There are basically three ways to
make a clitoris look smaller without removing the entire
organ. The most frequently used method is clitoral reduction,
where surgeons free the shaft and glans from the surrounding
tissue and peel away the skin that covers it. Then they
cut out pieces of the shaft to shorten the clitoris
before sewing the glans up tighter to the pubic bone.
(It's a little like someone taking out sections of the
bones in your arm and sewing your hand up closer to
your shoulder.) Sometimes a surgeon will make a running
stitch along both sides of the shaft and accordion the
entire clitoris back, sort of squishing it against the
pubic bone. The third technique is what one surgeon
calls "magic with skin." The skin is repositioned around
the clitoris so it looks smaller, without actually taking
away any tissue.
All over this country there are
people whose clitorises have been removed, either totally
or partially. They range from your great-aunt's roommate
in the nursing home to your neighbor's two-year-old.
They include hundreds of women from every generation.
Some were born clearly female; some were born clearly
male but were reassigned as female and then had their
genitals altered; and some were babies whose sex was
not so easy to define. Although statistics for childhood
clitoral surgery are extremely difficult to gather,
one can extrapolate a figure from the number of babies
born each year in the U.S., the number born with conditions
that produce enlarged clitorises, and the number-most
of them-who will undergo clitoroplasty. Approximately
five times a day in the U.S., surgeons change the size
and shape of a child's healthy clitoris. Few of these
children are capable of expressing what they want. Some,
if given the choice later in life, might choose clitoroplasty.
But judging from the responses of women who had the
surgery done either without their agreement or at an
age when they were too young to know what they were
agreeing to, many would have preferred to stay the way
Gaby Tako was born in the Bronx
just before Christmas in 1960. She arrived so fast that
her mother had to give birth at home. The neighborhood
doctor hurried over to help and announced to the waiting
parents, "Congratulations! It's a boy!" before quickly
adding that he wasn't exactly sure about that. Gaby
had labia fused into a scrotal-looking sac, a vagina
that shared an opening with her urethra, and a big clitorisnot
an untypical presentation for a girl with CAH-congenital
adrenal hyperplasiaa condition that causes the
adrenal glands to produce too many male steroids, which
in the case of girls, can masculinize their genitals.
One in about every 10,000 children is born with CAH.
Because the disease can wreak havoc with the balance
of chemicals in the body, it can be life-threatening.
The large clitoris that often accompanies CAH gets bundled
in with other medical concerns and often a clitoroplasty
is doneprimarily for cosmetic reasons. According
to Cathy Kusch, spokesperson for Magic Foundation, which
supports families whose children have CAH, many parents
do seek second or third opinions when it comes to clitoral
surgery, but in the end, the majority choose clitoroplasty.
A medical paper written in 1994 affirms that "parents
will feel reassured [after genital surgery on their
child] when they know that their daughter can develop
heterosexually just like other girls." In Gaby's case,
her endocrinologist, unlike other doctors at that time,
didn't think surgery on newborns was worth the risk.
The decision was made to wait.
Gaby's early childhood was rough.
Her body was different, and she knew it. "Between birth
and age 13, I was never outright ashamed about my body
because there are certain things you don't talk about
in polite society. I don't remember anyone telling me
that it was bad, but I picked up on the fact that I
was different and that this was not a 'good' difference.
The doctors would poke and prod me and because my genitals
were always the center of attention, that made me ashamed."
After having put the doctors off
for several years, Gaby's mother and stepfather consented
to surgery for her when she was 13. The surgeon told
Gaby he was going to "fix her." "But I didn't know I
was broken," says Tako. "I knew I was different but
not that I was broken." As she awaited surgery, Gaby
fantasized about climbing out of the windows of the
hospital, escaping across the rooftops. "I had no way
to articulate that this was not necessary." She awoke
from surgery with searing pain. The surgeons had created
a bottom portion for her vagina to make an outlet for
menstrual blood. They split her labia and, in a procedure
popular in the 1970s, buried her clitoris under a layer
of skin. "Three and a half inches of coiled phallus
with nowhere to go," is how Tako describes it now.
"I felt dirty after the surgery,"
she says. "I was, as we say, F.I.N.E.fucked-up,
insecure, neurotic, and emotional. My genitalia were
never painful before, but since then, to one extent
or another, they have been a source of pain." In a postsurgical
visit to the doctor, Gaby asked, "Can't we undo this?"
and the surgeon answered, "Why would you want to do
that?" Today, Tako, who lives as a lesbian, considers
herself a product of "forced feminization."
