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Genital Autonomy and Sexual Well-being

  • Sociocultural Issues and Epidemiology (J Abdulcadir and C Johnson-Agbakwu, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this study is to survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices.

Recent Findings

Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework is needed.

Summary

All children have an interest in genital autonomy, regardless of their sex or gender.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. DeLaet DL. Genital autonomy, children’s rights, and competing rights claims in international human rights law. Int J Child Rights. 2012;20(4):554–83. https://doi.org/10.1163/15718182-55680007.

    Article  Google Scholar 

  2. Mason P. Intersex genital autonomy: a rights-based framework for medical intervention with intersex infants. In: Denniston GC, Hodges FM, Milos MF, editors. Genital cutting: protecting children from medical, cultural, and religious infringements. Dordrecht: Springer Netherlands; 2013. p. 149–84. Available from: http://link.springer.com/10.1007/978-94-007-6407-1_11.

  3. Svoboda JS. Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting. Glob Discourse. 2013;3(2):237–55. https://doi.org/10.1080/23269995.2013.804757.

    Article  Google Scholar 

  4. Earp BD. In defence of genital autonomy for children. J Med Ethics. 2016;42(3):158–63. https://doi.org/10.1136/medethics-2015-103030.

    Article  PubMed  Google Scholar 

  5. Mazor J. On the child’s right to bodily integrity: when is the right infringed? J Med Philos. 2017. Available from: http://academic.oup.com/jmp.

  6. Glass M. Forced circumcision of men (abridged). J Med Ethics. 2014;40(8):567–71. https://doi.org/10.1136/medethics-2013-101626.

    Article  PubMed  Google Scholar 

  7. Sarajlic E. Can culture justify infant circumcision? Res Publica. 2014;20(4):327–43. https://doi.org/10.1007/s11158-014-9254-x.

    Article  Google Scholar 

  8. Ungar-Sargon E. On the impermissibility of infant male circumcision: a response to Mazor (2013). J Med Ethics. 2015;41(2):186–90. https://doi.org/10.1136/medethics-2013-101598.

    Article  PubMed  Google Scholar 

  9. McMath A. Infant male circumcision and the autonomy of the child: two ethical questions. J Med Ethics. 2015;41(8):687–90. https://doi.org/10.1136/medethics-2014-102319.

    Article  PubMed  Google Scholar 

  10. Möller K. Ritual male circumcision and parental authority. Jurisprudence. 2017;8(3):461–79. https://doi.org/10.1080/20403313.2017.1339535.

    Article  Google Scholar 

  11. Van Howe RS. Infant circumcision: the last stand for the dead dogma of parental (sovereignal) rights. J Med Ethics. 2013;39(7):475–81. https://doi.org/10.1136/medethics-2012-101209.

    Article  PubMed  Google Scholar 

  12. Darby RJL. The child’s right to an open future: Is the principle applicable to non-therapeutic circumcision? J Med Ethics. 2013;39(7):463–8. https://doi.org/10.1136/medethics-2012-101182.

    Article  PubMed  Google Scholar 

  13. Lightfoot-Klein H, Chase C, Hammond T, Goldman R. Genital surgeries on children below an age of consent. In: Szuchman LT, Muscarella F, editors. Psychological perspectives on human sexuality. New York: Wiley; 2000. p. 440–79.

    Google Scholar 

  14. Sardi LM. Male circumcision. In: The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies. 1st ed. Hoboken: John Wiley & Sons, Ltd; 2016. p. 1–3. Available from: http://onlinelibrary.wiley.com/doi/10.1002/9781118663219.wbegss255/abstract.

  15. Darby R. Targeting patients who cannot object? Re-examining the case for non-therapeutic infant circumcision. SAGE Open. 2016;6(2):1–16. https://doi.org/10.1177/2158244016649219.

    Article  Google Scholar 

  16. Svoboda JS. Circumcision of male infants as a human rights violation. J Med Ethics. 2013;39(7):469–74. https://doi.org/10.1136/medethics-2012-101229.

    Article  PubMed  Google Scholar 

  17. Archard DW. Children’s rights. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Summer 2016. Metaphysics Research Lab, Stanford University; 2016. Available from: https://plato.stanford.edu/archives/sum2016/entries/rights-children/.

  18. Hellsten SK. Rationalising circumcision: from tradition to fashion, from public health to individual freedom—critical notes on cultural persistence of the practice of genital mutilation. J Med Ethics. 2004;30(3):248–53. https://doi.org/10.1136/jme.2004.008888.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fischel JJ, O’Connell HR. Disabling consent, or reconstructing sexual autonomy. Columbia J Gend Law. 2015;30(2):428–528. https://cjgl.cdrs.columbia.edu/article/disabling-consent-or-reconstructing-sexual-autonomy/.

  20. Paalanen T. Sexual rights of young people: dilemmas concerning sexual autonomy. J Sex Med. 2017;14(5):e239. https://doi.org/10.1016/j.jsxm.2017.04.151.

    Article  Google Scholar 

  21. Earp B. The right to bodily integrity and the concept of sexual harm. J Sex Med. 2017;14(5, Supplement 4):e239. https://doi.org/10.1016/j.jsxm.2017.04.153.

    Article  Google Scholar 

  22. Dekkers W, Hoffer C, Wils J-P. Bodily integrity and male and female circumcision. Med Health Care Philos. 2005;8(2):179–91. https://doi.org/10.1007/s11019-004-3530-z.

