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Authors: Natalie Angier

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vulva is a candidate for a clitoridectomy. When a baby is born with equivocal genitals, surgery was, and is, the norm. We may tolerate sexual ambiguity in rock stars, but not in infants. Susan, the girl whose diaper my mother changed, very likely ended up in the hands of a pediatric plastic surgeon early in her childhood, never again to embarrass a peeping mom. Sometimes the young patient will undergo other surgery as well, to open up a fused vagina, repair a defective urethra, or remove imperfectly formed gonadal tissue. Though some of the surgery may be necessary for the child's health, in the case of clitoral reduction we're talking aesthetics. A big clitoris doesn't hurt anybody, certainly not the baby. But it looks funny, boyish, obscene, and parents are advised to fix it while the child is young enough to escape any putative psychological trauma that might accompany uncertainty about her sex. And so we may ask, what happens to girls whose clitorises are surgically micrometized or cauterized? Do they lose sexual sensation? Can a woman have an orgasm if she doesn't have a clitoris?
The clitoris is complex. Pandora's box is a hope chest and a box of rain, and results from the ongoing, ad hoc exploration of clitoral aptitude, brought about by the insistence on surgery for clitorimegaly, are mixed. Consider the following two cases.
Cheryl Chase is a computer analyst in her early forties. She wears wire-frame glasses, keeps her hair short, and often puts on dangling earrings and bright mulberry lipstick. She is quietly attractive and ferociously bright, fluent in Japanese. She is also angry. She thinks she will die angry. Cheryl has two X chromosomes, the conventional female complement, and today she looks very much the woman. But for unknown reasons she was born with hermaphroditic gonads that were part ovary and part testes, and a clitoris so big that at first the doctors told her parents, It's a boy. A year or so later, doctors at another hospital realized, Wait a minute, this child has a normal vagina, uterus, and fallopian tubes: it's a girl. They told her parents, The other doctors were wrong. You have a daughter, not a son. You'll have to rename her, move to a new town, and start over again. But first give us permission to fix her genitals. Immediately. Permission granted. "They removed my clitoris on the spot," Cheryl says, with the soft voice of somebody who's talking through clenched teeth. "They cut at the division of the crura, where the nerves enter the clitoral shaft. I have a small amount of crural

 

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tissue around the pelvic opening, but no innervation. Therefore, no feeling." A lesbian, she is sexually active, but she has never had an orgasm. She has tried everything. She has written to doctors and begged for their help, to find whatever nerve fibers might remain in her residual tissue to be rallied, resurrected. Most have ignored her pleas. Do I look like some sort of surgical Dr. Ruth? they say. She consulted surgeons who perform transsexual operations, changing males into females or females into males, and who attempt to preserve sexual responsiveness in the transformation. They told her, Forget it, they took away everything we would use. "I would have preferred to grow up in a place with no medicine," Cheryl says, "rather than to have had happen to me what did happen."
Martha Coventry is an editor and writer in her mid-forties and the mother of two children. She is thin, lanky, and has a cap of dark, springy curls. Martha is the sort of person you like having around because she makes you feel likable. Martha also was born with a beefy clitoris, the result of her mother's taking high doses of progesterone during pregnancy to prevent miscarriage. As an infant, her clitoris measured 1.5 centimeters, three times the average. Not an emergency case of megaly, but her parents decided that she shouldn't attend school with such a conspicuous knob and risk the verbal savagery of her peers. And so, at the age of six, she was shorn. "They snipped it off at the base," said Martha. "If you saw me now, you'd know something was missing." If the body is gone, the spirit yet lives. "I have emotional scars, but I'm not bitter," said Martha. "The reason is simple. I still have clitoral sensation. I'm orgasmic."
Cheryl and Martha are activists seeking to prevent the subjection of other babies born with intersexed genitals to cosmetic surgery, as they were. They and their fellow agitators have lobbied Congress to pass a law prohibiting clitoridectomies on patients too young to consent to the procedure or to cry, You want to do what, where?! Such legislation has yet to be passed, but Cheryl Chase and her peers gradually are persuading pediatricians that Hippocrates' familiar advice,
First, do no harm
, applies to them and theirs, for nobody knows how a given clitoris will respond when you start whacking away at it. Even a big clitoris on an infant is a small target, and with all the nerves and blood vessels bundled up in it, it is easily harmed. There are no long-term follow-up

