Because this needs to be said...

[mijan]

I'm sure quite a few of you have already seen the rants on your f-lists.  No, not the SPN fanfic stuff.  I'm talking about the total uproar some people are making over the ALLEGED "female genital mutilation" taking place at Cornell University. 

Personally, I find it mind-boggling how many people are ONLY reading the ranty, non-scientific, highly-biased, slant-angled BLOG POSTS about this, and not reading the goddamned MEDICAL RESEARCH PAPER to see what was actually done!  I've seen rant after rant linking to blog-post after blog-post like a line of dominos, but nobody is referencing the actual research paper.  Nobody is linking it!  Everyone is just screaming their heads off without even going back to the actual research paper.

Fandom, I'm disappointed in you.  For all that so many of you are well-read individuals who seem willing to dig up source material, you're awfully quick to jump on the bandwagon and scream bloody murder about this.  I'd guess that some of the people ranting don't have enough of a biomedical background to understand the research paper anyway, but for those of you who are able to untangle the med-speak, you owe it to yourself to read the actual source material.

READ IT:  The actual published research paper.  Until you read it, with comprehension, shut up.  And stop "boosting the signal" of something you don't even understand.  That makes you no better than Tea Partiers parroting Glenn Beck.

I have seen people call this research the following things:
Female genital mutilation, rape, sex abuse, child abuse, homophobia, trauma, sexual assault, and even torture.

To those of you who have BLINDLY SWALLOWED THIS LOAD OF BULLSHIT, how about doing some research before you jump to conclusions?  Otherwise, you're blindly following propaganda, which is a bad thing, whether it's conservative or liberal propaganda.  So let's dig into the issue a little bit, shall we?

Do you people know what this research is actually about?  Do you UNDERSTAND that this procedure is NOT being done on "healthy little girls" whose only "problem" is that they have big clitorises?  Do you understand what Congenital Adrenal Hyperplasia is?  (Probably not, so go here and read up before you say anything else.)  Can you please wrap your heads around the idea that this is NOT about "slightly larger-than-normal" clits.  These are girls whose clitorises are big enough AND MISSHAPEN so that they look like penises, and the REST of their genitals are also malformed.  Labia may be fused together, blocking the opening to the vagina.  Or they could be engorged, resembling testicle sacs.  The entire genital structure is morphed, somewhere between male and female.  Milder cases might not have any long-term problems, but for others, you're talking about a possible lifetime of sexual anguish and dysfunction. 

In the paper, it mentions the lengths of these penis-like clitorises.  The lengths don't seem very long, until you realize that these are the non-erect lengths of the PROTRUDING portion of the phallus on very small children, and some are almost equivalent to the penis lengths of boys that size.

The kids who are born with this condition start off in severely poor health due to endocrine system problems, and THOSE issues are treated immediately after birth.  (Those problems can be life-threatening.)  After the initial medical treatment for the life-threatening issues, parents decide how to proceed with the other issues based on the severity of malformation.  Again, these are not "big clits."  Go ahead and look up some pictures of people with this medical condition.  Go on, do it.  THAT'S what we're talking about here.

People should note that two of the researchers listed as authors of this research paper are women.  Let's talk hypothetical for a moment.  Maybe one of them was born with congenital adrenal hyperplasia.  Maybe she grew up with severe self-identity issues because she was a "girl with a penis" until finally having plastic surgery as a teenager, and then because of archaic surgical techniques, she was left with a clitoris that had almost no sensitivity.  Maybe this is her chance to spare these girls from that fate.  Consider that possibility.  Just... chew on it for a while.

Oh!  Almost forgot the male doctor who is being so horribly demonized as a rapist and child molester.  Let's give a hypothetical example for him.  Maybe his sister had this condition.  Maybe his mother had this condition.  Maybe his WIFE had this condition!  Maybe one of them was subjected to a more archaic procedure that left them with nerve damage.  Perhaps he has his own personal reasons that run very dear to his heart, and he's seriously trying to help these girls.  Did any of you even start to consider those possibilities?  I know that in medical research, a lot of people fall into certain fields by chance, but a lot of other researchers try to find cures and treatments for diseases that have impacted themselves or someone they love.  Did you consider that?  Maybe you should before blindly demonizing this guy.

