Policy on genital cutting and modification (GCM) discriminates against people from marginalised minority groupsFootnote 1 within existing Western multicultural societies. Public and political figures characterise GCM by marginalised groups as ‘cultural’ while simultaneously viewing GCM by dominant group members as in a person’s best interest,Footnote 2 or something that they choose for self-improvement.Footnote 3 But cultural norms and expectations influence and shape decisions made by parents and women choosing GCM for themselves within all groups. Differentiated policy on GCM hinders cultural integration and misdiagnoses dominant group members as being unaffected by cultural norms and values. This policy difference results in unequal treatment of individual women depending on their cultural background and means that many children are not protected from harmful dominant cultural group practices.Footnote 4

In part I, I outline the backdrop for the discussion as an analysis of unjustifiably different treatment of equivalent practices within culturally diverse societies. I claim that an ideal of integration should be equal treatment of people within diverse groups. I analyse the concept of culture to show that all people are affected by cultural norms, whether they are from dominant or marginalised groups. In part II, I analyse different legal and moral treatment of primarily adult GCM (AGCM). I demonstrate that members of marginalised groups are treated as less equal than members of dominant groups by being characterised as insufficiently autonomous due to their cultural background. I stress the idea that AGCM should be understood as ‘cultural’ whether chosen by adults from dominant or marginalised groups, and that individual women should be treated as equally capable of making decisions about their genitalia, whatever their cultural background. This means that if a state objects to a woman from a marginalised group having her genitalia cut or modified, they should also object to women from dominant groups having their genitalia cut or modified. In part III, I apply the account of culture to child GCM (CGCM) conducted by different groups emphasising the idea that intersex genital modification (IGM) should be understood as ‘cultural’.

A normative commitment to equality within multicultural societies results in the following analytical assumptions for this discussion: first, cultural groups should not be condemned or rejected, as such; second, there should be a spirit of inter-cultural dialogue and criticism, meaning that dominant and marginalised groups should be free to discuss and criticise particular practices and norms across groups; third, there should be a universal policy on genital cutting and modification that protects and treats all individual children and adults equally, whatever their cultural background.

Part I: Culture

Cultural Discrimination

The aim of policy targeting female genital cutting (FGC) practices is harm-reduction. These policies aim to protect girls and women from the physical and psychological harms of the procedures. But, policy inconsistency regarding different sex trait categories of CGCM in Western societies is increasingly recognised as morally unjustifiable (Svoboda 2006; Möller 2020; Shweder 2000; Dustin 2010; The Brussels Collaboration 2019; Earp 2020; Chambers 2018; Townsend 2020; 2021a; 2021b; Duivenbode 2021; Duivenbode and Padela 2019). FGC conducted by minority groups originating from some African countries in Western liberal societies (Mestre 2022), is packaged in a narrative that understands the groups to be ‘barbaric’ and harmfully culturally ‘coercive’ (Piontek and Albani 2019; Buckler 2022; Mazor 2013; Shweder 2000). The difference can be taken as evidence of sociocultural bias towards the familiar and suspicion of ‘the foreign’ on the part of dominant groups and powerful members of society (Galeotti 2007). This bias leads to policy-makers in Western liberal states ‘holding cultural minorities to much stricter standards of autonomy and equality than those to which they hold themselves’ (Williams 2005, p. 39). When the bias is translated into policy that is unjustifiably different for marginalised groups, it should be understood as discrimination against those groups.

Cultural discrimination occurs when cultural groups are unjustifiably treated differently to the wider society in which they reside. In culturally diverse societies, where dominant and minority groups cohabit, cultural discrimination refers to the treatment of people based on their group membership, rather than the treatment of individuals as such. That is, it refers to policies and attitudes that have as their object the members of particular cultural groups and their presumed characteristics. Cultural discrimination is observable by consulting legal, political, and public treatment of diverse groups, and might mean public denigration of a group or groups relative to others by characterising them as ‘barbaric’.Footnote 5 It might mean legislation that treats groups differently without plausible justification, or treating adults as less able to exercise autonomy based on the group to which they belong. Discriminatory treatment of a marginalised group relative to the dominant groups in culturally diverse societies is contrary to the ideal of respectful integration. For the issue at hand, I am particularly in interested in discriminatory state treatment of diverse groups in relation to GCM practices (Chambers 2019, 2004; Shahvisi and Earp 2019; Braun 2009; Galeotti 2015, 2007; Townsend 2020).

