Cornell doctor sliced young girls' genitals; Tested girls as young as six with vibrator, columnist says

A Cornell doctor is performing partial clitoris removal on young girls and then using a vibrator to test their sensation in follow-up tests, a shocking column by syndicated columnist Dan Savage asserted Wednesday.

Dr. Dix P. Poppas has been performing the procedure on girls older than five for several years, according to 2007 paper (PDF) documenting the research. The doctor and patients' parents allegedly believe that the girls' clitorises are too large and create too much sensation.

Doctors Alice Dreger and Ellen K. Feder have criticized the practice for almost ten years.

Critics in medicine, bioethics, and patient advocacy have questioned the surgery’s necessity, safety, and efficacy. We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm.

Dan Savage called the practice genital mutilation in a Wednesday column titled "Female Genital Mutilation at Cornell University."

There's lots to be outraged about here: there's nothing wrong with these girls and their healthy, functional-if-larger-than-average clitorises; there's no need to operate on these girls; and surgically altering a girl's clitoris because it's "too big" has been found to do lasting physical and psychological harm.

While many have been aware of the procedure, called "Nerve Sparing Ventral Clitoroplasty," for years, Poppas is now alarming many experts with new details of a follow-up exam. Dreger and Feder recently brought to light the practice of stimulating the young girls' clitorises with a vibrator to test the efficacy of the partial clitoris removal.

Here more specifically is, apparently, what is happening: At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.

Writing in an article for Psychology Today, Dreger suspected that the procedure and the follow-up exams were sure to cause more harm than good.

Many of us happen to think "normal" sexual development is actually likely to be thwarted by having parts of your genitals taken away without your consent, and thwarted by follow-up exams like the ones we are describing. Ellen and I have gotten to know hundreds of adults born with sex anomalies who went through these medical scenes growing up. Many have told us that the genital displays involved in the follow-up exams were more traumatic than any other part of the experience. Indeed, when I once asked a group of women with androgen insensitivity syndrome what they wanted me to work on primarily in my advocacy work, they said stopping the exams, particularly those in which med students, residents, and fellows parade through to check out the surgeon's handiwork.

The follow-up exam comes "very close to straight-up molestation," wrote conservative blogger Liz Mair.

"In fact, it seems to me that this is the kind of thing that a) Cornell University should not be tolerating, as a matter of practice and b) may well be worthy of actually legislating on, given the recent discussion of the American Academy of Pediatrics signing off on what amounts to better-branded female genital mutilation where needed to satisfy certain cultural dictates," said Mair.

"Cornell University needs to put a stop to this, immediately. If it is going on elsewhere, those cutting the checks wherever 'elsewhere' may be need to put a stop to it, also. This is, at a minimum, battery, and at worst, it's child abuse. Either way, it's intolerable," she concluded.