Now, as for the "stimulation" part of this study... the age RANGE for this part was 6 to 24.  My guess is that most of the patients were in the older part of that range, but regardless, here are a couple of points to note:
1. This is not something where the doctors use a "toy" vibrator and stimulate the girl to arousal.  It's a small probe (the same type used to test neuropathy and other nerve damage issues), and the length of contact is more "Can you feel that?  Okay."
2.  HOWEVER, I don't think this was a good idea for a study anyway.  A verbal survey of the girls who are at least teenagers ("Are you satisfied with your level of sensitivity?) should be sufficient, and then, if the girls OVER the age of 18 wanted to volunteer for testing, then they can volunteer themselves.
3. Still, I wouldn't call this rape, sex abuse, or any of those other accusations I've seen tossed around.  Yes, the ethics committee should have screened this study more carefully, and no, I don't think the stimulation portion was necessary, but it's NOT RAPE.

Next medical issue:  Capillary refill testing.  Do you know what capillary refill testing is?  Try this: Press down on one of your fingernails for a couple of seconds (not very hard) and then remove the pressure.  Watch how the tissue underneath the nail changes color as blood refills the capillaries.  The amount of time the refill takes indicates HEALTHY CIRCULATION.  After any sort of surgery, it's an important test to make sure that a person is getting enough blood flow.  It can be performed on any part of the body, not just the fingernail.  It's painless.  It's quick.  It's not sexual assault.

Okay, what about you folks who are set on the idea that parents and doctors should wait until these kids are 18 years old before letting them get the surgery?  I can understand that philosophy.  I can also understand that some people would argue that if they fix it before the kids are old enough to remember, it spares them the psychological trauma.  Those arguments will go back and forth endlessly, and I'm not going to get involved in that one. 

Yes, some people who are physically intersex have embraced their identities.  Some people who have ambiguous genitalia decide not to get cosmetic surgery as adults.  And some of them grow up not really sure who they are.  Some of them have severe body image issues.  I say this as a queer person; I don't identify as either gender.   And still, I recognize how traumatizing it might be for a young girl to grow up with malformed genitals (not "large clitoris"; I mean MALFORMED).

To compare this delicate medical procedure with FGM, rape, or torture is an insult to medical professionals, and shows a gross misunderstanding on the part of people perpetuating this terminology.  To compare this with homophobia (because lesbians often have larger clitorises) is ALSO obnoxious, and as a fairly masculine queer person, I find it offensive that this medical procedure would be considered homophobic.  (So all of you folks getting up in arms about homophobia on this one, DROP IT.  It makes you sound ignorant.)

So, here's my opinion, summarized: 

1. I do not agree with physically testing nerve sensitivity on patients under the age of 16 for research purposes.  (I think a 16-year old can consent.  Many teenagers are sexually active, and they can make the decision of whether or not to participate in further research.)
2. This is NOT FGM. 
3. This is not being perpetuated against women by men (an accusation I've seen on a couple of LJ's).
4. This is not rape.
5. This involves an actual medical condition, and as a biologist who works on a medical research campus who has been involved in the approval process of human research projects, I find the insults aimed at medical researchers to be off-putting at best, grotesquely insulting and libelous at worst.
6. While I do NOT completely agree that surgical intervention is the best or only approach to this condition, I believe that it's a legitimate approach, and is medically justifiable on a case-by-case basis.
7. My primary point is NOT about whether this procedure is a good one or not - it's all about the fact that too many people are jumping to conclusions, and really should read up before screaming about it.

Also, the brilliant and creative lizardspots posted about this issue, HERE.  She's just about to finish up med school and has already been working directly with patients for a couple of years at this point, and quite sharp and fair-minded.  Give her a listen, ok?

That's all I've got.  If you want to argue with me, read the actual research paper first.  If I decide to lock horns with someone over this, it would have to be a well-considered argument.  I agree - the decision of whether to surgically "correct" genital malformations is a very touchy subject.  The severity of the malformation different case to case, and only some girls have severe deformities.  I think the decision is extremely personal to the individual if older, and the family if it's a baby, and can only be decided on a case-by-case basis.  I'm not in those shoes, and I wouldn't dare to judge those decisions either way.  There are valid arguments on both sides of the issue.  

If you read the research paper itself and come to different conclusions from mine based on the facts, then I can fully respect that.  That's the nature of debate in medical research, and there will ALWAYS be differing opinions.  I welcome that discussion.  There's a lot of gray area in this sort of thing, and that's why rational discourse is so important.  However, if anyone wants to continue to scream that this medical procedure is rape, torture, FGM, or sexual abuse... back up your argument with medical science before you click "reply."

