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Liao and Creighton ask how healthcare providers in the United Kingdom should respond to requests for “genitoplasty,”1 or what two UK websites call “labial reduction” and “female genital reshaping.”2 3 This procedure, which entails “the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons,”4 is a criminal offence in the UK under the Female Genital Mutilation Act.4 5
Notes to the act say that no offence has been committed if the surgery is necessary for the woman's physical or mental health—for example, in cases of cancer, gender reassignment surgery, or “distress caused by a perception of abnormality.”5 The BMJ article focuses on the latter. The women interviewed who had this surgery were “anxious” because they had been led to believe—for example, by advertisements for cosmetic surgery—that their labia were too large, uneven, or unshapely. Their reasons were without exception non-therapeutic.
The contradictions are blatant. If a woman (probably African) asks for her own or her daughter's genitals to be excised for traditional reasons, it is refused as a criminal offence. Yet if a woman thinks her own genitals are an abnormal shape or size, the surgery is provided. The Department of Health is lending legitimacy to this on its website giving advice on cosmetic surgery.2 Yet the Department for International Development supports efforts to combat female genital mutilation in other countries.
Surgery is rarely an answer to psychological problems. This surgery is exploiting women's lack of bodily self esteem. No one is offering to shorten or lengthen men's penises or change the shape or size of their testicles for “cosmetic” reasons. There is no evidence of any benefit of this surgery for mental health, but ample evidence of its potential and actual harm. The law against female genital mutilation must be enforced.
Competing interests: None declared.