Genital modification and mutilation

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Circumcision and genital piercing: Two Kenyah-Dajaks, with ampallang piercings - Borneo, 1920 (left) and modern man with Prince Albert piercing (right)

The terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs. Some forms of genital alteration are performed on adults with their informed consent at their own behest, usually for aesthetic reasons or to enhance stimulation. However, other forms are performed on people who do not give informed consent, including infants or children. Any of these procedures may be considered modifications or mutilations in different cultural contexts and by different groups of people.

Reasons

Body modification

Many types of genital modification are performed at the behest of the individual, for personal, sexual, aesthetic or cultural reasons. Penile subincision, or splitting of the underside of the penis, is widespread in the traditional cultures of Indigenous Australians. This procedure has taken root in Western body modification culture, the modern primitives. Meatotomy is a form that involves splitting of the glans penis alone, while bisection is a more extreme form that splits the penis entirely in half.

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Contemporary, western women with clitoral hood piercing and genital tattooing (left) and Hanabira (right)

Genital piercings and genital tattooing may be performed for aesthetic reasons, but piercings have the benefit of increasing sexual pleasure for the pierced individual or their sex partners.[1][2]

Similarly, Pearling involves surgical insertion of small, inert spheres under the skin along the shaft of the penis for the purpose of providing sexual stimulation to the walls of the vagina. Similar to tattooing, genital scarification is primarily done for aesthetic reasons by adding cosmetic scars to the skin. The genital decoration by scars is an ancient tradition in many cultures, both for men and women.[3] The Hanabira-style (Jap. for petal) is a special form of scarification originating in Japan, it involves the decoration of the mons pubis.[4][5]

Clitoris enlargement may be achieved temporarily through the use of a clitoral pump, or it may be achieved permanently through the application or injection of testosterone. Penis enlargement is a term for various techniques used to attempt to increase the size of the penis, though the safety and efficacy of these techniques are debated.

Voluntary sex reassignment

People who are transgender or intersex may undergo sex reassignment surgery in order to modify their bodies to match their gender identity. Not all transgender people elect to have these surgeries, but those who do usually see an improvement in their sexual lives as well as their mental and emotional well-being.[6] Some of the surgical procedures are breast augmentation and vaginoplasty (creation of a vagina) for trans women and mastectomy (breast removal), metoidioplasty (elongation of the clitoris), and phalloplasty (creation of a penis) for trans men. Trans women may also benefit from hair removal and facial feminization surgery, while some trans men may have liposuction to remove fat deposits around their hips and thighs.

Hijra, a third gender found in the Indian subcontinent, may opt to undergo castration.[7]

Involuntary sex assignment

Intersex children and children with ambiguous genitalia may be subjected to surgeries to "normalize" the appearance of their genitalia. These surgeries are usually performed for cosmetic benefit rather than for therapeutic reasons. Most surgeries involving children with ambiguous genitalia are sexually damaging and may render them infertile.[8] For example, in cases involving male children with micropenis, doctors may recommend the child be reassigned as female.[9] The Intersex Society of North America objects to elective surgeries performed on people without their informed consent on grounds that such surgeries subject patients to unnecessary harm and risk.[10]

In some cases, a child's gender may be reassigned due to genital injury. There have been at least seven cases of healthy male infants being reassigned as female due to circumcision damaging their penises beyond repair,[11][12][13][14] including the late David Reimer (born Bruce Reimer, later Brenda Reimer), who was the subject of John Money's John/Joan case; an unnamed American child, who was awarded $750,000 by Judge Walter McGovern of the Federal District Court after a military doctor was found guilty of medical malpractice in 1975; and an unnamed child who was circumcised at Northside Hospital, who received an undisclosed amount of money from the hospital.

In Andhra Pradesh, India, a 75 year old surgeon working at the Kurnool Government Hospital in Kadappa named as Naganna was arrested by the CB-CID for conducting forced sex change surgeries on kidnapped victims for nearly a decade by using a nationwide network of hijras (transgenders).[15][16][17]

Some homophobic societies force sex reassignment to non-heterosexual. The Aversion Project is a well-known example.

As treatment

If the genitals become diseased, as in the case of cancer, sometimes the diseased areas are surgically removed. Females may undergo vaginectomy or vulvectomy (to the vagina and vulva, respectively), while males may undergo penectomy or orchiectomy (removal of the penis and testicles, respectively). Reconstructive surgery may be performed to restore what was lost, often with techniques similar to those used in sex reassignment surgery.

During childbirth, an episiotomy (cutting part of the tissue between the vagina and the anus) is sometimes performed to increase the amount of space through which the baby may emerge. Advocates of natural childbirth and unassisted birth state that this intervention is often performed without medical necessity, with significant damage to the person giving birth.

Hymenotomy is the surgical perforation of an imperforate hymen. It may be performed to allow menstruation to occur. An adult individual may opt for increasing the size of her hymenal opening, or removal of the hymen altogether, to facilitate sexual penetration of her vagina.

The world's first penis reduction surgery was performed in 2015, on a 17-year-old boy who had an American football-shaped penis as a result of recurrent priapism.[18]

Self-inflicted

A person may engage in self-inflicted genital injury or mutilation such as castration, penectomy, or clitoridectomy. The motivation behind such actions vary widely; it may be done due to skoptic syndrome, personal crisis related to gender identity, mental illness, self-mutilation, body dysmorphia, or social reasons.