Comments

[calmnla.livejournal.com]

Hear hear! No more Glenn Becks! No more Glenn Becks! (your analogy is spot on)

[mijan.livejournal.com]

*tips hat* Thank you.

Again, I'm not saying whether the surgical procedure is always the right answer for this condition. I'm just trying to get people to stop blindly parroting the accusations of rape, abuse, torture, and FGM. It was getting to be a bit much, seeing stuff so horribly misrepresented.

[graspless.livejournal.com]

Thanks for posting about this and providing a logical perspective.

[mijan.livejournal.com]

Thanks for reading. I was just getting tired of the situation being so grossly misrepresented.

[the-willow.insanejournal.com (from livejournal.com)]

Hi,

I honestly can't remember how I ended up here. I was sure I was looking up information about the J2 BB AU.

But I find myself wanting to point out that perhaps the individuals who see the procedure you're discussing as a sexual violation, are individuals who've had their needs and autonomy brushed aside by doctors and are imagining the discomfort of a young girl or even a young woman trying to tell an authority figure, like a doctor - no.

I haven't been able to do more than read the one, I believe it was a news article on the topic (but it might have been a blog). I'm not in a place to handle something I find so creepy (I've read the accounts of various intersexed individuals who were also stimulated as children to confirm their parents had made the right choice in choosing their physical gender; and thus that image came immediately to mind). As well as myself being someone who's had some serious difficulties with medical professionals.

I don't know how up in arms fandom is, or is becoming on this topic. Your post points out the importance of going to source and linking it, and for that alone I hope it gets more attention. But isn't part of your opinion also that a certain emotional and mental maturity of the subject should go hand in hand with sensitivity testing?

Like I said, I don't know how explosive or not things have gotten. But I can understand the many abuse survivors in fandom being upset at young children having sexual sensation impressed on them at a young age, in a situation where they really have no autonomy. It might not read like abuse to you, but to individuals who were being 'good' when various family members or other authority/powerful figures stimulated them - it's likely fairly triggering.

[mijan.livejournal.com]

I did say, quite bluntly, that I didn't approve of the sensitivity testing in young girls, and that I felt the age of 16 was a minimum for consenting to such a test. I also have ambiguity about whether surgical intervention is the right approach, and said that I can't decide that for anyone, and it's a case-by-case situation.

My point, specifically, is that this is not rape, FGM, torture, or any of the other inflammatory things it's being described as.

Beyond that... how do you know I haven't had bad experiences with doctors? I've had a few, trust me. However, I refuse to paint this situation with a broad brushstroke of judgment.

Try this: If, for example, a young woman is raped by a man, is it rational for her to operate under the assumption that all men are rapists? Of course it's not rational. It IS an emotional response, and you can't necessarily change your innate emotional responses to things. So, just because a person has had a bad experience with a doctor (ob-gyn, urologist, whatever), does not make it rational or legitimate to accuse the doctors doing this research of abusing children.

You said you don't know how "up in arms" fandom is getting over this. The answer is "quite." I've seen several very inflammatory posts, linked to yet more posts, linked to other blogs... like a web being woven rapidly and recklessly. There's a lot to be said for responsible blogging. Posting a gut emotional response to half-facts (as many people on LJ are doing right now) and screaming "RAPE!" about something they haven't even researched is IRRESPONSIBLE at best.

I want people to look for more facts and first-hand sources, and then draw more rational conclusions. I want people to consider that there is far more to this research than what they expect. I want them to realize that a friend-of-a-friend's blog is NOT a reliable source. And THEN, if they're still upset, make a rational argument.

I'm quite tempted to send a message to Cornell myself. As a person who works at a medical research university, and who has been directly involved in the approval process for human research, I'm uniquely qualified. I would suggest to them that they re-evaluate their inclusion criteria for any test that involves the stimulation of genitalia, even if it's to legitimately test nerve function. I would actually suggest that under the age of 16, the doctors are permitted to ask "Do you feel that you have recovered good sensitivity? Are you feeling any pain?" Beyond that, the age of 16 should be required as inclusion criteria for patients to VOLUNTARILY undergo further testing.

