There exists a raft of subjects upon which the views of clerics and medics may be assumed to diverge, but a most powerful magnet of convergence for all should be the principle of doing no harm. The examination of such apparent unity leads into a treacherous mire, especially where human genitalia is concerned. Stones overturned have exposed inconsistency and double-standards, a good deal of looking the other way and abject failure by so-called leaders to present any challenge to an extremely pernicious ideology.
The surgical removal or modification of human genitalia is a somewhat gruesome and most controversial subject. It is also one which illustrates the many and varied contradictions which exist within the espoused positions and practices of the medical professions and the religious faiths in the United Kingdom. We are told, insistently and incessantly, that gender affirmation surgery (GAS) is good, and we are told, less so these days, that female genital mutilation (FGM) is bad. As for the debate surrounding male circumcision, it is barely audible. However, whilst the results of each of these practices—in that genitalia is removed or modified—are identical, the messaging surrounding them could hardly be more different.
The approved method for explaining such differences is to consider the factors of consent, age, harm and medical necessity. It is put forward that those undergoing gender affirmation surgery have chosen to do so, in an informed fashion, which means that they consent to the harm to be inflicted by the surgeon. As to age, the bar for GAS is set at 17 in England, 16 in Scotland, 18 in Wales and 18 in Northern Ireland, for now. It is important to note that so-called ‘puberty blockers’—drugs which affect normal physical changes in the bodies of developing children—are available to minors from the NHS. The NHS has this to say:
Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria’ and it’s ‘also not known whether hormone blockers affect the development of the teenage brain or children’s bones.
But despite this, the NHS prescribes them anyway. It is the creation and labelling of gender dysphoria as a clinical illness which enables the construction of any argument in favour of medical necessity.
In a way, age and consent may be dealt with together. Whilst it is, of course, fair to say that FGM is almost exclusively conducted when girls are young, it should be pointed out that male circumcision is almost exclusively conducted at a young age in boys. There may not be a close comparison to make in terms of outcomes or pain, but it is absolutely true that—in most cases—neither is performed with the consent of the subject, as they are not old enough to give it. If it is possible to carry out male circumcision before adulthood, when there exists no medical necessity, the case against FGM is found wanting. Another issue that crops up regularly in this discussion is that of Gillick competence; a most dangerous piece of case law. The situation most often used to explain Gillick competence posits that a child, if deemed competent, may consent to an immunisation without parental consent; even if the parents do not wish for the child to have the immunisation. You are likely to guess the next part. If the child is competent, and does not consent to the immunisation, but the parent wishes the child to be immunised, the parent’s wishes take precedence. With hormone treatment, if a child is deemed competent, he or she may not be denied access to medication. The suggestion that a child could have got to this point with no external influence is patently absurd.
If it is the creation of so-called medical necessity via gender dysphoria that has given rise to the possibility of state-funded genital surgery, then what—if any—are the medical reasons for the practices of FGM and male circumcision? The BBC says:
The most frequently cited reasons for carrying out FGM are social acceptance, religion, misconceptions about hygiene, a means of preserving a girl or woman’s virginity, making the woman “marriageable” and enhancing male sexual pleasure.
The NHS explains:
Female genital mutilation (FGM) is a procedure where the female genitals are deliberately cut, injured, altered or removed for non-medical reasons.
This could just as readily describe gender affirmation surgery. However, it clarifies the position by noting that ‘FGM is illegal in the UK and is child abuse’. As to male circumcision in boys, the Health Service says, ‘It’s rare for circumcision to be recommended for medical reasons in boys’, thus skating over the much more common cultural or religious reasons. They do go on to refer to the risks associated with the procedure—which are, of course, described as ‘small’.
Even if the origins of FGM and male circumcision are lost in the sands of time, there are still many people today that believe there are compelling reasons for both, which is exactly why they persist. Falling upon a cast-iron means of deciding how to distinguish between them, in terms of social acceptability, is extremely difficult. Assuming each practice is carried out in good faith (which may be an assumption too far for many), the way to explore the difference may be to examine what are referred to as ‘known health benefits’. Around the turn of the last century, Dr Peter Remondino was one of the great cheerleaders for male circumcision and attributed very many health benefits to it; many more than the NHS, at any rate. It is interesting to note that Remondino did also believe the practice would make black men less likely to rape white women and, thus, advocated for ‘the wholesale circumcision of the Negro race as an efficient remedy in preventing the predisposition’. Dr Remondino finds himself at one end of the spectrum, and there are acknowledged risks in male circumcision, but these would appear to be very heavily outweighed by those associated with FGM. In a thoughtful piece for the Guardian, some years ago, Adam Wagner cites the joint statement from the United Nations (UN) and other agencies in 2008, in which FGM is referred to as having ‘no known health benefits’. This would seem to form the crux of the matter, and this point will be returned to.
Gender dysphoria is described by the NHS as ‘a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.’ This hardly reads like the basis for life-altering surgery on the grounds of medical necessity. They go on to explain that ‘Gender dysphoria is not a mental illness, but some people may develop mental health problems because of gender dysphoria.’ However, medical literature on the subject is almost exclusively the preserve of the discipline of psychiatry and, of course, all the ‘signs’ listed by the NHS (shown below) are mental and not physical. Drawing the conclusion that gender dysphoria may lead to mental illness with no allusion to the possibility of things happening the other way suggests an abandonment of the scientific method, at least. Indeed, to go on to suggest that the solution to a problem with exclusively mental symptoms is the physical altering of the human form raises significant questions of medical ethics.