    Article  PubMed  Google Scholar 

  23. Ludbrook R. The child’s right to bodily integrity. Curr Issues Crim Just. 1995;7(2):123–32. http://heinonline.org/HOL/Page?handle=hein.journals/cicj7&div=23&g_sent=1&casa_token=.

  24. Earp BD. Sex and circumcision. Am J Bioeth. 2015;15(2):43–5. https://doi.org/10.1080/15265161.2014.991000.

    Article  PubMed  Google Scholar 

  25. • Earp BD. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework. Medicolegal Bioeth. 2015;5(1):89–104. https://doi.org/10.2147/MB.S63709. Extensive discussion of the parallels between male and female forms of genital cutting; undermines the view that the two cannot be compared on the basis of health consequences or symbolic meanings.

    Article  Google Scholar 

  26. Svoboda JS. Growing world consensus to leave circumcision decision to the affected individual. Am J Bioeth. 2015;15(2):46–8. https://doi.org/10.1080/15265161.2014.990760.

    Article  PubMed  Google Scholar 

  27. Earp BD, Darby R. Circumcision, autonomy and public health. Public Health Ethics. 2018. https://doi.org/10.1093/phe/phx024.

  28. • Earp BD, Darby R. Circumcision, sexual experience, and harm. Univ Pa J Int Law. 2017;37(2–online):1–57. Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2986449. In-depth analysis of the concept of “harm” as applied to genital cutting debates. Explains why some people feel greatly harmed by their childhood genital operations while others feel relatively unharmed, and attempts to take both perspectives seriously.

  29. Smith NK, Butler S, Wagner B, Collazo E, Caltabiano L, Herbenick D. Genital self-image and considerations of elective genital surgery. J Sex Marital Ther. 2017;43(2):169–84. https://doi.org/10.1080/0092623X.2016.1141820.

    Article  PubMed  Google Scholar 

  30. Fudge MC, Byers ES. “I have a nice gross vagina”: understanding young women’s genital self-perceptions. J Sex Res. 2017;54(3):351–61. https://doi.org/10.1080/00224499.2016.1155200.

    Article  PubMed  Google Scholar 

  31. Archard D. The wrong of rape. Philos Q. 2007;57(228):374–93. https://doi.org/10.1111/j.1467-9213.2007.492.x.

    Article  Google Scholar 

  32. Waites M. The age of consent: young people, sexuality and citizenship. Houndmills: Palgrave Macmillan; 2005. 294 p. https://doi.org/10.1057/9780230505933.

    Book  Google Scholar 

  33. Chegwidden J. Response: Tasmanian Law Reform Institute Issues Paper No. 14: non-therapeutic male circumcision (pp. 1–79). 2009. Available from: http://www.utas.edu.au/__data/assets/pdf_file/0003/283701/CircumcisionIssuesPaperA4toPrint.pdf

  34. Askew I, Chaiban T, Kalasa B, Sen P. A repeat call for complete abandonment of FGM. J Med Ethics. 2016;42(9):619–20. https://doi.org/10.1136/medethics-2016-103553.

    Article  PubMed  PubMed Central  Google Scholar 

  35. • Earp BD. Between moral relativism and moral hypocrisy: reframing the debate on “FGM.” Kennedy Inst Ethics J. 2016;26(2):105–44. https://doi.org/10.1353/ken.2016.0009. Extensive critique of the 2008 World Health Organization policy on “FGM,” showing that it contains anatomical errors, anthropological weaknesses, and other scholarly shortcomings, which together threaten to undermine its stated aim of protecting girls from harm.

    Article  PubMed  Google Scholar 

  36. Weston J. Female genital mutilation: the law as it relates to children. Arch Dis Child. 2017;102(9):864–7. https://doi.org/10.1136/archdischild-2017-313090.

    Article  PubMed  Google Scholar 

  37. • La Barbera MC. Ban without prosecution, conviction without punishment, and circumcision without cutting: a critical appraisal of anti-FGM laws in Europe. Glob Jurist. 2017;17(2):20160012. https://doi.org/10.1515/gj-2016-0012. Insightful feminist analysis of some of the strengths and weaknesses of current anti-FGM laws throughout Europe.

    Google Scholar 

  38. Center for Reproductive Rights. Female genital mutilation (FGM): legal prohibitions worldwide. Center for Reproductive Rights. 2014. Available from: http://www.reproductiverights.org/document/female-genital-mutilation-fgm-legal-prohibitions-worldwide.

  39. Braun V. ‘The women are doing it for themselves’: the rhetoric of choice and agency around female genital ‘cosmetic surgery.’ Aust Fem Stud. 2009;24(60):233–49. https://doi.org/10.1080/08164640902852449.

    Article  Google Scholar 

  40. Mason C. Exorcising excision: medico-legal issues arising from male and female genital surgery in Australia. J Law Med. 2001;9(1):58–67. http://www.cirp.org/library/legal/mason1/.

  41. Dustin M. Female genital mutilation/cutting in the UK: challenging the inconsistencies. Eur J Womens Stud. 2010;17(1):7–23. https://doi.org/10.1177/1350506809350857.

    Article  Google Scholar 

  42. Chambers C. Are breast implants better than female genital mutilation? Autonomy, gender equality and Nussbaum’s political liberalism. Crit Rev Int Soc Polit Philos. 2004;7(3):1–33. https://doi.org/10.1080/1369823042000269366.

