Trigger warnings: Descriptions of Female Genital Cutting; gender-based violence; sexism; transphobia; pain and distress; trauma

---

In the UK, FGC is considered child/ sexual abuse and a form of gender-based violence (GBV) because it is medically unnecessary, potentially harmful to health, reinforces harmful gender norms, and is a violent, painful, and traumatising act performed upon a child’s genitalia- without their consent [1].

However, there are other procedures performed on the genitalia of children and adults, which are not considered criminal/ GBV in the UK, even though they meet many of the same ‘harmful’ criteria. Researchers, such as those described by Earp & Johnsdotter (2021) have exposed this ‘double standard’ in legislation and argue that it has racist and other discriminatory implications [2]. In short, FGC laws appear to selectively criminalise all non-Western forms of genital cutting, while normalising similar medical/ cosmetic procedures that originate in the West [2].

Let’s compare some of the procedures we’re talking about here:

1. Hymen Repair/Restoration Surgery

Let’s start with an operation that is now also criminalised in the UK (but only since 2022!) [3]. Hymenoplasty claims to be the surgical reconstruction of the hymen (wrongly believed to be a physical indicator of virginity) [4]. The fact that this type of surgery even exists reproduces harmful myths about the female body and reinforces the discriminatory belief that having sex makes a woman (but not a man) “impure”, “unclean”, “immoral”, or “dishonourable”.

In communities where premarital sex is heavily stigmatised, women and girls (even if they have never engaged in consensual sex) may be forced to pursue hymenoplasty out of fear of social exclusion, punishment, and even death (i.e., murder- as in so-called ‘honour killings’) [4].

The concept of “informed consent” cannot apply for hymenoplasty because the procedure is not based on anatomical fact, the surgery is only harmful, the patient’s decision is clearly always influenced by false beliefs about virginity, and the surgery is now illegal (although, I’m willing to bet some private doctors still do it for the money) [5].

---

2. Labiaplasty

Labiaplasty is an elective (sought out) cosmetic surgery where some of the labia minora is cut away [6], individuals may also have some of their clitoral hood tissue removed [7]. This can reduce sexual function and pleasure, since labial and clitoral tissue contain lots of nerve endings. Complications occur in approx. 1-4% of surgeries [8].

When asked, people who had sought this type of genital cutting said that they wanted it for cosmetic reasons- based on harmful gendered beauty myths influenced by pornography and other dodgy media/ commercial/ pseudo-medical discourses [9]. Some people also mention physical issues, such as chafing- although researchers suspect this may be mentioned to ‘legitimise’ a desire to change the appearance of the labia [9].

In fact, the labia naturally vary greatly in their size, colour, and shape [10]. However, since we are not taught this at school, one could argue, ‘informed consent’ for labiaplasty is difficult to ensure. If we are not taught what is/ not ‘normal’, or why certain gender norms or surgical procedures have come into existence, how can we fully understand and consent to the personal and societal implications of labiaplasty?

---

3. Female Genital Piercing

Research suggests that female genital piercing may be sought to ‘improve’ sexual stimulation (with highly variable results), as a form of self-expression, or even to reclaim bodily autonomy after sexual assault [11]. Interestingly, these motivations do not reflect gender norms. In the UK, genital piercings can only be performed on people over the age of 16 (or 18 in Wales) who have been informed of the potential health risks.

However, the complication rate for genital piercings is relatively high-30-45% (between 3 to 5 out of every 10 piercings) [12]. Complications include lasting pain, loss of sensation, prolonged bleeding, scarring, and reduced blood flow [12]. So, it seems as though ‘informed consent’ is a more important factor than ‘potential risk to health’ when it comes to UK legislation regarding female genital cutting…

---

4. Intersex/ DSD ‘normalisation surgery’

Differences in sex development (DSD) is a group of conditions involving genes, hormones and reproductive organs, including genitals. Some people with such conditions prefer to use the term intersex [13].