Until about six years ago, no one
challenged the established protocol of altering the
clitoris of a girl like Gaby, nor of any other child
in our country. The U.S. public had no idea these surgeries
were going on, and most doctors considered them a necessary
treatment for a rare group of people. Medical schools
spend only a few hours on the subject of intersexuality,
with surgery hardly mentioned at all. Intersexed children
with "abnormal" genitals are depicted in medical books
naked and with a black band across their eyes in photographs,
lending an aura of freakishness to them. They historically
have been given the label "hermaphrodite," and further
categorized as "true hermaphrodites" (people who have
some ovarian and some testicular tissue), or "pseudohermaphrodites"
(boys with testes and some feminine characteristics
or girls with ovaries and some masculine characteristics).
These names also serve to marginalize the children,
hiding the fact that this is a far larger group than
anyone realizes. Even the doctors who care for these
patients as children know little or nothing about them
as they grow into their adult lives. They are "fixed,"
like Gaby, and lost to follow-up.
decades it was assumed that everything was more or less
all right with these patients. Ian Aaronson, a pediatric
urologist with a history of performing genital surgeries
on girl babies, believes that most, who are now adult
women, "have no idea they had surgery done and regard
themselves as absolutely fine, and they look absolutely
normal"although he acknowledges there is no proof
of that. But in 1993, a letter to the editor of The
Sciences magazine began to cast doubt on the optimism
of people like Aaronson. In an earlier issue of the
magazine Anne Fausto-Sterling had written an article
that she hoped would rattle the public's narrow thinking
about sexual dimorphism. With tongue-in-very-erudite-cheek,
she proposed that there are not two sexes, but fivemale,
female, herm (for hermaphrodite), ferm (for female pseudohermaphrodite),
and merm ( for male pseudohermaphrodite). At the time,
Cheryl Chase, a young businesswoman, had just returned
to the U.S. from Japan, where she had helped found a
successful software company. Chase had been born in
1956 and named Charlie. He was a little boy with a little
penis. Eighteen months later, doctors found that Charlie
had a uterus and ovaries and that each ovary had a small
corner of testicular tissue. But because the ovaries
were found to be functional, the decision was made to
change his sex of rearing.
Charlie became Cheryl. What doctors
had considered a "tiny" penis was now seen as a grossly
large clitoris. In order to feminize the toddler, the
surgeon incised deeply to obliterate any trace of a
clitoris, removing the shaft along with the glans. Chase
was left with a smooth, Barbie-doll look and a thin
layer of scar tissue with no erotic sensation. On the
advice of the doctors, her parents destroyed all evidence
of her as a boy, and when it was time for her to begin
school, they moved to another town where no one knew
When Cheryl was ten years old, her
parents told her that when she was a baby, her clitoris
had been "enlarged" and had had to be removed. Everything
was fine now, they continued, but she should never tell
anyone what was done to her. Chase describes herself
as growing into a "withdrawn, depressed adolescent,
trying to steal a glance of a woman's genitals" so she
could figure out what she was supposed to look like.
At age 19, she went searching for her medical records.
After several years of struggle, she finally obtained
them and discovered what had been done to her. The fact
that her parents, doctors, and relatives had hidden
the truth so completely from her confirmed its unspeakable
nature. Suicide beckoned. "It is not possible," she
remembers telling herself. "This cannot be anyone's
story, much less mine. I don't want it."
Fifteen years later, in Japan,
Chase suffered a "complete meltdown." She came back
to the U.S. partly because she thought there would be
help for her here. There wasn't. Not a single clinician
she contacted, including John Money, the sexologist
at Johns Hopkins, would acknowledge that her treatment
might have done more harm than good, nor would they
introduce her to others like her. It was during this
time that she read Fausto-Sterling's article and fired
off a letter to the editor announcing the formation
of the Intersex Society of North America (ISNA) complete
with post-office box address. Within weeks, Chase found
her postbox stuffed with letters from people from all
over the country who had had cosmetic genital surgery
performed on them as children. All of them had grown
up thinking there was no one else like them in the world.
As of today, hundreds of intersexed adults and families,
and scores of physicians worldwide, have contacted ISNA.
Chase's letter to The Sciences
is noteworthy for three reasons: it marked the first
time a person subjected to cosmetic genital surgery
as a child had publicly broken the silence around this
practice. It gave intersexed people a way to find each
other. And it fostered the growth of a grassroots movement
to change a surgical protocol so entrenched that surgeons
fly all over the world to perform it gratis as a humanitarian