So, yes, I think there were problems with the way the research was conducted. However, I still don't think it's rape, regardless of the visceral gut-instinct response is by some people. People who were abused as kids carry wounds and scars I can't imagine, and won't pretend to imagine. Still, they do these patients and doctors a severe disservice AND insult by making assumptions about the professionalism, purpose, and ethics of all involved.

That's all.

[elfflame]

Yay for some more facts-opposed-to-outrage out there.

I understand that this is easy to make a hot-button issue, and that there are problems with it, but I just really can't stand how much some are over-reacting.

I'm of the mind that intersexed should be allowed to choose whether to get any cosmetic procedures done, but I don't think most people who don't actually know someone who is intersexed really understand what the condition entails. But then, that's what comes from the medical professionals hiding this from the populace at large for so long.

And more than anything else, I think that this is no one's business but the people who love the person being given the procedure, that person themselves, the medical professional helping them, AND if necessary, the Medical board. Because otherwise it becomes too abstract.

We can get angry all we want. It still doesn't actually affect us. And keeping doctors from finding ways to decrease the trauma certainly won't help.

[mijan.livejournal.com]

This IS a hotbutton issue. And yes, there's a lot of ambiguity about which is the "right" approach... early surgical intervention so that the child doesn't even remember, or wait to let the child decide when he or she is older? Both have benefits AND drawbacks.

The thing is, congenital adrenal hyperplasia is NOT just being "intersexed." It's a complicated endocrine disorder, and ONE of the POSSIBLE effects is EXTERNAL genital ambiguity. On the inside, the girls generally have properly formed genitals and reproductive organs. Every individual is different, of course. Sex and gender are NOT easily defined. As a gender-queer person, I know just how hard it is to define gender.

But yes, in the end, it's up to the families, doctors, and the people directly involved. It's an intensely personal and private decision. I guess I'm also just upset that these parents who love their children are being called neglectful child abusers, and these doctors who are trying to help these families are being called rapists and child molesters.

[hitlikehammers.livejournal.com]

*sigh* People really need to learn that being informed does not equal being intelligently informed. Because I can inform you that the sky is green with shiny yellow polkadots.

For you to be intelligently informed, you'd have to take a look at the sky and tell me that no, the sky that you see is blue, and I'm actually wrong. Because what did you just do? You evaluated and analyzed the fact presented logically. You thought about it, formed an opinion from the facts and your thoughts about those facts, and voila: you made progress. Wonderful.

Yes, I'm being facetious; and yes, I'm only a student who's still pursuing the title of "Doctor" -- but it doesn't take training to learn how to freaking read and not jump on the controversy bandwagon without some logically-deduced, justifiable reason that an individual can defend and articulate for themselves. I mean, there are definitely moral and ethical questions and grey areas involving this study, and I don't know where, exactly, I fall on the spectrum at the present time. But as someone who has spent more than a year prepping for the dreaded human subjects review board shakedown? I do know that few institutions, and particularly ones that are so prestigious, would be allowed to do something blatantly illegal and/or unethical without some major backlash happening before now. And I also know that, while gross oversights occur more times than we like to think, if the gains outweigh the risks in the field of science? Ethics can, and will, be bent. Because ethics? They're tricky, even medical ones. Perhaps particularly medical ones. Because they're subjective, and they always will be. And there are always going to be these issues that polarize public, and even professional, opinions. And so yes, maybe it was a questionable endeavor, and there may have been better ways to have gone about it. But unfounded conclusions aren't helping anyone get anything out of the actual research being done. I mean, come on people: PEER REVIEWED JOURNALS. For pity's sake.

And I'm going to stop rambling now, because I'm rather exhausted, and I'm likely not making any real sense anymore. But ignorance and hysteria about things people don't bother to take the time to comprehend is unacceptable, in my book. Voluntary ignorance is a sickening epidemic, and this instance is a prime example of it.

[mijan.livejournal.com]

I understand your rambling. Quite okay. And yes, people clearly don't understand the scrutiny in the medical research community. Seriously. *headdesk*

[lurkitty.livejournal.com]

I agree with you for the most part.

That said, I would not be so quick to dismiss the sensitivity test. For decades, intersexed children were surgically altered with no regard for future sensitivity or sexual function. There were a variety of sick beliefs about women's sexuality including that a proper lady would never "enjoy" sex, so a woman having an orgasm was out of the question, that female sexual arousal was linked to hysterical and aberrant behavior of all sorts and that the clitoris was simply unnecessary. In my opinion, the fact that the research team is paying attention to sensitivity is a blessing, not a curse. A child as young as six is capable of experiencing sensations in their sexual organs. Why is that so repugnant? If done in a respectful way, I don't have a problem with it.