These conditions mean that sometimes, a baby’s genitalia at birth don’t conform exactly to either end of the spectrum of male or female anatomy (see figure 1)[14].

‘Gender normalisation’ surgery may be performed to make an infant’s body conform with more typical forms of male or female genitalia, even though the procedure is usually medically unnecessary and all surgery involves possible complications and risks to health/ life [13]. Some parents and doctors feel that ‘normalising’ genital surgery is needed to protect the child from social exclusion [13]. [Very much like traditional FGM beliefs and practices].

However, when parents consent to ‘normalisation’ surgery on the behalf of their infant, they cannot know if the child will grow up to identify as the chosen sex and/ or gender. This can lead to poor mental health, social exclusion, and gender dysphoria, especially if the individual remains unaware that they were born intersex (which is often the case) [15].

While it is increasingly common to wait until a child is old enough to provide informed consent for any genital reconstruction procedures (described as ‘gender affirming’ below), infant ‘normalisation’ surgeries still legally happen in the UK today, despite a relatively high complication rate of around 25-45% (see Figure 2) [16].

---

5. Gender affirming surgery

Typically, this term refers to procedures that are elected (sought out) by adults experiencing gender dysphoria (psychological distress caused by identifying as a gender other than that associated with one’s sex identified at birth) and/ or body dysmorphia (psychological distress caused by perceiving parts of one’s body to be ‘wrong’ or ‘defective’ in some way) [17].

Gender affirming surgery can also refer to procedures performed on intersex/ DSD individuals who decide as an adult or teen to physically align with a gender/ sex they most closely identify with [15].

None of the various female-to-male (ftm) genital surgeries available (in the UK and beyond) involve the cutting/ removal of the clitoris, but the labia may be cut, if such surgery is desired [18]. All gender-affirming procedures require informed consent from adult patients [18].

The complication rates for Metoidioplasty (Clitoral‑based Urethral Lengthening) are around 12% and for Phalloplasty (Neophallus Construction + Urethral Extension around 24% [19]. However, gender-affirming surgeries typically improve the mental health of patients [20]. So, while there may be no physical medical need, there is an identified psychological medical need and subsequent mental health benefits.

Note: It could be argued that gender affirming surgery is influenced by/ reinforces harmful ‘biological essentialist’ beliefs that conflate sex with gender and attribute certain behaviours, roles, rights, opportunities, and social status to people- based on rigid binary conceptions of ‘normal’ male/ female genitalia [21].

This argument is technically valid but fails to properly consider the embodied life experiences of trans/ non-binary/ intersex people, the distress caused by gender dysphoria and/ or body dysmorphia [21], or the fact that relatively few trans/ non-binary people ultimately seek ftm genital surgery (i.e., around 2-3% of an already small and highly oppressed sub-population) [22].

Therefore, we cannot justifiably or usefully conclude that gender affirming surgery is a major cause or contributing factor in the perpetuation of binary gender norms. In fact, we could just as validly argue that these procedures directly challenge biological essentialism by ‘queering’ the spectrum of what human genitalia look like and enabling individuals to free themselves of any (preconceived) biological destiny [23]!

---

6. Genital reconstruction/ de-infibulation

Survivors of FGC, sexual violence, birth trauma, disfigurement, and complications relating to cosmetic procedures may choose to have surgery to help reconstruct their genitalia. The operation required to ‘open up’ a survivor of Type 3 FGC is called ‘de-infibulation’. Most UK patients are adults but children under 18 can also access this type of surgery (subject to a discussion of the potential risks, safeguarding protocols, guardian/ parental support, and usually some form of psychological counselling) [24].

In nearly all cases, there is a clear medical need for, and health benefits associated with, such operations. For instance, if a survivor is due to give birth, has associated menstrual or gynaecological health issues, or if scarring/ pain is impacting their mental and/ or physical health [24]. There are clear obstetric/ gynaecological health benefits but the complication rate (relating to the reconstruction part of the surgery only) may be up to 22% [25].

