Clitoral surgery on minors: an interview study with clinical experts of differences of sex development

What is it about?

When a child is born with a larger-than-typical clitoris, some parents and health professionals opt to surgically alter the clitoris. This kind of surgery has historically been the standard approach in many instances. However, clitoral surgery on children is now increasingly considered to violate the child’s human rights. The present research investigates how health professionals in British and Scandinavian hospitals navigate the controversial issue of clitoral surgery. This study is based on interviews with thirty-two health professionals working in specialist teams concerned with diverse sex development. The focus of this research paper is on four key ways that health professionals negotiate the dilemmas around clitoral size and clitoral surgery. First, health professionals sometimes engage with new ways of thinking about clitoral differences and consider that clitoral surgery on children is not appropriate. Second, health professionals sometimes hold on to the belief that clitoral surgery is socially and psychologically helpful for girls, even though this assumption has never been properly researched. Third, health professionals sometimes find ways to make surgery seem less controversial, such as by focusing on the idea that surgical techniques are better these days. Fourth, health professionals can take a flexible approach, which means letting parents’ psychological reactions guide the treatment plan. This research suggests health professionals still lack a principled and consistent way to respond to the question of clitoral size. This lack has significant implications for health professionals’ ability to support parents to develop richer ways of thinking about clitoral differences. Health professionals’ ways of talking about this topic suggest that they are not consistently working with the existing guidelines that offer socially inclusive ways of talking with parents whose child has a larger-than-typical clitoris. If health professionals are not able to talk about clitoral size in a non-pathologising way, and do not routinely put in place a psychologically informed, non-surgical care pathway, then surgery continues to be presented as the only solution. This means that parents do not have a genuine choice about whether or not their child undergoes clitoral surgery.

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