The decision to make alterations to genitalia of intersexed persons is a very touchy subject. Many such decisions were made in the Sixties and Seventies without regard to the person (and without informing them until they broke down decades later), and a lot of pain resulted. But it has nothing to do with FGM or any of the other things people are harping about.

[mijan.livejournal.com]

I'm not dismissing the value of the sensitivity test. Honestly, I see a great medical and research value in it. I think that the fact that people finally DO care about a woman's ability to enjoy sexual pleasure is great progress.

However... think about the society in which we live. Also remember that in ANY research involving underage patients, the absolute RULE is that you don't perform any test that isn't 100% medically necessary. So... yes, it would be prudent to ensure that these girls retain their sensitivity and function... but in our society, the implications of performing those tests in underage girls are touchy at best.

I fully agree - young children DO have sexual sensitivity. Hell, I can remember masturbating at the age of four. Not kidding. So... yes, kids can be sensitive at that age. I know this.

And yes, this is a touchy subject all around. I think that ten people can look at the exact same information and come to different conclusions about the best approach for treatment (or even non-treatment). That part is a matter of opinion. I guess what I want out of this is for people to at least get the REAL facts on this issue before storming off with torches and pitchforks. That's all.

[ias.livejournal.com]

Crikey, there's a fuss about a retrospective study of patients who've undergone a type of surgery to find out if the surgery has been effective? Do the people who object want to stay in the dark ages?

Personally I don't have a problem with any person over 5 (at which age you can expect truthful answers to 'can you feel this') having a sensitivity test when they have undergone an op which could have caused nerve damage. If they had had an operation on their hand they wouldn't not have their finger sensation tested because they were under 16. Genitalia shouldn't be exempt from this testing due to squeamishness over sex. Sensory testing isn't in any form sexual, no more than having a transvaginal ultrasound or a cervical smear test (or would these people still view a smear test as rape?). The mere fact that this sort of testing hasn't been routinely done on patients who have undergone NSVC means that much of the debate about whether the operation should be done at all is done from positions of ignorance of the benefits or disadvantages of the surgery.

The lack of a control group is problematic but the way medical science often works is for comparatively small studies to bring attention to the lack of solid research in an area and then another team of researchers to follow-up with larger, controlled trials (randomisation is, of course, impossible in this sort of area).

I'm shocked that people can be getting upset about this, which is a study of the efficacy of a surgical technique previously preformed on the patients by a single surgeon and is not an advocacy paper for the surgery being a 'cure' for any given disorder. Heavens the study group involved patients who has this surgery as a result of a variety of conditions.

Hey ho, bandwagons as you say.

[mijan.livejournal.com]

"or would these people still view a smear test as rape?"

Some would.

The reason I'd advocate for an older cutoff for the sensitivity testing is because of the misconceptions and the risk of people throwing a hissy fit. I've worked on a committee at a medical research center that actually screens research projects with human subjects (patients) to make sure the project design is fully ethical and unquestionable. When the research involves children, the standards are EXTREMELY tight. The standard is that no test can be done for RESEARCH ONLY beyond a blood draw.

I agree - the sensitivity testing does seem prudent and highly valuable, and unlike what some people are imagining, they're not "sexually stimulating" these girls. They're just checking for nerve function in a clinical manner, but some people can't see the difference.

I'm not shocked that people are getting upset about this. (C'mon, this is LJ. Any excuse for wank, right?) It's controversial as far as many people are concerned. What I'm upset about is that people are snapping to flash judgments without getting the facts. If they read all the facts and THEN disagree with the ethics of the research, then I'm open to that debate. There is significant gray area in this issue, open for debate - whether they should be doing the surgery at all, whether they should wait until the kids are older, at what ages research and testing should be done, and more.

But simply put - people get squeamish about ANYTHING that could be remotely related to sex. Some people have had honest, authentically traumatizing experiences that would cause them to strongly object to any of these things. And some people simply don't understand medical science. It's not an easy topic.

Thanks for reading.

[oconel]

I hadn't read anything before in my f-list, so thanks for the info :)

What saddens me is that there are several people on lizardspot's post that don't listen (it's the Internet, right?) to what she's saying about CAH and its problems and focus only on the intersex part (as if having a closed vagina can't be problematic).