Note: As above (re gender affirming surgery), one could technically argue that the cosmetic element of genital reconstruction is influenced by/ reproduces harmful gender norms that dictate what female genitalia ‘should’ look like. However, given the circumstances of genital reconstruction patients, it would be unfair, inaccurate, and unethical to position such surgery as a major contributing factor in the perpetuation of societal gender norms. It is more useful to consider the cosmetic aspect of genital reconstruction as ‘gender affirming’ and beneficial for the patient’s mental (as well as their physical) health.

---

So, what can we conclude?

By comparing different forms of female genital cutting, it appears that ‘medical need/ health benefits’ and ‘informed consent’ might be crucial criteria for assessing if a particular procedure could count as a form of gender-based violence (a crime) within the current UK legal context (see table below).

Note: ‘Medical need’ includes psychological as well as physical health issues, and ‘informed consent’ relates to the patient (rather than their parents/ doctors), and would ideally involve a discussion of reproductive anatomy and physiology, gender norms/ myths, plus the potential for surgical complications.

Based on these criteria, ‘hymenoplasty,’ ‘labiaplasty’ and ‘gender normalisation surgery’ could all technically count as FGC ‘Type 4’. The relatively high complication rate for genital peircings should also be transparently shared with those seeking them. In fact, to ensure informed consent and to avoid further unecessary/ unjustified harm in relation to any type of genital procedure, we urgently need to improve UK reproductive health education.

---

Please cite as: King, S. and Dajani, J. (2025) ‘Myth Busting Female Genital Cutting (FGC): Part 7- The importance of informed consent…’ Menstrual Matters www.menstrual-matters.com/part-7-fgc-informed-consent  [Accessed DATE]

---

References

[1] https://www.gov.uk/government/publications/female-genital-mutilation-leaflet/female-genital-mutilation-the-facts-accessible-version

[2] Earp, B.D., Johnsdotter, S. Current critiques of the WHO policy on female genital mutilation. Int J Impot Res 33, 196–209 (2021). https://doi.org/10.1038/s41443-020-0302-0

[3] https://www.health-ni.gov.uk/news/uk-wide-ban-virginity-testing-and-hymenoplasty

[4] There is a pervasive myth that the hymen ‘breaks’ and bleeds during our first experience of penetrative heterosexual sex. This is simply not true, nor based on the available anatomical evidence. The hymen is very stretchy, has lots of holes (how else can menstrual fluid leave the body?), very scant blood supply, and its presence or absence is not an accurate predictor of whether or not someone has had sex before. Blood during sex is also no indicator of virginity- it only indicates injury (typically to the vagina, not the hymen). Proper lubrication reduces the risk of vaginal injury during sex (for the first time and subsequent times).

Even forensic scientists are often unable to tell if someone has ever had sex or not, so some untrained yet well-paid ‘virginity tester’ or corrupt private gynaecologist won’t be able to, either.  This is a seriously dangerous myth that has damaged/ ended the lives of many men, women, and children- so please do not reproduce it. https://karmanirvana.org.uk/data/interactive-map-of-honour-based-abuse-deaths-in-the-uk/ 

See this paper for a great overview- Mishori R, Ferdowsian H, Naimer K, Volpellier M, McHale T. (2019) The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault. Reprod Health. Jun 3;16(1):74. https://pmc.ncbi.nlm.nih.gov/articles/PMC6547601/

[5] https://www.gov.uk/government/publications/expert-panel-on-hymenoplasty/final-report-of-the-expert-panel-on-hymenoplasty-ethical-legal-and-clinical-implications#the-case-for-criminalisation

[6] Veale, D., Eshkevari, E., Ellison, N., Costa, A., Robinson, D., Kavouni, A. and Cardozo, L., 2014. Psychological characteristics and motivation of women seeking labiaplasty. Psychological medicine, 44(3), pp.555-566. https://doi.org/10.1017/S0033291713001025 

