Clitoridectomy

Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. It is often performed on intersex newborns. Commonly, non-medical removal of the clitoris is performed during female genital mutilation (FGM). Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. It is often performed on intersex newborns. Commonly, non-medical removal of the clitoris is performed during female genital mutilation (FGM). A clitoridectomy is often done to remove malignancy or necrosis of the clitoris. This is sometimes done along with a radical complete vulvectomy. Surgery may also become necessary due to therapeutic radiation treatments to the pelvic area. Removal of the clitoris may be due to malignancy or trauma. Female infants born with a 46,XX genotype but have genitalia affected by congenital adrenal hyperplasia and are treated surgically with vaginoplasty that often reduces the size of the clitoris without its total removal. The atypical size of the clitoris is due to an endocrine imbalance in utero. Other reasons for the surgery include issues involving a microphallus and those who have Mayer-Rokitansky-Kustner disorder. Treatments on children raise human rights concerns. Clitoridectomy surgical techniques are used to remove an invasive malignancy that extends to the clitoris. Standard surgical procedures are followed in these cases. This includes evaluation and biopsy. Other factors that will affect the technique selected are age, other existing medical conditions, and obesity. Other considerations are the probability of extended hospital care and the development of infection at the surgical site.The surgery proceeds with the use of general anesthesia, and prior to the vulvectomy/clitoridectomy an inguinal lymphyadenectomy is first done. The extent of the surgical site extends one to two centimeters beyond the boundaries of malignancy. Superficial lymph nodes may also need to be removed. If the malignancy is present in muscular tissue in the region, it is also removed. In some cases, the surgeon is able to preserve the clitoris though the malignancy may be extensive. The cancerous tissue is removed and the incision is closed. Post operative care may employ the use of suction drainage to allow the deeper tissues to heal toward the surface. Follow up after surgery includes the stripping of the drainage device to prevent blockage. A typical hospital stay can be up to two weeks. The site of the surgery is left unbandaged to allow for frequent examination.Complications can be the development of lymphedema though not removing the saphenous vein during the surgery will help prevent this. In some instances, foot elevation, diuretic medication and compression stockings can reduce the build up of fluid. In a clitoridectomy for intersex infants, the clitoris is often reduced instead of removed. The surgeon cuts the shaft of the elongated phallus and sews the glans and preserved nerves back onto the stump. In a less common surgery called clitoral recession, the surgeon hides the clitoral shaft under a fold of skin so only the glans remains visible. While much feminist scholarship has described clitoridectomy as a practice aimed at controlling women's sexuality, the historic emergence of the practice in ancient European and Middle Eastern cultures appears to have derived from ideas about intersex people and the policing of boundaries between the sexes. In the seventeenth century, anatomists remained divided on whether a clitoris was a normal female organ, with some arguing that only intersex people had one and that, if large enough to be visible, it should always be removed at birth. In the 19th century, a clitoridectomy was thought by some to curb female masturbation. Isaac Baker Brown (1812–1873), an English gynaecologist who was president of the Medical Society of London believed that the 'unnatural irritation' of the clitoris caused epilepsy, hysteria, and mania, and he worked 'to remove whenever he had the opportunity of doing so', according to his obituary in the Medical Times and Gazette. Peter Lewis Allen writes that Brown's views caused outrage, and he died penniless after being expelled from the Obstetrical Society. Occasionally, in American and English medicine of the nineteenth century, circumcision was done as a cure for insanity. Some believed that mental and emotional disorders were related to female reproductive organs and that removing the clitoris would cure the neurosis. This treatment was discontinued in 1867.