[mijan.livejournal.com]

Yeah, people aren't recognizing that CAH-induced ambiguous external genitalia cause a specific set of problems, and that perhaps these people's situation is NOT what they're imagining.

While I don't fully support the idea of the cosmetic portions of the surgery before the kid can make her own decisions, I understand both sides of the argument. It's an honest debate of medical ethics, and both sides have valid points. What I can't tolerate are the misrepresentations and false information being spread to incite anger.

Thanks for checking this out.

[melusinahp.livejournal.com]

Thank you. This was a great, well-reasoned and well-researched post.

[mijan.livejournal.com]

Thanks. But I'm sure some folks are going to de-friend me or secretly hate me for it now. C'est la vie.

[nixied.livejournal.com]

You don't know me, but I want to say, thank you. Thanks for posting this and sticking to your guns. And thanks for posting the images on Lizards blog, even if some annon got their panties in a wad, (it's a shame they got screened considering they were only scientific images, it's not like you pulled out pictures of the surgery). Thanks for trying to educate people who just wouldn't listen. Thank you for calling people out on the labels they've bestowed it and the language their using. Just, thanks.

[mijan.livejournal.com]

Thank you for listening. I knew that what I was saying would piss off some people, but some people just want any reason they can find to get pissed off, and to hell with facts if the facts might cool their hot heads.

The way I figured it with the pictures, if people on that thread were already using graphic verbal descriptions of these things, and that medical condition was already the topic of the post, then people have no business calling foul when someone posts medically relevant photo documentation of the condition. I think they were most angry because the images shot their "slightly enlarged clitorises" description to hell.

I don't mind if people disagree with me on their interpretation of the facts. That's a perfectly fair and valid debate. I was upset because people were screaming their heads off based on hearsay, conjecture, and false information.

Anyway, thanks for this.

[rubymiene.livejournal.com]

I feel like you (and lizardspots) are coming from the perspective that if a girl grows up having a "penis" she will be traumatized by it, but if she has surgery at such a young age that she can't remember the surgery, she won't be traumatized by finding out about it years later. I think what traumatizes a girl is being told by her parents and doctors that there is something wrong with her, something so wrong that surgery was necessary. Having a life-threatening condition goes in this category, but having a clitoris shaped like a penis? A girl should be allowed to decide for herself when she's old enough. Not to mention, there's no way this surgery doesn't affect her sexual function as an adult. As the paper itself notes, preserving nerve function is not the same as preserving sexual function. Can you imagine cutting the shaft off a boy's penis because it's too big and leaving him with only the glans?
We as a society have a concept of how genitalia "should" look. Many doctors and parents think that if these girls' genitalia don't look like all the other little girls', they'll be traumatized or ostracized or have difficulty functioning sexually. These arguments are not so different that the ones made by supporters of FGM, that women should look "smooth" or that if they are not cut, men will not want to marry them. There are a lot of issues concerning hygiene and lack of anesthetics associated with FGM as it's practiced, but it's not like Western medicine considers clitoral hood removal (or even a symbolic nick!) by a surgeon in a hospital to be acceptable. If we dare judge FGM as it's practiced by other cultures, we must judge genital surgery as it's practiced by ours. I read the paper, and there is nothing in it that indicated to me that clitoroplasty was medically necessary (unlike some of the other conditions associated with the disorder that lizardspots cited).
As for the sensitivity testing, they said that patients older than 5 were candidates, which suggests to me there was at least one patient aged 6, but maybe none of 6 year olds went for it. We don't know the exact ages, but I don't think that say, a 10 year old is old enough to knowingly consent to this kind of testing, so I do consider it an assault, and from the perspective of the patient, very easily as traumatizing as a sexual molestation. I would feel okay about this if all the patients tested were at least teens (and since the testing was a few years after the surgery, that would mean they were at least old enough to understand what was happening pre-surgery).

[mijan.livejournal.com]

See, this is an opinion that I can respect and discuss!

As I said, I'm NOT decided on whether or not early surgical intervention is the right answer. I wasn't even trying to argue that. My only hope was for people to actually read the paper and know what was being discussed before debating it.

