Genital modification and mutilation

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 at the behest of an adult, with their informed consent. Others are performed on infants or children. Any of these procedures may be considered modifications or mutilations by different groups of people.

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. Meatotomy is a form that involves splitting of the glans penis alone, while genital bisection is a more extreme form that splits the penis entirely in half.

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. 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.

Clitoris enlargement may be achieved temporarily through the use of a clitoral pump, or it may be achieved permanently through application of testosterone cream to the clitoris, or through injectable 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
Some transgender people choose to undergo sex reassignment surgery as part of their gender transition. Male to female transgenders, mtfs, or transwomen may undergo castration, with or without vaginoplasty, while female to male, ftms, or transmen transgenders may undergo phalloplasty or metoidioplasty, with or without oophorectomy or hysterectomy. Transgender people who wish to make this surgical transition are referred to as transsexuals.

Involuntary sex assignment
If a baby is born with ambiguous genitalia due to an intersex condition, it may not be clear whether the child is female or male. In certain cases, the child's chromosomal makeup is neither female nor male, but a combination. In these cases, the baby is usually given a sex assignment, and in many cases, the child's genitals are surgically altered to conform to those of the assigned sex. This practice is met with strong dissent from advocates for genital integrity. As cosmetic surgery is not medically necessary for health, they argue that the individual should be free to make the choice whether to pursue cosmetic surgery upon their genitals. Advocates state that the surgery can damage the individual's ability to experience sexual arousal and can render the individual incapable of orgasm. Another concern is that sex assignment holds a significant element of guesswork, and that an individual's sex assignment may turn out to be incorrect. If, for instance, an individual is assigned female, their phallus is usually surgically reduced in size, and the shape of a vulva may be created. If, upon maturing, the individual identifies as male; their phallus is still gone, and the individual may require further surgery to try to reverse the erroneous sex assignment. Those who oppose medically unnecessary genital surgery, and genital surgery coerced or performed without consent comprise the genital integrity movement. The case of David Reimer, the victim of a botched circumcision who was raised as a girl alongside his twin brother, bears many parallels to this issue.

In disease or medical necessity
If the genitals become diseased, as in the case of cancer, sometimes the diseased areas are surgically removed. Biological females may undergo vaginectomy, while males may undergo penectomy. Reconstructive surgery may be performed to restore what was lost, often with techniques similar to those used in sex reassignment surgery.

Similarly, during childbirth, episiotomy 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.

Female genitals
Cosmetic surgery of female genitalia, known as elective genitoplasty, has become pejoratively known as designer vagina. In May 2007, an article published in the British Medical Journal blasted the "designer vagina" craze, citing its popularity being rooted in commercial and media influences. Similar concerns have been expressed in Australia.

Female genital cutting
Female genital cutting (FGC), also known as female genital mutilation or female circumcision, refers to "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons." It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. FGC is practiced throughout the world, but the practice is concentrated more heavily in Africa, Indonesia, and the Middle East. There is much controversy surrounding infibulation procedures, due to concerns regarding the safety and consequences of the procedure. In the past several decades, efforts have been made by global health organizations, such as the WHO, to end the practice of FGC. However, because of its importance in traditional and religious life, FGC continues to be practised in many societies.

Hymenorrhaphy
Hymenorrhaphy refers to the practice of thickening the hymen, or, in some cases, implanting a capsule of red liquid within the newly-created vaginal tissue. The newly-created hymen is created to cause physical resistance, blood, or the appearance of blood, at the time that the individual's new husband inserts his penis into her vagina. This is done in cultures where a high value is placed on female virginity at the time of marriage. In these cultures, a woman may be punished, perhaps violently, if the community leaders deem that she was not virginal at the time of consummation of her marriage. Individuals who are victims of rape, who were virginal at the time of their rape, may elect for hymenorrhaphy.

Vaginoplasty and labiaplasty
Some women undergo vaginoplasty or labiaplasty procedures to alter the shape of their vulvas to meet personal aesthetic standards. The surgery itself is controversial, and critics refer to the procedures as "designer vagina".

Labia pulling
See labia stretching and elongated labia.

Male circumcision


Male circumcision involves the removal of the foreskin. It may also involve frenectomy, the removal of the frenulum. A related procedure is preputioplasty, which is used as a treatment for phimosis. This procedure is most often performed upon infant boys. It has religious significance in the Jewish religion and in Islam. It spread into Western culture, and peaked in the early 80s. The bioethics of neonatal circumcision are a subject of intense debate, with circumcision advocates promoting it as beneficial, and supporters of genital integrity opposing it as harmful and/or a violation of the individual's human rights. Some adults who were circumcised as infants engage in foreskin restoration, a method of stretching the penile skin in order to partially recreate the foreskin.

Penile subincision
Penile subincision is a form of body modification consisting of a urethrotomy, in which the underside of the penis is incised and the urethra slit open lengthwise, from the urethral opening (meatus) toward the base. The slit can be of varying lengths.

Infibulation
Infibulation refers to suturing of the foreskin. In ancient Greece, performers infibulated themselves by using a clasp or string to foreskin and draw the penis over to one side.