 

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studies of children who have been clitoridectomized, to see how they fare sexually. All we have are anecdotes. Martha and Cheryl each had her clitoris cut off at the base, yet one sings and the other doesn't. Nobody knows why. Some surgeons claim that their clitoral reduction techniques now are far superior to the crude hacksmanship of the past, but they have no proof. Nor do they have proof that life with a large clitoris presents an insuperable psychospiritual challenge to either a child or her parents.
What is it about the clitoris, our orchid style, our semi-clandestine Corinthian column, that makes it so vulnerable to the hatchet? Like an artist, the clitoris has won its greatest fame only upon its death its murder. The intersexual activists in this country truss their grievances by equating their stories with the far more publicized custom of ritual genital amputation practiced in Africa. The unarguably vile practice goes by various names, including female genital mutilation, or FGM; African genital cutting; and female circumcision although as many have pointed out, it is more akin to penile amputation than to male circumcision and should not be given the courtesy of comparison. The tradition dates back at least two thousand years, and it has never been much of a secret, but the general impression until recently was (a) that it was fairly uncommon, confined mostly to small remote villages, and (b) that it was on its way out. Neither has proved to be true. At least one hundred million women living in twenty-eight countries have had their genitals cut, and two million girls are added to the ranks of the lacerated each year. In some countries, including Ethiopia, Somalia, Djibouti, Sierra Leone, Sudan, and Egypt, the prevalence rate approaches 100 percent. Some gifts and young women have fled their native homes, vulva intact, and sought asylum abroad, but putatively enlightened nations such as the United States have been slow to sympathize, or to acknowledge that the threat of genital carnage counts as persecution. Now we in America have a self-congratulatory bill banning African genital cutting in this country, though the bill doesn't prevent the medically approved cutting of any clitorimegalic Susans who may be born; nor does it come with the necessary teeth of economic sanctions against nations where girls are sheared en masse.
In learning about genital vandalism, we have heard about the gradations of the procedure. The "mildest" form is a straightforward clito-

 

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ridectomy that removes part or all of the organ. Intermediate dismemberment eliminates the inner labia along with the clitoris. Infibulation, the grisliest horror show of all, chops away clitoris and inner labia, and then incises the outer labia to create raw surfaces that can be stitched together to cover the urethra and vagina, leaving just enough of an opening for the passage of urine and menstrual blood. Eventually, when the infibulated girl marries and must accommodate her husband's penis, the stitches are removed and the scarred skin of the outer labia is pushed apart.
However limited or extensive the cutting, it is done without anesthesia, under unsterile conditions, and the tool used is whatever crude blade the local low priestess of mutilation it is often a woman has deemed the most appropriate instrument for the ritual. It is usually performed on a young girl of seven or eight, who may anticipate the ceremony with a certain excitement, thinking at last she will be counted a woman, but who ends up screaming in pain and must be held down by several adult women as she flails to escape, unless she is fortunate enough to pass out from the shock and pain and loss of blood. Sometimes the girl hemorrhages to death immediately, or dies soon afterward of sepsis, tetanus, or gangrene. If she survives, she may suffer chronic pelvic pain from wounds that do not heal, or infections from urine and blood that cannot flow cleanly. Cysts often form along the line of the scar, some growing as big as grapefruits and making the woman feel ashamed, fearful that her genitals are returning in monstrous form or that she is dying of cancer. When an infibulated woman gives birth, she is like a poor, mewling hyena on first parturition, her infant having no choice but to tear its way to the light.
According to its proponents, genital cutting serves several purposes. It supposedly tames a woman, abridging her innate wantonness and discouraging her from any thoughts of cuckoldry. Less familiar to westerners is the cosmetic objective of the pruning, the desire to accentuate the visual discrepancy between female and male. Eliminating the clitoris, the woman's penis-equivalent, is a start; losing the labia, which can resemble a scrotum, takes the polarity to an extreme. No protrusion, no pouches, no confusion. As photographs of infibulated women show, the operation can produce a smooth pelvic profile that is superfeminine by some infantile mental module of femininity. In fact, it looks like it