    Article  Google Scholar 

  43. •• Shahvisi A. Why UK doctors should be troubled by female genital mutilation legislation. Clin. Ethics. 2017;12(2):102–8. https://doi.org/10.1177/1477750916682671. Critical examination of double-standards in UK legislation concerning female genital cutting, with practical implications for doctors who must make real-life decisions based on an unclear and in some ways incoherent law.

    Article  Google Scholar 

  44. Kelly B, Foster C. Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? BJOG Int J Obstet Gynaecol. 2012;119(4):389–92. https://doi.org/10.1111/j.1471-0528.2011.03260.x.

    Article  CAS  Google Scholar 

  45. Jones M. Intersex genital mutilation—a Western version of FGM. Int J Child Rights. 2017;25(2):396–411. https://doi.org/10.1163/15718182-02502008.

    Article  Google Scholar 

  46. Horowicz EM. Intersex children: who are we really treating? Med Law Int. 2017;17(3):183–218. https://doi.org/10.1177/0968533217726109.

    Article  Google Scholar 

  47. McNamara ER, Swartz JM, Diamond DA. Initial management of disorders of sex development in newborns. Urology. 2017:101(Supplement C):1–8.

  48. Carmack A, Notini L, Earp BD. Should surgery for hypospadias be performed before an age of consent? J Sex Res. 2016;53(8):1047–58. https://doi.org/10.1080/00224499.2015.1066745.

    Article  Google Scholar 

  49. Ford K-K. “First, do no harm”: the fiction of legal parental consent to genital-normalizing surgery on intersexed infants. Yale Law Policy Rev. 2001;19(2):469–88. http://heinonline.org/HOL/LandingPage?collection=journals&handle=hein.journals/yalpr19&div=30&id&page.

  50. Ehrenreich N, Barr M. Intersex surgery, female genital cutting, and the selective condemnation of cultural practices. Harv Civ Rights-Civ Lib Law Rev. 2005;40(1):71–140. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2926589.

  51. Karkazis K. Fixing sex: intersex, medical authority, and lived experience. Durham: Duke University Press; 2008. 381 p. https://doi.org/10.1215/9780822389217.

    Book  Google Scholar 

  52. Reis E. Intersex surgeries, circumcision, and the making of “normal.” In: Denniston GC, Hodges FM, Milos MF, editors. Genital cutting: protecting children from medical, cultural, and religious infringements. Dordrecht: Springer Netherlands; 2013. p. 137–47. Available from: http://link.springer.com/10.1007/978-94-007-6407-1_10.

  53. Dreger A. Intersex in the age of ethics. Hagerstown: University Publishing Group; 1999. Available from: http://repository.library.georgetown.edu/handle/10822/919081.

  54. Dreger AD, Herndon AM. Progress and politics in the intersex rights movement: feminist theory in action. GLQ J Lesbian Gay Stud. 2009;15(2):199–224. https://doi.org/10.1215/10642684-2008-134.

    Article  Google Scholar 

  55. Dreger A. Do you have to pee standing up to be a real man? Pacific Standard. 2014. Available from: https://psmag.com/social-justice/pee-standing-real-man-73133.

  56. Schlomer B, Breyer B, Copp H, Baskin L, DiSandro M. Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey. J Pediatr Urol. 2014;10(4):672–9. https://doi.org/10.1016/j.jpurol.2014.01.024.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Green FJ. From clitoridectomies to ‘designer vaginas’: the medical construction of heteronormative female bodies and sexuality through female genital cutting. Sex Evol Gend. 2005;7(2):153–87. https://doi.org/10.1080/14616660500200223.

    Article  Google Scholar 

  58. Dangle PP, Lee A, Chaudhry R, Schneck FX. Surgical complications following early genitourinary reconstructive surgery for congenital adrenal hyperplasia—interim analysis at 6 years. Urology. 2017;101(Supplement C):111–5. https://doi.org/10.1016/j.urology.2016.11.027.

    Article  PubMed  Google Scholar 

  59. Raveenthiran V. Neonatal sex assignment in disorders of sex development: a philosophical introspection. J Neonatal Surg. 2017;6(3):58. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593477/.

  60. Creighton S. Surgery for intersex. J R Soc Med. 2001;94(5):218–20. https://doi.org/10.1177/014107680109400505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Baratz AB, Feder EK. Misrepresentation of evidence favoring early normalizing surgery for atypical sex anatomies. Arch Sex Behav. 2015;44(7):1761–3. https://doi.org/10.1007/s10508-015-0529-x.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Creighton S, Minto C. Managing intersex. BMJ. 2001;323(7324):1264–5. https://doi.org/10.1136/bmj.323.7324.1264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Bougnères P, Bouvattier C, Cartigny M, Michala L. Deferring surgical treatment of ambiguous genitalia into adolescence in girls with 21-hydroxylase deficiency: a feasibility study. Int J Pediatr Endocrinol. 2017;2017(3):1–5. https://doi.org/10.1186/s13633-016-0040-8.

    Google Scholar 

  64. Human Rights Watch. “I want to be like nature made me.” Medically unnecessary surgeries on intersex children in the US. Human Rights Watch. 2017. Available from: http://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us.

  65. • Svoboda JS, Adler PW, Van Howe RS. Circumcision is unethical and unlawful. J Law Med Ethics. 2016;44(2):263–82. https://doi.org/10.1177/1073110516654120. Synthesizes arguments suggesting that male circumcision performed before an age of consent and without a proper medical diagnosis may be unlawful.

