Aspects of

Throughout history different cultures have used genital alteration of males and females to express religious identity, inscribe social values, and enforce social norms of marriage, sexuality, and appropriate gender behavior. Societies differ greatly on whether they practice genital alteration on males and females, both, or neither, and on the stage of life at which procedures are done. Male circumcision, for example, is done on the eighth day of life by observant Jews, at around four or five years of age by Muslims in Turkey, and at puberty in some sub-Saharan African cultures.

Genital alteration became the subject of controversy toward the close of the twentieth century for a number of reasons. First, it is primarily performed on children and women, two groups perceived to be especially vulnerable. In the case of children, there is obvious lack of informed consent. Second, as immigrants from cultures that performed female genital alteration settled in Western countries, healthcare providers became aware of the procedures and of their negative effects on women's health. Third, a strong international feminist movement produced critics of the female procedures, both from within and without the indigenous cultures. Fourth, a century-long controversy in the United States over the health benefits of the male procedure began to move the practice away from routine recommendation of male circumcision. Fifth, a nascent children's rights movement began to question the ethics of performing surgery to excise healthy, normal tissue, with no proven medical benefit and, some argued, a diminution of sexual function.

The content of the controversy can be categorized into three parts. First, although there is no dispute over the lack of health benefit to females and the terrible impact of these surgeries on women's health, lively controversy exists over the negative and positive impact of male circumcision on males's health and sexual function.

Second, there is serious disagreement over appropriate language, reflecting the competing values in the debate. Male newborn genital alteration is almost always referred to as circumcision, a vaguely medical term that signals society's acceptance of this procedure. Conversely, the term uncir-cumcised, as opposed to intact or natural, signals the normative status of the circumcised male in American culture. When writers use circumcision to refer to the female procedure, there is often an outcry; opponents of the female procedure and defenders of the male procedure alike object to casting them in the same light. The term female genital mutilation, preferred by most opponents of the procedure and the term officially adopted by the World Health Organization (WHO), has its own problems. For one, as anthropologists Sandra D. Lane and Robert A. Rubinstein point out, "mutilation implies removal or destruction without medical necessity," which logically ought to refer to routine male circumcision as well (Lane and Rubinstein, p. 35). Further, the term ignores the meanings of female genital alteration in the cultures in which it is practiced, in which not to be circumcised is to look weird and disgusting. Finally, the term polarizes people rather than inviting discussion. Cosmetic genital surgeries, as a term for male and female procedures, has the advantage of inviting comparison with more widely accepted surgical interventions, such as breast augmentation, but the disadvantage of misleadingly implying a surgical environment, a far cry from the primitive conditions that attend most female genital surgeries. This entry uses the neutral terms male and female genital alteration.

Third, there is debate about whether genital alterations stem from religion or culture, with the explicit or implicit inference that the former commands more respect.

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