[7] Placik, O.J. and Arkins, J.P., 2015. A prospective evaluation of female external genitalia sensitivity to pressure following labia minora reduction and clitoral hood reduction. Plastic and reconstructive surgery, 136(4), pp.442-452. https://www.washingtonianplasticsurgery.com/wp-content/uploads/2016/03/A-Prospective-Evaluation-of-Female-External-Genitalia-Sensitivity-to-Pressure-following-Labia-Minora-Reduction-and-Clitoral-Hood-Reduction-1.pdf

[8] Escandón, Joseph M. M.D.; Duarte-Bateman, Daniela M.D.; Bustos, Valeria P. M.D., M.S.; Escandón, Lauren; Mantilla-Rivas, Esperanza M.D.; Mascaro-Pankova, Andres M.D.; Ciudad, Pedro M.D., Ph.D.; Langstein, Howard N. M.D.; Manrique, Oscar J. M.D.. Maximizing Safety and Optimizing Outcomes of Labiaplasty: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery 150(4):p 776e-788e, October 2022. | DOI: 10.1097/PRS.0000000000009552

[9] Dogan, O. and Yassa, M., 2019. Major motivators and sociodemographic features of women undergoing labiaplasty. Aesthetic surgery journal, 39(12), pp.1-27 https://doi.org/10.1093/asj/sjy321

Mackenzie, J., 2017. Vagina surgery ‘sought by girls as young as nine’. BBC News. Available at: https://www.bbc.co.uk/news/health-40410459. (Accessed: 20 January 2025).

Özer, M., Mortimore, I., Jansma, E.P. and Mullender, M.G., 2018. Labiaplasty: motivation, techniques, and ethics. Nature Reviews Urology, 15(3), pp.175-189. https://doi.org/10.1038/nrurol.2018.1

Runacres, S.A. and Wood, P.L., 2016. Cosmetic labiaplasty in an adolescent population. Journal of pediatric and adolescent gynecology, 29(3), pp.218-222. https://doi.org/10.1016/j.jpag.2015.09.010

Gemma Sharp, Marika Tiggemann, Julie Mattiske, Factors That Influence the Decision to Undergo Labiaplasty: Media, Relationships, and Psychological Well-Being, Aesthetic Surgery Journal, Volume 36, Issue 4, April 2016, Pages 469–478, https://doi.org/10.1093/asj/sjv270

Walden, R.L., Abdulcadir, J. and Earp, B.D., 2024. Labiaplasty in minors: medicalizing mutilation?. Archives of Sexual Behavior, pp.1-12. https://doi.org/10.1007/s10508-024-03021-1

[10] Labia come in all different shapes, colours and sizes! See the Labia library- https://www.labialibrary.org.au/labia_gallery/

[11] Stirn, A., Oddo, S., Peregrinova, L., Philipp, S. and Hinz, A., 2011. Motivations for body piercings and tattoos—the role of sexual abuse and the frequency of body modifications. Psychiatry Research, 190(2-3), pp.359-363. https://doi.org/10.1016/j.psychres.2011.06.001

[12] Bone A, Ncube F, Nichols T, Noah ND. Body piercing in England: a survey of piercing at sites other than earlobe. BMJ. 2008 Jun 21;336(7658):1426-8. doi: 10.1136/bmj.39580.497176.25

[13] Moreno-Begines MLN, Arroyo-Rodríguez A, Borrallo-Riego Á, Guerra-Martín MD. Intersexuality/Differences of Sex Development through the Discourse of Intersex People, Their Relatives, and Health Experts: A Descriptive Qualitative Study. Healthcare (Basel). 2022 Apr 2;10(4):671. doi: 10.3390/healthcare10040671

Zeeman L, Aranda K. A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance. Int J Environ Res Public Health. 2020 Sep 8;17(18):6533. doi: 10.3390/ijerph17186533.