 

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belongs on everybody's favorite feminine fetish, the smooth-groined doll named Barbie.
Many have written of genital mutilation, and many have denounced it. Even those who are sensitive to cultural traditions see genital cutting as a tradition worth destroying. I feel enfeebled here, unable to add a constructive word or insight, depressed by the persistence of a repulsive "rite," and made small, as we all are, by capitulation through inertia. Genital cutting is an extreme abuse of human rights. Like slavery and apartheid, it is unacceptable. How can we stop it? By talking about it with angry, unbitten tongues. By never forgetting about it, and by not letting the issue slide back into obscurity now that we have learned of its pervasiveness and tenacity. Some recommend that efforts to end the practice respect the underlying belief systems of those who cut and have been cut. The nonprofit organization Population Council has argued that it is no good barking about a woman's right to sexual integrity to an audience that values sexual modesty. Instead, the council recommends we should emphasize the risks of genital cutting to a woman's most cherished asset: her fertility. Fine. Let's be sensitive, not self-righteous. Emphasize reproductive health over a carnal entitlement program, responsibility over narcissism. Say what you will just put down that knife.
I'm all for pragmatism, but the clitoris is idealistic, utopian, and in the end it's hard to kill a good fantasy. Which may offer us a paradoxical argument against cutting a girl's genitals: the operation doesn't always work. Destroying the clitoris in body may or may not destroy it in spirit. Like Martha Coventry, some African women who have been clitoridectomized, even infibulated, describe themselves as erotic beings who enjoy sex and experience orgasm very fierce orgasms, they add. Their phantom clitorises, it seems, are like the ghost of Hamlet's father: persistent, present, incorrigible. These women may have been subjected to grave medical risks during their ceremonial evisceration, but ultimately they were not tamed or chastened. So why put a girl's life (or fecundity) in danger, when there's no guarantee that her lust will die? And if a woman remains orgasmic and yet does not surprise! walk the path of a Barbary macaque, perhaps we can see here proof that the clitoris has no power over a woman, none at all, beyond what she will receive and what she will give it in return.

 

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5
Suckers and Horns: The Prodigal Uterus
Hope Phillips has the sort of job that the brain loves but the pampered body hates. She is a project manager for the World Bank, and she is on the road for months at a stretch, traveling to places where there are no roads. Instead, there are bodily threats: parasites of extravagant variety and design; mosquitoes that hum in malarial choirs; two-fisted heat; the combined effluvia of local sewage and imported toxic waste; and a blood supply that should never again see the inside of anyone's veins. She has traveled throughout South America and Asia, but lately most of her work has been in southern Africa. And it was in Africa that she began to wonder if she could afford the luxury of her body's increasingly fitful behavior.
Phillips is a slender woman in her mid-forties with smooth skin, fine bones, and a precise, thoughtful manner. She is American but was raised in Taiwan, where her father, a physician, studied cholera, and there is the faintest hint in her locution of the Chinese she grew up speaking. I visited her in her home in Arlington, Virginia, a boxy, almost prim little house inspirited with rugs and furniture and carvings scavenged during her forays abroad. I drank coffee and nibbled on Milano cookies; she drank tea, ate nothing, and talked about her medical problems and the solution she had settled on.
For the past several years, Hope had been bleeding in what she considered an extracurricular fashion. "About five days a month, apart from my period, I'd start bleeding at nine o'clock in the evening," she said. "It would come out in a gush." She let her torso and arms fall forward slightly to emphasize
gush
. At first she didn't make a big deal of it, but eventually she decided, Oh, yes, I'd better consult a doctor. An

 

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