‘Gender Affirmation’: The New Female Genital Mutilation

E arlier this year, during a virtual symposium hosted by Duke University with multiple clinician activists, Marci Bowers, a surgical pioneer of so-called gender affirmation, compared the potential loss of sexual functioning in children subjected to transgender drugs and surgeries with the outcomes suffered by those subjected to female genital mutilation (FGM). Bowers was not trying to suggest that gender-affirmation treatment is, like FGM, a human-rights violation. Quite the opposite. Still, the comparison was revealing.

On Bowers’s website, a blog about female genital mutilation describes sexuality as “one of the basic human senses”: “Imagine if we took our children and poked their eyes out in childhood? or their sense of hearing? or even smell? it would be an outrage and we all should feel no less outraged about this process of FGM.” This is true. But it also applies to transgender drugs and surgeries used to impair children’s sexual development for ideological reasons.

The World Health Organization describes FGM as involving “the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons.” Likewise, gender-affirmation surgery involves the removal of healthy genitalia or breasts, while transgender drugs cause other injury to functioning sex organs. Clinician activists claim that these treatments are “medically necessary” to alleviate the distress associated with gender dysphoria. But what evidence do they have that harming the body helps the mind? Most children, when allowed to, grow out of gender dysphoria. The WHO warns that female genital mutilation has “no health benefits for girls and women.” Advocates of transgender drugs and surgeries insist that their interventions are “life-saving.” Yet the only long-term follow-up study on postoperative transsexuals suggests the opposite. Across the West, there is fierce debate among medical professionals about the safety and efficacy of so-called gender affirmation. Moreover, as in the case of FGM, children cannot possibly consent to these treatments. No child can be expected to understand the consequences of forgoing fertility and sexual functioning.

Whereas mutilating girls’ genitals is, according to the WHO, “associated with cultural ideals of femininity” — including the idea that “girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male” — transgender drugs and surgeries are used to enforce new cultural ideals of masculinity, femininity, and identity. Indeed, what’s really informing the decision to thwart gender-confused children’s sexual development is gender ideology: The idea that boys can really be girls, and girls really boys, or either sex can really be neither sex (i.e., “nonbinary”), and that the body should be medically manipulated to reflect these beliefs.

That transgender drugs and surgeries are medicalized is no proof of their legitimacy. After all, FGM has also been medicalized. One justification for this has been “harm reduction” — the idea that FGM will inevitably be carried out but entails less risk when performed by a medical professional. As the WHO explains, one reason for this is that “health care providers who perform FGM are themselves members of FGM-practicing communities and are subject to the same social norms,” while having an added “financial incentive to perform the practice.” Similarly, clinicians and surgeons offering transgender treatments commonly identify as trans themselves, as in the case of Marci Bowers.

The WHO describes the effects of FGM as including “severe bleeding and problems urinating,” as well as cysts, infections, and complications for sexual intimacy and reproductive health. Transgender surgeries, especially female-to-male, can do all this and more. Not only does phalloplasty involve disfiguring the female genitalia (as in FGM), it also involves disfiguring a patient’s arm or thigh. Phalloplasty has a complication rate of 51 percent. Cross-sex hormones cause sterilization as well as a permanent lowering of the voice and sometimes baldness in females.

Despite the obvious harms of FGM, in 2010, the American Academy of Pediatrics downplayed them, declaring “female genital cutting” to be a clinically acceptable practice. The policy paper was written by a religious-studies professor, who advised that “above all” what was important in handling this issue was “sensitivity to the cultural background of the patient and her parents and appreciation of the significance of this custom in their tradition.” Feminists were outraged — rightly so. The AAP rescinded the statement. Sadly, it’s not surprising that, twelve years later, the same organization is endorsing transgender drugs and surgeries.

Female genital mutilation involves disfiguring and impairing a child’s sexual organs for nonmedical reasons. So-called gender affirmation does the same. Clinical activists have been allowed to hide behind euphemisms for too long. It’s time to call “gender affirmation” what it truly is — sex mutilation.