The paper only addressed one aspect of the surgical intervention. I know that the complete surgery also addresses other issues, including fused labia (which seals the vagina - a true medical problem), urethral problems, and other malformed parts that could actually interfere with sexual and hygienic functions. And yes, in some of these cases, leaving the genitals as they are (including the clitoris) DOES severely hinder sexual pleasure and activity when the person becomes an adult.

Do I think having a penis-like clitoris could be psychologically damaging to a girl? I KNOW it can be, based on multiple reports that I've read (I went and did some research here), including letters and essays from people whose parents waited, and they WISHED their parents had "taken care of the problem" when they were too young to remember.

Likewise, you're absolutely right - for some people, discovering later that their parents had them surgically altered is traumatic.

There's no easy answer, and no clearly defined right answer. Both sides have valid arguments for and against.

As for the research itself... you have to know how research studies like this are done. 99% of the time, they find patients who are ALREADY planning to have the procedure done and ask, essentially, "Hey, if you're already planning to have this procedure done, are you willing to participate in this study while you're doing it? Here's what it entails..."

Anyway, I appreciate you reading the actual source document. I respect your opinion, and understand your points. It's absolutely valid and should be an essential part of the discussions in the medical research community.

I am curious... if you read the research paper, did you also do some background reading on congenital adrenal hyperplasia, and the associated type of genital ambiguity exhibited by these children?

[gasphemer.livejournal.com]

I've read this and have seen people go off their rocker over it, just like you, and turn into irrational people. I respect your opinion, but at the same time I see that it's just a huge grey area. Like what would the definition of sexual dysfunction be if the person doesn't like to be penetrated vaginally anyway? I do know people who would rather get their pleasure anally because they hate their parts anyway, no matter how normal or abnormal they may be. I suppose the principle is that things should be working to their full potential, and how are we going to know by looking at a 6 year old girl what she will grow up to find as dysfunctional. Speaking from personal experience I can't stand to even think about my vagina. I wish it wasn't there, I don't like to touch it, I don't want it, knowing it's even there makes me want to cry. And I don't even want to know if I'm normal down there. But hey, people are all different and it's just, there's no way of telling whether they'll be happy with their genitals growing up.

So in a sense yeah, I agree with you, but at the same time wonder whether much of what is performed is considered medically necessary, and whether it should be performed on a person at a young age, whether it should be stigmatized, whether the parents should be sad that their child is malformed down there.... where is the line between sexual function as a normal person, and the line where it interferes with urination or other things. And whether a person is the sum of their parts. I know it's not just girls with large clitorises, I looked up the Prader Scale and decided that yes, there's a point where it is medically necessary, but I think... it's just touchy. It's hard for me not to kick around on it too.

I understand the compassion that these people in the medical research community feel about it, it's great that they're trying, great that they are trying to make it all work. And for that I tip my hat off to them, I don't have it in me to be a doctor so I deeply admire those who are. Or anyone who goes into the medical field, period. And I understand that their decisions are hard ones. And so are the decisions the parents make (or don't make), and that, even if a child had normal functioning genitalia, they may still want to be rid of them and have problems growing up even though there's nothing medically wrong with them being there.

[gasphemer.livejournal.com]

it's just, so iffy and makes a person simply grateful to be alive.

[dswdiane.livejournal.com]

It is late and I am tired, so forgive me if I have not carefully read all the posts. I am a psychologist and one of my areas of specialization is working with transgendered and gender-queer individuals. I have only three comments to make. One, what is the criteria by which these babies (when the surgery was done to babies) are decided to be of the female gender? I know of more than one case study in which an individual had an overly large clitoris removed and a vagina constructed because it was decided by medical professionals that it would be easier for the intersex individual to be raised as a "girl," and in later years these individuals identified as being male and felt horribly violated that their genitals had been altered before they were old enough to make a decision.

Secondly, I agree with your comments about the sensation testing before the age of consent.

Thirdly, if you have never seen the movie XXY , you really should give it a look. One can see a review here http://movies.nytimes.com/2008/05/02/movies/02xxy.html
And major rejection to the review is the consistent use of the pronoun "she" to refer to the main character. What is particularly moving and lovely about this movie is the attitude of the father of Alex who says that his child was perfect as is from the moment the child was born. Not to mention the question Alex asks toward the end.

Why the hell does gender have to be such a big deal as I am sure you agree since you identify as gender queer?

If there are hormonal treatments needed to protect the health of the child, then by all means such treatments should be done. But I personally don't think any kind of genital surgery should be done even if such decision can be legally made by parents.