[14] The Prader Scale- free image from: Yau M, Khattab A, Yuen T, et al. Congenital Adrenal Hyperplasia. [Updated 2022 Nov 3]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Figure 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278953/figure/congn-adren-hyprplsa.F3/

[15] Behrens KG. A principled ethical approach to intersex paediatric surgeries. BMC Med Ethics. 2020 Oct 29;21(1):108. doi: 10.1186/s12910-020-00550-x. PMID: 33121480; PMCID: PMC7597036.

Muschialli L, Allen CL, Boy-Mena E, Malik A, Pallitto C, Nihlén Å, Gonsalves L. Perspectives on conducting “sex-normalising” intersex surgeries conducted in infancy: A systematic review. PLOS Glob Public Health. 2024 Aug 28;4(8):e0003568. doi: 10.1371/journal.pgph.0003568

[16] Bernabé KJ, Nokoff NJ, Galan D, Felsen D, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Ellens R, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Delozier AM, Mullins LL, Palmer B, Paradis A, Reddy P, Reyes KJS, Schulte M, Swartz JM, Yerkes E, Wolfe-Christensen C, Wisniewski AB, Poppas DP. Preliminary report: Surgical outcomes following genitoplasty in children with moderate to severe genital atypia. J Pediatr Urol. 2018 Apr;14(2):157.e1-157.e8. doi: 10.1016/j.jpurol.2017.11.019

[17] Here’s a useful overview- https://www.medicalnewstoday.com/articles/body-dysmorphia-vs-body-dysphoria

[18] Check out this overview of the different female-to-male genital surgery options- https://www.leedsandyorkpft.nhs.uk/our-services/wp-content/uploads/sites/2/2022/02/Phalloplasty_leaflet_v3.pdf

[19] Oles, N; Darrach, H; Landford, W; Garza, M; Twose, C; Park, C; Tran, P; Schechter, L; Lau, B; Coon, D. Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 2: Genital Reconstruction). Annals of Surgery 275(1):p e67-e74 DOI: 10.1097/SLA.0000000000004717

[20] Javier C, Crimston CR, Barlow FK. Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review. Int J Transgend Health. 2022 Mar 18;23(3):255-273. doi: 10.1080/26895269.2022.2038334.

Kilmer LH, Chou J, Campbell CA, DeGeorge BR, Stranix JT. Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria. Plast Reconstr Surg. 2024 Nov 1;154(5):1142-1149. doi: 10.1097/PRS.0000000000011325. Epub 2024 Feb 2. PMID: 38315125.

Ren T, Galenchik-Chan A, Erlichman Z, Krajewski A. Prevalence of Regret in Gender-Affirming Surgery: A Systematic Review. Ann Plast Surg. 2024 May 1;92(5):597-602. doi: 10.1097/SAP.0000000000003895

[21] Lane, R. (2009). Trans as bodily becoming: Rethinking the biological as diversity, not dichotomy. Hypatia, 24(3), 136-157.

[22] Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol. 2019 Jun;8(3):184-190. doi: 10.21037/tau.2019.04.09

[23] LaLuzerne, D. (2020) ‘Queering the Sex Binary: Decolonial Biology’ in Danie Hernandez; E. Hernández-Medina; Emrys Yamanishi (Eds.) Prospects to Queer Future: A Guide to Intersectional, queer and Feminist Theory Claremont Press https://pressbooks.claremont.edu/gws180po01/chapter/chapter-11-queering-the-sex-binary-decolonial-biology-dani-laluzerne/

[24] RCOG Green top guideline no 53. Female Genital Mutilation and its Management. July 2015.

[25] Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S. The effectiveness of surgical interventions for women with FGM/C: a systematic review. BJOG. 2018 Feb;125(3):278-287. doi: 10.1111/1471-0528.14839