By Brian D. Earp

I have published several papers on the ethics of medically unnecessary genital cutting practices affecting children of all sexes and genders. When my writing touches on the sub-set of these practices that affect persons with characteristically female sex-typed genitals, I have received some pushback for using the term female genital cutting (FGC) rather than female genital mutilation (FGM).

An instance of such pushback came from a respected colleague in response to a paper of mine in Archives of Sexual Behavior, in which I argue against the use of ‘mutilation’ in certain contexts, as there is evidence that such stigmatizing language may have adverse effects on the very people who are meant to be helped. Given that this terminological issue is likely to keep coming up, I thought I would share parts of the reply I wrote to my colleague. I hope it can shed some light on at least one plausible way of thinking about such matters.

My colleague argued that my use of ‘FGC’ rather than ‘FGM’ is disrespectful because it goes against the recommendation of the 2005 Bamako Declaration adopted by the Inter-African Committee (IAC) on Traditional Practices Affecting the Health of Women and Children. 

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On the matter of disrespect. I have had many conversations with women who consider themselves circumcised, rather than mutilated, and even if they agree that medically unnecessary genital cutting should not be performed on persons who are incapable of consenting, primarily children, they insist that it is harmful, stigmatizing, and paternalistic for others to simply define their own modified genitals as mutilated (a term that implies disfigurement or even an intent to cause harm).

They explain that their loving parents, however misguided, did not intend to cause them net harm, just as, for example, Jewish parents who authorize that their sons be circumcised do not intend to harm them, but rather, take an action that is sincerely believed to appropriately integrate the child into an ancestral community. They recognize that, in their own communities, both male and female genital cutting practices are widely seen as improving the genitalia, including aesthetically, which is contrary to the very notion of mutilation. I may not agree with that interpretation myself, but it is not my position to tell these women (or their brothers) that their altered genitals are ugly or disfigured rather than, as they see it, aesthetically (or in some cases, culturally or religiously) improved.

I will ask: Were these leaders democratically elected to express the considered opinions of their constituents, or were these leaders self-appointed? At the very least, they cannot have been authorized to speak on behalf of countless Southeast Asian or Middle Eastern women who have been affected by ritual forms of female genital cutting.

In any event, I face a choice. I can disagree with the conclusion of these African leaders who seem to feel qualified to speak on behalf of millions of other women, including non-African women, and impose an entirely negative and stigmatizing interpretation of all of their altered genitalia regardless of how those women see their own bodies. Or I can show respect to those women who have shared their stories with me, as well as all the women in various reports and testimonies who have expressed strong objections to the term ‘mutilation’ being forced on them, and who would simply like to have the room to be able to evaluate and describe their own genitals as they see fit. 

One woman explained her feelings: “In my opinion, the word ‘mutilation’ used in reference to [what happened to me] is a degrading and disempowering term that strips women of their dignity and self-worth. Basically, it is a label that has the power to negatively influence one’s self-identity. If you understand labelling theory you will understand how damaging/influential a term or classification can be to an individual.”

She continued with her experience: “Having just about survived my ordeal of forced body alteration I was very aware of the violation to my body. However, the introduction of the term ‘mutilation’ into my consciousness affected me mentally and physically. It made me view myself as an ugly, mutilated, and frowned-upon member of society. There started my journey of self-hate, which presented itself in many forms, including bulimia and social anxiety, to name but a few. To be called the ‘mutilated’ girl by health professionals stripped me of any dignity and covered me in shame on numerous occasions. Thankfully, I no longer see myself as a victim or survivor of ‘FGM’ – I refuse to allow that term to take away my power or to define who I am.”

Faced with the choice between respectfully disagreeing with the analysis and conclusion of a group of leaders whose qualification to speak on behalf of others I do not know, versus showing respect to those women, such as the one quoted above, who have asked for the right to determine their own victim status (including whether they regard their genitals as mutilated or otherwise), I choose the latter.

Referring to “the event” and “the torture” is using singular language to refer to a plurality of quite different events carried out in different ways by different groups for different reasons. As you know, the World Health Organization (WHO) uses the term FGM to refer to a dozen or more practices, ranging from nicking of the clitoral hood, which does not remove tissue. In many communities, for example in Malaysia, it’s often done by a doctor with sterile equipment and pain control, through to excision of the external clitoris with a rusty implement and no pain control followed by infibulation, as occurs in some rural parts of Northeast Africa, for example.

It is entirely accurate to say that all of those quite different interventions are medically unnecessary acts of genital cutting; and I argue that all of them are morally impermissible if carried out on a non-consenting person. I have written about labiaplasty, a common procedure in Western countries. I tend to think it is morally permissible for an adult, fully-informed woman to decide that she wants what she regards as a cosmetic alteration to her genitals. I would not presume to tell my friends who have undergone what they see as cosmetic labiaplasty that they are victims of genital mutilation. Rather, I would accept their interpretation of their own bodies as having been enhanced.

What this suggests to me is that the sheer alteration of healthy genital tissue is not inherently mutilating. Rather, a person could interpret altered genitalia in a wide range of ways, including as improved or enhanced. This is the majority way that persons with altered genitalia regard their own bodies, as far as I can tell from reading the primary and secondary literature on this topic. What makes medically unnecessary genital cutting morally wrong is its being done non-consensually. It does not matter if it is mutilating or not – that is up to the person who is affected to decide. What matters is that it should be that person’s own choice.

Finally, my work is dedicated to the human rights argument that all non-consenting individuals, whether female, male, or intersex, have a fundamental moral claim against any interference with their genitals that is not medically necessary. That means that I believe that medically unnecessary intersex genital cutting is wrong, as is such cutting of the penis, when either is done without the informed consent of the affected person. And so, since I write about all medically unnecessary genital cutting practices, which includes alterations of the vulva that are less severe than penile circumcision as it is commonly performed in my country, I cannot go around calling one set of procedures ‘mutilations’ based on the sex of the person to whom they happen, while using a different term for another set of procedures. So, I choose to use the entirely accurate, non-stigmatizing language of ‘medically unnecessary genital cutting’ in all cases, leaving 100% of the leeway to each individual to determine for themselves.

It is not my place to speak on behalf of others about their bodies. Nor do I think it is the place of these African leaders to speak on behalf of millions of women who may not agree with them. Moreover, as I argue at length in the paper I sent around, there is very good reason to think that the language of mutilation is stigmatizing and harmful. Since it is not necessary to stigmatize women’s bodies in order to ground the ethical claim that cutting children’s genitals is morally wrong, if not medically necessary, I choose to use non-stigmatizing language.

Brian Earp is an American bioethicist, philosopher, and interdisciplinary researcher. He is currently Associate Director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center, and a Research Fellow at the Oxford Uehiro Centre for Practical Ethics.

This piece was originally published in Practical Ethics at The University of Oxford.