I'm tempted to go on and on about the studies being done in The Netherlands with children who identify as being transgendered. Well, briefly, these children are being given puberty delaying medications and counseling until they are 16 or so, when they are allowed to choose their gender on their own. The psychological results indicate significantly less depression, almost no suicide ideation, and general better psychological health than gender questioning adolescents in other populations.

I was upset by this particular research study for the reasons I have just described. If you think my thought processes in regard to the study are flawed, I would appreciate your input. Thanks.

[mijan.livejournal.com]

Okay, answer to the first question:

With the exception of three older male-to-female transgendered individuals who elected to have this surgery, almost all of the patients in the study were females with congenital adrenal hyperplasia. It's an adrenal gland disorder that causes various health problems (some life-threatening) in addition to atypical genitalia. In a male with this condition, if there are any atypical genital traits, it's that the otherwise fully-typical penis is actually larger than usual. CAH causes NO genital ambiguity in males. Therefore, all these individuals in this study with this condition were definitely chromosomally female, with ovaries and fully developed female internal reproductive organs. It's a very specific medical condition. I strongly recommend, if you're actually curious about it, that you look up this medical condition and actually look at medical photo-documentation of XX-individuals who have ambiguous genitalia as a result of having this condition.

Also, you mentioned a vagina being "constructed." In the case of each child in this study, there was a fully-formed and function vagina and uterus already present. Some of them had external fusion of the labia OVER the vagina (partial or total), which is actually a serious health risk (because they WOULD start menstruating eventually). They didn't need to create a vagina, but they did need to expose it for actual health purposes. Of course, that still does not necessitate the alteration of the clitoris/phallus, but suffice to say, in some cases, there were medical reasons for surgery, not just cosmetic reasons.

THAT BEING SAID, I am absolutely aware that just because a person is chromosomally female does not mean that zie will identify as female-gendered. I know this personally (not that I've had my chromosomes checked).

I've seen XXY. Good movie.

I don't see why gender has to be such a big deal. But if it wasn't, even socially, I'd still wake up every morning, look in the mirror, and wish that my breasts (however small they are) would just disappear.

Believe it or not, despite my post, I agree philosophically that no child's parents should make gender-defining decisions for them, ESPECIALLY not surgical ones. I like the approach you described with the Netherlands. I'm rather jealous of that, honestly. I wonder what the health repercussions of delaying puberty might be. Those would have to be some pretty powerful drugs. But still, the fact that they actually have that option is pretty awesome.

I'm also very uncomfortable with several aspects of this research study. My purpose in posting was NOT to support it. I don't. My purpose was to get people to look at the facts before using extreme inflammatory language to describe what's being done. While I agree that gender-assignment should be decided by the person in question when zie is old enough, and that parents should be educated better about gender identity, I DO NOT agree with people on other various blogs and journals who have described this as rape, sexual assault, molestation, or female genital mutilation. That was the entire point of my post.

I don't think your thought process is flawed at all. I agree with pretty much everything you wrote, actually. I only judge as flawed the thought processes of those people who didn't bother to read any source material yet were quick to jump on the bandwagon of calling this procedure "rape" and "FGM." That doesn't seem to be what you're doing here at all.

[sanat.livejournal.com]

I think you provided an important counterpoint to the hysteria over this story. However, hysteria over this one (http://slog.thestranger.com/slog/archives/2010/06/29/doctor-treating-pregnant-women-with-experimental-drug-to-prevent-lesbianism) seems pretty valid so far--unless there's anything buried in the original report that we're missing?

[mijan.livejournal.com]

Yeah, I saw that one. And I've been trying to see if there are ANY redeeming graces that I could attribute to these bigoted, self-serving, manipulative bastards... and I can't. Whereas I can SORTA understand parents' and doctors' choices to surgically alter a physically atypical child whose development has been impacted by a specific disease, this hormonal treatment to prevent, essentially, lesbianism and "butchness" infuriates me on SO many levels. I happen to personally LIKE strong, androgynous/masculine women, but even if that's not what these docs like, then who the hell are they to decide how people should behave??? I mean, are they scared of women who don't want to become mothers? Do they think that women's only purpose in life is to breed, cook, sew, and keep house?

I wonder what they'd say about my "masculine" career choices - military, science, leadership positions - and the fact that I don't want kids.

Yeah, I agree with the outrage over this one. Completely outraged.