    Article  PubMed  Google Scholar 

  66. Boyle GJ, Svoboda J, Price C, Turner JN. Circumcision of healthy boys: criminal assault? J Law Med. 2000;7:301–10. http://www.cirp.org/library/legal/boyle1/.

  67. National Secular Society. Doctor faces private prosecution for circumcising baby boy without the mother’s consent. National Secular Society. 2017. Available from: http://www.secularism.org.uk/news/2017/05/doctor-faces-private-prosecution-for-circumcising-baby-boy-without-the-mothers-consent.

  68. Munzer SR. The German circumcision controversy—and beyond. Univ Pa J Int Law. 2017;37(2):1–34. http://www.ssrn.com/abstract=2947893.

  69. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999;83(S1):34–44. https://doi.org/10.1046/j.1464-410x.1999.0830s1034.x.

    Article  PubMed  Google Scholar 

  70. Werker PM, Terng AS, Kon M. The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap. Plast Reconstr Surg. 1998;102(4):1075–82. https://doi.org/10.1097/00006534-199809020-00024.

    Article  CAS  PubMed  Google Scholar 

  71. Kigozi G, Wawer M, Ssettuba A, Kagaayi J, Nalugoda F, Watya S, et al. Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters). AIDS Lond Engl. 2009;23(16):2209–13. https://doi.org/10.1097/QAD.0b013e328330eda8.

    Article  Google Scholar 

  72. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996;77(2):291–5. https://doi.org/10.1046/j.1464-410X.1996.85023.x.

    Article  CAS  PubMed  Google Scholar 

  73. Scott S. The anatomy and physiology of the human prepuce. In: Male and female circumcision. Springer; 1999. p. 9–18. Available from: http://link.springer.com/chapter/10.1007/978-0-585-39937-9_2.

  74. Bossio JA, Pukall CF, Steele SS. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J Urol. 2016;195(6):1848–53. https://doi.org/10.1016/j.juro.2015.12.080.

    Article  PubMed  Google Scholar 

  75. Frisch M. Re: “Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing”. J Urol. 2016;196(6):1821–2. https://doi.org/10.1016/j.juro.2016.05.127.

    PubMed  Google Scholar 

  76. Rotta A. Re: “Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing.”. J Urol. 2016;196(6):1822–3. https://doi.org/10.1016/j.juro.2016.05.127.

    PubMed  Google Scholar 

  77. Van Howe RS, Sorrells ML, Snyder JL, Reiss MD, Milos MF. Re: “Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing.”. J Urol. 2016;196(6):1824. https://doi.org/10.1016/j.juro.2016.05.127.

    PubMed  Google Scholar 

  78. Earp BD. Infant circumcision and adult penile sensitivity: implications for sexual experience. Trends Urol Mens Health. 2016;7(4):17–21. https://doi.org/10.1002/tre.531.

    Article  Google Scholar 

  79. Harrison DM. Rethinking circumcision and sexuality in the United States. Sexualities. 2002;5(3):300–16. https://doi.org/10.1177/1363460702005003003.

    Article  Google Scholar 

  80. Frisch M, Earp BD. Problems in the qualitative synthesis paper on sexual outcomes following non-medical male circumcision by Shabanzadeh et al. Dan Med J. 2016;63(7):A5245. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27399981#cm27399981_77941.

  81. Fox M, Thomson M. Foreskin is a feminist issue. Aust Fem Stud. 2009;24(60):195–210. https://doi.org/10.1080/08164640902852415.

    Article  Google Scholar 

  82. Earp BD, Darby R. Does science support infant circumcision? A skeptical reply to Brian Morris. Skeptic. 2015;25(3):23–30. http://www.academia.edu/9872471/Does_science_support_infant_circumcision.

  83. Ball PJ. A survey of subjective foreskin sensation in 600 intact men. In: Bodily integrity and the politics of circumcision. New York: Springer; 2006. p. 177–188. Available from: http://link.springer.com/content/pdf/10.1007/978-1-4020-4916-3_16.pdf.

  84. Rickwood AMK. Medical indications for circumcision. BJU Int. 1999;83(S1):45–51. https://doi.org/10.1046/j.1464-410x1999.0830s1045.x.

    Article  PubMed  Google Scholar 

  85. Sneppen I, Thorup J. Foreskin morbidity in uncircumcised males. Pediatrics. 2016;137(5):e20154340. https://doi.org/10.1542/peds.2015-4340.

    Article  PubMed  Google Scholar 

  86. Gollaher DL. Circumcision: a history of the world’s most controversial surgery. New York: Basic Books; 2000. 274 p.

    Google Scholar 

  87. Geisheker JV. The completely unregulated practice of male circumcision: human rights’ abuse enshrined in law. New Male Stud. 2013;2(1):18–45. http://newmalestudies.com/OJS/index.php/nms/article/view/60.

  88. Davis DS. Ancient rites and new laws: how should we regulate religious circumcision of minors? J Med Ethics. 2013;39(7):456–8. https://doi.org/10.1136/medethics-2013-101469.

    Article  PubMed  Google Scholar 

  89. Fahmy M. Complications of male circumcision (MC). In: Congenital anomalies of the penis. Cham: Springer; 2017. p. 227–35. Available from: http://link.springer.com/chapter/10.1007/978-3-319-43310-3_35.

  90. Earp BD, Allareddy V, Allareddy V, Rotta AT. Factors associated with early deaths following neonatal circumcision. American Academy of Pediatrics National Conference; 2017 Sep 15; Chicago.

