of (partially) removing the female foreskin or prepuce is also referred to as a ‘ritual nick’ (a small nick in the clitoral hood or vulva, which might not actually remove any tissue) or a clitoridotomy (removal of the clitoral hood—note this is not a clitoridectomy which affects the glans clitoris) and the latter is sometimes considered as the anatomical equivalent of male circumcision as commonly known in the West. The external clitoral glans and body (shaft) are not involved in these procedures and should, if performed by a sufficiently skilled practitioner, remain intact. This is the form of FGC that is most commonly practiced in South and Southeast Asia and is sometimes proposed as an alternative to more extensive procedures practiced elsewhere in the world as part of a harm-reduction strategy. In this context, two gynecologists have argued that particularly the ‘ritual nick’ should “not have a lasting effect on morphology or function” [1]. It is important to note that while a ritual nick can take place at a young age, it is anatomically difficult to perform a clitoridotomy in infancy and this usually takes place later in the child’s life. Male circumcision is generally performed in infancy by US Americans and Jews, while Muslims may perform the procedure anywhere from infancy to puberty. Circumcision could also be performed as a peripubertal rite of passage in Africa.

  3. 3.

    By using this terminology, I want to recognize that the child’s physical integrity is disrupted through a “cut,” without labeling the procedures as mutilation—which is a loaded term that precludes meaningful dialog and unnecessarily stigmatizes individuals, usually women, and minority communities. I do want to note, however, that the communities who value the practice of partial or total foreskin removal tend to refer to both male and female procedures as circumcision.

  4. 4.

    See for example Germany (2012), Iceland (2018) and Finland (2020) in Table 1.

  5. 5.

    See for example the proposal of the Tasmanian Law Reform Institute in Australia (2012) in Table 1.

  6. 6.

    Berer writes that, upon parental arrest, children are generally taken into the social care system, even when arrests are made based on suspicion or accusation alone, and forced to undergo (multiple) genital exams, see: [16]. For negative, and at time traumatic, effects of targeted genital exams see also: [17]. Further raising concerns is that expert witnesses might present significantly different interpretations of these exams because of limited knowledge and clinical experience with both FGC and the development of female genitalia, casting doubt as to whether parents are justly convicted. See for example: [18].

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Acknowledgements

I would like to thank Prof. Shweder for many valuable conversations on genital cutting over the years, for his encouragement to take up this project, and for his expert advice while writing it. I would also like to acknowledge my colleagues Yaseen Andrewsen and Henry Brefka for their thorough feedback and support. The two anonymous reviewers and issue editors have helped me improve this text and I want to thank them warmly for their time and efforts.

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Correspondence to R. Duivenbode.

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Duivenbode, R. Criminalizing medically unnecessary child genital cutting in Western countries: the terms of the debate and some reasons for caution. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00491-y

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