Culture and Autonomy

The relationship between culture and the individual is complex. Kukathas (1992) argues that identities—ethnic, cultural, gendered—are not static across time and context. The characteristics of a particular group identity differ between people within the same group, but also within one person across their lifetime. A person’s commitment to Christian values and norms at age 18 may be very different to the same person’s commitment to Christian values and norms at age 40, indicating that whatever cultural norms and values are, they can be revised (Kukathas 1992). If cultural norms and values can be revised, then the people within cultural groups must have skills to recognise, reflect, and enact change. That is, they must have cultural autonomy. Kwame Anthony Appiah stresses the difficulty of defining individuals in a way that respects their autonomy and their cultural embeddedness (Appiah 1995). Appiah suggests that any adequate conception of personhood must take both aspects into account without endorsing either as the most significant: ‘[o]f course, neither the picture in which there is just an authentic nugget of selfhood, the core that is distinctively me, waiting to be dug out, nor the notion that I can simply make up any self I choose, should tempt us’ (Appiah 1995, p. 76). To take culture seriously in relation to the individual, we must understand it as a fundamental aspect of experience that is compatible with respecting individual autonomy. It is as a value currency that is not determining and rigid, but flexible and revisable. Individuals cultivate their autonomy in dialogue with the norms and values of their cultural group(s). For Clare Chambers, ‘social construction is omnipresent and inevitable. Although we can engender change, and even radical change, we cannot escape the social’ (Chambers 2008, p. 124). Human social interaction is inescapable, and we cultivate our understanding of the world and our preferences socially. ‘[W]e cannot escape the social’, none of us. The inescapability of social and cultural influence is universal. This basic social premise is the foundation of my understanding of culture and the relationship between an individual’s culture and their autonomy.

An adult who has been raised within a particular association of people has been influenced by that group’s social and cultural norms, values, and practices (Chambers 2008, esp. pp. 123–127). These norms and practices are part of the external conditions through which individuals develop, test, and exercise their autonomy (Cloward 2016; Westlund 2009). They inform the individual’s self-understanding and impression of their place in the world. But this need not imply that individuals’ preferences and choices are completely determined by social construction and cultural norms. The development of an individual’s moral code depends on social interaction, indeed ‘[p]ersons, and legal persons as well, become individualized only through a process of socialization’ (Habermas 1994, p. 58). It is expressed in language acquired by interaction with other people and so the internal moral code is necessarily dialogical (Taylor 1992, p. 32). Individuals depend on significant others to develop their understanding of the social world and their role within it; we make sense of the world in dialogue with those that raise us. This does not mean that culture exhausts the person’s preferences—if norms and preferences can be adapted over time they cannot be fixed and static. It is through dialogical interaction with cultural norms and values that an individual develops their preferences.

Practices and norms can be distinguished. Cultural practices are repeated actions that have developed and been shared by people who regard themselves (and are regarded) as part of a cultural group, over an extended period of time, and have become a part of what is perceived internally and externally as traditional and valuable for that group. They are generally perpetuated and promoted as something important for group members to retain their cultural character. Cultural practices are maintained on two levels—as informed by socio-cultural norms and passed on due to familial-cultural values. A cultural norm is something that the cultural group—or ‘reference group’ expects or anticipates in terms of its members’ behaviour and characteristics (Cloward 2016, pp. 5/6). It is ‘a shared "standard of appropriate behaviour for actors within a given identity." The key characteristic of a norm is that it carries a "prescriptive…. Quality of "oughtness"’ (Cloward 2016, pp. 4-5). So, members of the wider society or group commonly behave in a particular way, and do so because they attribute moral value to the behaviour, which is among the reasons it continues. When members of groups act in particular ways that continue or revise or reject a given norm, they influence the character of the socio-cultural context by contributing to its maintenance. The reference group expects individual members to observe the norm.

Norm maintenance can be unreflective. A norm may be so well embedded in a group that its members do not consider the possibility of not conforming, or do not recognise it as a cultural norm. Cloward calls this ‘unthinking’ norm adherence. Some norms are so deeply entrenched in a group’s collective psyche that doing otherwise is ‘unthinkable (in the most literal sense of the word—the norm is so fundamentally embedded within a reference group that the possibility of violating it simply doesn’t occur to anyone, making compliance automatic)’ (Cloward 2016, p. 5). This does not necessarily mean that the norm will never change, but that it will either take a very long time to change, or it will take a radical shift in perspective which would involve a dramatic reshaping of the group’s understanding of the issue. This idea is important for understanding GCM practices amongst dominant groups in Western liberal states, which I turn to now.