  91. • Darby R. Risks, benefits, complications and harms: neglected factors in the current debate on non-therapeutic circumcision. Kennedy Inst Ethics J. 2015;25(1):1–34. https://doi.org/10.1353/ken.2015.0004. Explains why “risk” in the genital cutting debate should not be narrowly construed to mean “risk of surgical complications,” but should rather be taken to mean “risk of harm” as is consistent with the wider meaning of the term in bioethics.

    Article  PubMed  Google Scholar 

  92. Earp BD, Steinfeld R. Gender and genital cutting: a new paradigm. In: Barbat TG, editor. Gifted women, fragile men. Brussels: ALDE Group-EU Parliament.; 2017. (Euromind Monographs). Available from: http://euromind.global/brian-d-earp-and-rebecca-steinfeld/?lang=en.

  93. AAP. Male circumcision (technical report). Pediatrics. 2012;130(3):e756–85. https://doi.org/10.1542/peds.2012-1990.

    Article  Google Scholar 

  94. Al-Salem AH. Urinary tract infection in infants and children. In: An illustrated guide to pediatric urology. Cham: Springer; 2017. p. 323–35. Available from: http://link.springer.com/chapter/10.1007/978-3-319-44182-5_12.

  95. Frisch M. Penile cancer. In: Thun M, Linet MS, Cerhan JR, Haiman CA, Schottenfeld D, editors. Cancer epidemiology and prevention. Oxford: Oxford University Press; 2017.

    Google Scholar 

  96. Bossio JA, Pukall CF, Steele SS. A review of the current state of the male circumcision literature. J Sex Med. 2014;11(12):2847–64. https://doi.org/10.1111/jsm.12703.

    Article  PubMed  Google Scholar 

  97. Frisch M, Earp BD. Circumcision of male infants and children as a public health measure in developed countries: a critical assessment of recent evidence. Glob Public Health. 2016;19:1–16. https://doi.org/10.1080/17441692.2016.1184292.

  98. Jansen M. Still locked: a reply to Wodak, Ziegler and Morris. J Paediatr Child Health. 2017;53(1):93–4. https://doi.org/10.1111/jpc.13381.

    Article  PubMed  Google Scholar 

  99. Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy S-A, Czauderna P, et al. Cultural bias in the AAP’s 2012 technical report and policy statement on male circumcision. Pediatrics. 2013;131(4):796–800. https://doi.org/10.1542/peds.2012-2896.

    Article  PubMed  Google Scholar 

  100. Hartmann W. Expert statement: Dr med. Wolfram Hartmann, President of “Berufsverband der Kinder- und Jugendärzte” for the hearing on the 26th of November 2012 concerning the drafting of a federal government bill. 2012. Available from: http://www.kinderaerzte-im-netz.de/bvkj/kinpopup/psfile/pdf/70/121126_Ste50aa5e211e6a6.pdf

  101. Darby R, Cox L. Objections of a sentimental character: the subjective dimensions of foreskin loss. Matatu-J Afr Cult Soc. 2009;37(1):145–68. https://doi.org/10.1163/9789042030619_007.

    Google Scholar 

  102. RACP. Circumcision of infant males. R Australas Coll Physicians. 2010;1–28. Available from: http://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf.

  103. KNMG. Nontherapeutic circumcision of male minors. R Dutch Med Assoc KNMG. 2010;1–17. Available from: http://www.scribd.com/document/324337526/KNMG-Viewpoint-Non-Therapeutic-Circumcision-of-Male-Minors-27-05-2010-v2.

  104. England C. Doctors in Denmark want to stop circumcision for under-18s. The Independent. 2016. Available from: http://www.independent.co.uk/news/world/europe/denmark-considering-banning-circumcision-for-children-under-18s-a7459291.html.

  105. CPS. Newborn male circumcision. Paediatr Child Health. 2015;20(6):311–20. Available from: http://www.cps.ca/en/documents/position/circumcision.

  106. BMA. The law and ethics of male circumcision: guidance for doctors. J Med Ethics. 2004;30(3):259–63.

    Article  Google Scholar 

  107. AAP. Circumcision policy statement. Pediatrics. 2012 Sep 1;130(3):585–6. https://doi.org/10.1542/peds.2012-1989.

    Article  Google Scholar 

  108. Svoboda JS, Van Howe RS. Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision. J Med Ethics. 2013;39(7):434–41. https://doi.org/10.1136/medethics-2013-101346.

    Article  PubMed  Google Scholar 

  109. Freedman AL. The circumcision debate: beyond benefits and risks. Pediatrics. 2016;137(5):e20160594. https://doi.org/10.1542/peds.2016-0594.

    Article  PubMed  Google Scholar 

  110. Earp BD, Shaw DM. Cultural bias in American medicine: the case of infant male circumcision. J Pediatr Ethics. 2017;1(1):8–26. Available from: https://www.researchgate.net/publication/316527603_Cultural_bias_in_American_medicine_the_case_of_infant_male_circumcision.

  111. • Bossio JA, Pukall CF. Attitude toward one’s circumcision status is more important than actual circumcision status for men’s body image and sexual functioning. Arch Sex Behav. 2017. https://doi.org/10.1007/s10508-017-1064-8. Provides empirical support for the view that a person’s attitude about having been genitally altered in childhood can be more important than the actual fact of alteration for one's body image and sexual functioning. Here, men who were circumcised neonatally (i.e., before they could provide consent) showed greater distress and sexual dysfunction than men who were circumcised voluntarily (i.e., in adulthood) or who remained genitally intact; this difference was mediated by the more negative attitudes of the former group toward their circumcision status.