Part II: “Girl Includes Woman”: Controversies of Consent-Capacities

A cultural norm influencing dominant group members in Western liberal states, like the UK, expects female genitalia to look a certain way. The promotion of labiaplasy encourages women to alter their genitalia for aesthetic reasons, but the idea that women’s genitalia should look a certain way is not recognised as a cultural norm and labiaplasty is not understood to be a cultural practice. Rather, it is characterised as something that a woman might do for her own ‘self-improvement’.Footnote 6 Meanwhile, UK legislation states that it is a criminal offence to cut the genitalia of any woman from a cultural group that practises genital cutting as a ‘matter of custom’, even when the women seek minor cutting or stitching, for themselves, as adults (Female Genital Mutilation Act 2003; Shahvisi 2021). This inconsistency means that women from dominant and marginalised groups are not treated equally by the state. The idea that women from groups that practise FGC as a ‘matter of custom’ have not had the chance to develop sufficient autonomy but that dominant group women have, is a form of cultural discrimination on two levels. First, on the individual level, it assumes that women from dominant groups who seek labiaplasty are not influenced by the norms and expectations of their cultural contexts but that women from marginalised groups are. The inconsistency both infantilises women from marginalised groups and exalts women from dominant groups to superior levels of autonomy. Second, on a group level, it characterises marginalised groups as coercive and static, but dominant groups as liberated and liberating despite the similarly patriarchal expectations about women’s and girls’ bodies.

I compare similar practices across diverse groups within multicultural settings to show that all cultural groups contain cutting practices that are materially similar and maintained by cultural norms. The normative upshot of doing so, is to shift the focus of criticism regarding GCM away from the group per se, and towards the individuals conducting the practices. Norms and practices change over time which means that within cultural groups, people can and do exercise cultural autonomy by rejecting or revising the practices that they inherited. As such, narratives that characterise entire cultural groups as ‘barbaric’, ‘backward’, and ‘coercive’, overlook internal group dynamics of norm and value exchange, maintenance, and resistance. Policy and public attitudes within Western liberal states treat women from marginalised groups that have historically practised FGC for reasons of ‘custom or ritual’ as though the groups they come from are static and rigid. Doing this reductively oversimplifies the way that culture functions, and overlooks the fact that dominant group culture in these societies contains similarly harmful and coercive norms and practices. I do not intend to take a normative position that is culturally relative by showing that there are similar practices within different groups, or to suggest that there should not be cross-group criticism. Rather, the point is to show that not only marginalised cultural group members practise GCM that is harmful to vulnerable people within the groups. It is to point out that adults and children within dominant groups also have their autonomy and preferences shaped by cultural norms and values that expect their bodies to look and behave a particular way.

Women are frequently treated as less able to exercise autonomous choice if they belong to a marginalised cultural group within Western societies (Galeotti 2015; 2007; Shahvisi 2021). For example, British law states that it is an offence to cut a woman’s genitals if she is from a group that traditionally practises ‘ritual’ FGC, even if she has given explicit consent for the procedure (Townsend 2021a, 2021b; Shahvisi 2021; Chambers 2019). When it comes to cutting ‘as a matter of custom or ritual… girl includes woman’ and cutting girls’ (and women’s) genitals for such purposes is strictly prohibited (Female Genital Mutilation Act 2003). Similarly, Italian women of Somali heritage were denied the possibility to have their genitalia nicked, even within a medically safe setting and with their expressed consent and desire for the procedure (Galeotti 2007; Townsend 2020). At the same time, it is permitted to cut, stitch, or modify a girl or woman’s genitals ‘if it is necessary for her physical or mental health’ or if it is necessary after giving birth (Female Genital Mutilation Act 2003; Townsend 2021b). So, if a woman seeks genital modification for aesthetic purposes, it is permitted, and it is not considered a criminal offence to promote and conduct female genital cosmetic surgeries (FGCS) (Chambers 2019; Braun 2009; Shahvisi 2021). If, however, a woman from a group that traditionally practices FGC seeks ‘ritual’ cutting, her wishes and consent are discarded by the law.

The moral and legal double standards concerning procedures affecting women from marginalised groups in Western societies has been analysed and highlighted by numerous contemporary scholars (Chambers 2004, 2008, 2019; Shahvisi 2019; 2021; Braun 2009; 2019). For instance, Chambers argued that the distinction between ‘FGM’ and breast augmentation should be queried because the norms shaping the preferences for such changes are based on unjust social norms (Chambers 2004). For Chambers, the idea that choice should act as a ‘normative transformer’ when it comes to practices such as FGCS, that are sustained by norms and expectations about women’s bodies that are unjust and harmful, should also be treated with caution (Chambers 2004, 2008, 2019). Choice generally functions as a ‘normative transformer’ in liberal societies, because of the liberal principle that individuals should be free to make decisions affecting themselves (Chambers 2008, pp. 124–126; 2019, pp. 72-73). But, Chambers points out, we should not accept choice as a normative transformer under certain conditions; specifically, when ‘disadvantage’ and ‘influence’ factors are at play (Chambers 2019).