  112. • Hammond T, Carmack A. Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: an overview of health and human rights implications. Int J Hum Rights. 2017;21(2):189–218. https://doi.org/10.1080/13642987.2016.1260007. Comprehensive discussion of adverse outcomes that may be associated with neonatal circumcision, derived from a qualitative survey of 1,008 men claiming harm and dissatisfaction. Findings placed in the wider context of human rights and related discourses.

    Article  Google Scholar 

  113. Earp BD. Male circumcision: who should decide? Pediatrics. 2016;37(5):e-letter. Available from: http://www.researchgate.net/profile/Brian_Earp/publication/303858317_Male_circumcision_Who_should_decide/links/5758c2f408aed88462068068/Male-circumcision-Who-should-decide.pdf.

  114. Earp BD. Gender, genital alteration, and beliefs about bodily harm. J Sex Med. 2017;14(5, Supplement 4):e225. https://doi.org/10.1016/j.jsxm.2017.04.182.

    Article  Google Scholar 

  115. Bossio JA, Pukall CF, Steele SS. Response to: the literature supports policies promoting neonatal male circumcision in N. America. J Sex Med. 2015;12(5):1306–7. https://doi.org/10.1111/jsm.12852.

    Article  PubMed  Google Scholar 

  116. Kim D, Pang M-G. The effect of male circumcision on sexuality. BJU Int. 2007;99(3):619–22. https://doi.org/10.1111/j.1464-410X.2006.06646.x.

    Article  PubMed  Google Scholar 

  117. Earp BD, Sardi L, Jellison W. False beliefs predict increased circumcision satisfaction in a sample of US American men. Cult Health Sex. 2018. https://doi.org/10.1080/13691058.2017.1400104.

  118. • Arora KS, Jacobs AJ. Female genital alteration: a compromise solution. J Med Ethics. 2016;42(3):148–54. https://doi.org/10.1136/medethics-2014-102375. Controversial article claiming that, since nontherapeutic childhood male genital cutting is tolerated in Western societies, it is only fair to tolerate nontherapeutic childhood female genital cutting (i.e., those forms that are as invasive or less invasive than infant male circumcision). For a response and rebuttal to this argument, see reference 4, “In Defence of Genital Autonomy for Children.”

    Article  PubMed  Google Scholar 

  119. Frisch M. Author’s response to: does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? Int J Epidemiol. 2012;41(1):312–4. https://doi.org/10.1093/ije/dyr181.

    Article  Google Scholar 

  120. Earp BD. Strengths and weaknesses in the 2015 Canadian Paediatric Society statement regarding newborn male circumcision. Paediatr Child Health. 2015;20(8):433–434.

  121. Srikrishna S, Cardozo L. Female genital cosmetic surgery. In: Female sexual function and dysfunction. Cham: Springer; 2017. p. 175–88. Available from: https://link.springer.com/chapter/10.1007/978-3-319-41716-5_16.

  122. Goodman MP. Commentary on: a retrospective study of the psychological outcomes of labiaplasty. Aesthet Surg J. 2017;37(3):332–6. https://doi.org/10.1093/asj/sjw245.

    PubMed  Google Scholar 

  123. Wood PL. Cosmetic genital surgery in children and adolescents. Best Pract Res Clin Obstet Gynaecol. 2017. Available from: http://www.sciencedirect.com/science/article/pii/S1521693417301219.

  124. Johnsdotter S, Essén B. Cultural change after migration: circumcision of girls in Western migrant communities. Best Pract Res Clin Obstet Gynaecol. 2016;32:15–25. https://doi.org/10.1016/j.bpobgyn.2015.10.012.

    Article  PubMed  Google Scholar 

  125. Ahmadu F. Ain’t I a woman too? Challenging myths of sexual dysfunction in circumcised women. In: Hernlund Y, Shell-Duncan B, editors. Transcultural bodies: female genital cutting in global context. New Brunswick: Rutgers University Press; 2007. p. 278–310. Available from: http://anthropology.msu.edu/anp270-us15/files/2015/05/6.3-Ahmadu.pdf.

  126. Owojuyigbe M, Bolorunduro M-E, Busari D. Female genital mutilation as sexual disability: perceptions of women and their spouses in Akure, Ondo State, Nigeria. Reprod Health Matters. 2017;25(50):80–91. https://doi.org/10.1080/09688080.2017.1331685.

    Article  PubMed  Google Scholar 

  127. Smith H, Stein K. Psychological and counselling interventions for female genital mutilation. Int J Gynecol Obstet. 2017;136:60–4. https://doi.org/10.1002/ijgo.12051.

    Article  Google Scholar 

  128. Waldeck SE. Using male circumcision to understand social norms as multipliers. Univ Cincinnati Law Rev. 2003;72:455–526. Available from: http://www.cirp.org/library/legal/USA/waldeck1/.

  129. • Earp BD, Hendry J, Thomson M. Reason and paradox in medical and family law: shaping children’s bodies. Med Law Rev. 2017;25(4):604–27. https://doi.org/10.1093/medlaw/fwx027.Critical analysis of a recent British court decision holding that both female and male forms of nontherapeutic childhood genital cutting can be considered ‘significant harms’ in the eyes of the law. Argues that purported distinctions between the two forms of cutting based on their religious-versus-cultural status and supposedly different health consequences cannot be empirically supported when the full range of cutting practices across cultures is considered.

    Article  PubMed  Google Scholar 

  130. Earp BD. Does female genital mutilation have health benefits? The problem with medicalizing morality. Quillette Magazine. 2017. Available from: http://quillette.com/2017/08/15/female-genital-mutilation-health-benefits-problem-medicalizing-morality/.

  131. Munzer SR. Secularization, anti-minority sentiment, and cultural norms in the German circumcision controversy. Univ Pa J Int Law. 2015 2016;37(2):503–82.

  132. Merkel R, Putzke H. After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault? J Med Ethics. 2013;39(7):444–9. https://doi.org/10.1136/medethics-2012-101284.

    Article  PubMed  Google Scholar 

  133. AAP. Ritual genital cutting of female minors. Pediatrics. 2010;125(5):1088–93. https://doi.org/10.1542/peds.2010-0187.

    Article  Google Scholar 

  134. Pearce AJ, Bewley S. Medicalization of female genital mutilation. Harm reduction or unethical? Obstet Gynaecol Reprod Med. 2014;24(1):29–30. https://doi.org/10.1016/j.ogrm.2013.11.003.

    Article  Google Scholar 

  135. Lang DP. Circumcision, sexual dysfunction and the child’s best interests: why the anatomical details matter. J Med Ethics. 2013;39(7):429–31. https://doi.org/10.1136/medethics-2013-101520.

    Article  PubMed  Google Scholar 

  136. Davis D. Male and female genital alteration: a collision course with the law. Health Matrix. 2001;11(1):487–570.

    CAS  PubMed  Google Scholar 

  137. Earp BD. The ethics of infant male circumcision. J Med Ethics. 2013;39(7):418–20. https://doi.org/10.1136/medethics-2013-101517.

    Article  PubMed  Google Scholar 

  138. Steinfeld R, Earp BD. How different are female, male and intersex genital cutting? The Conversation. 2017. Available from: http://theconversation.com/how-different-are-female-male-and-intersex-genital-cutting-77569.

  139. Steinfeld R, Earp BD. Could efforts to eliminate female genital cutting be strengthened by extending protections to male and intersex children? Reprod Health. 2017;14(S2):115. https://doi.org/10.1186/s12978-017-0362-x.

    Article  Google Scholar 

  140. Newcombe P. Blurred lines-intersexuality and the law: an annotated bibliography. Law Libr J. 2017;109(2):221–67. Available from: http://heinonline.org/HOL/LandingPage?handle=hein.journals/llj109&div=18&id=&page.

  141. Coleman DL. The Seattle compromise: multicultural sensitivity and Americanization. Duke Law J. 1998;47(4):717–83. https://doi.org/10.2307/1372912.

    Article  Google Scholar 

  142. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002;7(3):329–43. https://doi.org/10.1177/135910530200700310.

    Article  PubMed  Google Scholar 

  143. Johnsdotter S. Discourses on sexual pleasure after genital modifications: the fallacy of genital determinism (a response to J. Steven Svoboda). Glob Discourse. 2013;3(2):256–65. https://doi.org/10.1080/23269995.2013.805530.

    Article  Google Scholar 

  144. Van den Brink M, Tigchelaar J. Shaping genitals, shaping perceptions: a frame analysis of male and female circumcision. Neth Q Hum Rights. 2012;30(4):417–45. https://doi.org/10.1177/016934411203000404.

    Article  Google Scholar 

  145. Abdulcadir J, Ahmadu FS, Essen B, Gruenbaum E, Johnsdotter S, Johnson MC, et al. Seven things to know about female genital surgeries in Africa. Hast Cent Rep. 2012;42(6):19–27. https://doi.org/10.1002/hast.81.

    Article  Google Scholar 

  146. Johnson M. Male genital mutilation: beyond the tolerable? Ethnicities. 2010;10(2):181–207. https://doi.org/10.1177/1468796810361654.

    Article  Google Scholar 

  147. DeLaet DL. Framing male circumcision as a human rights issue? Contributions to the debate over the universality of human rights. J Hum Rights. 2009;8(4):405–26. https://doi.org/10.1080/14754830903324795.

    Article  Google Scholar 

  148. Leonard L. Intepreting female genital cutting: moving beyond the impasse. Annu Rev Sex Res. 2000;11(1):158–90. https://doi.org/10.1080/10532528.2000.10559787.

    CAS  PubMed  Google Scholar 

  149. Shweder RA. The goose and the gander: the genital wars. Glob Discourse. 2013;3(2):348–66. https://doi.org/10.1080/23269995.2013.811923.

    Article  Google Scholar 

  150. Ahmadu FS, Shweder RA. Disputing the myth of the sexual dysfunction of circumcised women: an interview with Fuambai S. Ahmadu by Richard A. Shweder. Anthropol Today. 2009;25(6):14–7. https://doi.org/10.1111/j.1467-8322.2009.00699.x.

    Article  Google Scholar 

  151. Ahmadu FS. Rites and wrongs: an insider/outsider reflects on power and excision. In: Shell-Duncan B, Hernlund Y, editors. Female “circumcision” in Africa: culture, controversy, and change. Boulder: Lynne Rienner Publishers; 2000. p. 283–315.

    Google Scholar 

  152. Leonard L. “We did it for pleasure only”: hearing alternative tales of female circumcision. Qual Inq. 2000;6(2):212–28. https://doi.org/10.1177/107780040000600203.

    Article  Google Scholar 

  153. Wade L. Learning from “female genital mutilation”: lessons from 30 years of academic discourse. Ethnicities. 2012;12(1):26–49. https://doi.org/10.1177/1468796811419603.

    Article  Google Scholar 

  154. Silverman EK. Anthropology and circumcision. Annu Rev Anthropol. 2004;33(1):419–45. https://doi.org/10.1146/annurev.anthro.33.070203.143706.

    Article  Google Scholar 

  155. Abu-Sahlieh SAA. Male and female circumcision: religious, medical, social and legal debate. Warren, PA: Marco Polo Monographs, Shangri-La Publications; 2001. Available from: http://sami-aldeeb.com/livres/Circumcision.pdf.

  156. Shell-Duncan B, Hernlund Y. Female “circumcision” in Africa: culture, controversy, and change. Boulder: Lynne Rienner Publishers; 2000.

    Google Scholar 

  157. Solomon LM, Noll RC. Male versus female genital alteration: differences in legal, medical, and socioethical responses. Gend Med. 2007;4(2):89–96. https://doi.org/10.1016/S1550-8579(07)80023-4.

    Article  PubMed  Google Scholar 

  158. •• Johnsdotter S. Girls and boys as victims: asymmetries and dynamics in European public discourses on genital modifications in children. Paper presented at: International Seminar FGM/C: From Medicine to Critical Anthropology, Rome. 2017. Available from: https://www.academia.edu/35343412/Girls_and_Boys_as_Victims_Asymmetries_and_dynamics_in_European_public_discourses_on_genital_modifications_in_children. Excellent discussion of the complex discourse surrounding female versus male forms of nontherapeutic childhood genital cutting, with a focus on the context in Europe.

  159. Darby R, Svoboda JS. A rose by any other name? Rethinking the similarities and differences between male and female genital cutting. Med Anthropol Q. 2007;21(3):301–23. https://doi.org/10.1525/maq.2007.21.3.301.

    Article  PubMed  Google Scholar 

  160. Svoboda JS, Darby R. A rose by any other name? Symmetry and assymmetry in male and female genital cutting. Matatu-J Afr Cult Soc. 2009;37(1):249–95. Available from: https://www.circinfo.org/documents/RoseByAnyOtherName-Zabus.pdf.

  161. Shahvisi A. Cutting slack and cutting corners: an ethical and pragmatic response to Arora and Jacobs’ ‘Female genital alteration: a compromise solution’. J Med Ethics. 2016;42(3):156–7. https://doi.org/10.1136/medethics-2015-103206.

    Article  PubMed  Google Scholar 

  162. Merli C. Male and female genital cutting among Southern Thailand’s Muslims: rituals, biomedical practice and local discourses. Cult Health Sex. 2010;12(7):725–38. https://doi.org/10.1080/13691051003683109.

    Article  PubMed  Google Scholar 

  163. Earp BD. Boys and girls alike: the ethics of male and female circumcision. In: Gathman ECH, editor. Women, health, & healthcare: readings on social, structural, & systemic issues. Dubuque: Kendall Hunt Publishing Company; 2016. p. 113–6.

    Google Scholar 

  164. • Reis-Dennis S, Reis E. Are physicians blameworthy for iatrogenic harm resulting from unnecessary genital surgeries? AMA J Ethics. 2017;19(8):825–33. https://doi.org/10.1001/journalofethics.2017.19.08.msoc3-1708. Argument that physicians are morally blameworthy for harms resulting from medically unnecessary genital surgeries performed on children, regardless of the child's sex or gender.

    Article  PubMed  Google Scholar 

  165. Jacobs AJ, Arora KS. Punishment of minor female genital ritual procedures: is the perfect the enemy of the good? Dev World Bioeth. 2017;17(2):134–40. https://doi.org/10.1111/dewb.12135.

    Article  PubMed  Google Scholar 

  166. Gordon J-S. Reconciling female genital circumcision with universal human rights. Dev World Bioeth. 2017. Available from: http://doi.wiley.com/10.1111/dewb.12173

  167. Ben-Yami H. Circumcision: what should be done? J Med Ethics. 2013;39(7):459–62. https://doi.org/10.1136/medethics-2012-101274.

    Article  PubMed  Google Scholar 

  168. Shahvisi A, Earp BD. The law and ethics of female genital cutting. In: Creighton S, Liao L-M, editors. Female genital cosmetic surgery: interdisciplinary analysis & solution. Cambridge: Cambridge University Press; 2018. Available from: http://www.academia.edu/35591618/The_law_and_ethics_of_female_genital_cutting.

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Acknowledgments

The authors would like to thank the editors of this collection for inviting them to contribute and Professor Robert Van Howe, M.D., and Professor Elizabeth Reis for feedback on an earlier draft.

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  1. Yale-Hastings Program in Ethics and Health Policy, Yale University and The Hastings Center, 2 Hillhouse Avenue, New Haven, CT, 06511, USA

    Brian D. Earp

  2. Visiting Research Fellow at the Centre of the Body, Goldsmiths, University of London, London, England

    Rebecca Steinfeld

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Earp, B.D., Steinfeld, R. Genital Autonomy and Sexual Well-being. Curr Sex Health Rep 10, 7–17 (2018). https://doi.org/10.1007/s11930-018-0141-x

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