Virginia Braun examined the contexts of the choices made by Western women seeking FGCS and women seeking FGC for culturally ‘traditional’ reasons and argued that:

Any ‘choice’ a (non-Western) woman may (want to) make to undergo a ‘traditional’ genital cutting procedure is seen to be overdetermined by culture, and therefore impossible. So ‘we’ are culturally free, agentic and empowered; ‘they’ are culturally oppressed, duped and victimised, unable to step beyond culture into autonomy and agency. (Braun 2009, p. 235)

Braun has argued more recently that FGCS procedures should be understood as contributing to the cultural expectation that vulvas should look a certain way (Braun 2019). Thus, these procedures not only follow but maintain the aesthetic norm. Braun claims that women seeking genital modification for cosmetic purposes have been persuaded by a narrative that packages ‘designer vaginas’ as an option which ‘rhetoric frames…as a practice for the self’ (Braun 2019, p. 24). FGCSs are packaged as self-improvement even though the proposed benefits are other oriented, the preference for a different smell or taste involves the imagined partner(s), the preference for shorter labia involves imagined witness(es), and so on (Braun 2019, p. 24). Chambers’s and Braun’s analyses target arguments that women in Western liberal societies choose FGCS without external influence by highlighting the social contexts and normative expectations within which women choose to have their breasts enlarged or their genitals altered for cosmetic reasons. The existence of the imagined other who prefers neater labia or large and pert breasts undermines the idea that these interventions are entirely for the self and suggest that there is a disadvantage factor at play when it comes to cosmetic surgeries, mainly, the disadvantage is that women’s male counterparts are not exposed to the same system of beautification norms that influence the decisions of women undergoing labiaplasty. In doing so, Braun and Chambers illustrate that the distinction between FGC and FGCS procedures cannot reasonably be justified with reference to the choice-making capacities of different groups of women.

Often women and girls coming from cultural backgrounds that are not understood to be liberal are automatically presumed to be oppressed and consequently less autonomous than those from liberal cultural backgrounds (Shahvisi and Earp 2019; Galeotti 2015). This kind of assumption is reflected in the work of scholars who claim that the primary reason to object to FGC, but not male genital cutting (MGC), is that the groups that traditionally practise FGC are ‘patriarchal’ to an extent that thwarts women and girls’ ability to develop autonomy (Mazor 2013; Piontek and Albani 2019). For instance, Joseph Mazor has claimed that a primary reason to object to FGC but not MGC is because the contexts of FGC are culturally patriarchal and limit women’s autonomy (Mazor 2013, p. 427). Elizabeth A. Piontek and Justin M. Albani argue MGC is permissible, but FGC is not, and claim that equating male and FGC ‘is absurd’ (Piontek and Albani 2019, p. 35). They claim that ‘[m]ale circumcision remains one of the oldest and most commonly performed surgical procedures in the world’, and insist that parents should be permitted to decide whether to have their male children cut (Piontek and Albani 2019, p. 35). They insist that ‘barbaric’ FGC practices are only conducted with the intention to remove the child’s ability to experience sexual pleasure in later life (Piontek and Albani 2019).

It is also clear from analysis of legislation in the UK that women from these groups are not thought to be sufficiently autonomous to be permitted to have FGC even when they consent (Female Genital Mutilation Act 2003; Shahvisi 2021; Shahvisi and Earp 2019; Townsend 2021b). The idea that women from cultural groups with patriarchal characteristics cannot develop sufficient autonomy to legitimately choose FGC, but that women from dominant Westernised groups should be permitted to have FGCS as a part of their self-development, implies that Westernised women are thought to have been raised in conditions that permit them to develop sufficient autonomy to self-select genital modification. The reaction in Italy to women seeking nicking for their own genitalia suggested that the dominant groups viewed women of Somalian heritage as unable to resist or reject the norms of their culture, and that this meant their autonomy was impaired in a way that meant they should be protected from their own choices (Galeotti 2015; 2007). Mazor’s view that groups practising FGC are marked by patriarchal attitudes about women and girls suggests that his take on practising groups is that their character is fixed and will reproduce itself (Mazor 2013). Viewing group membership in this way is problematic because it implies that the people within the groups are unable to respond to, resist, reject, or affirm norms and practices. It assumes that people from these groups lack the skills of autonomy to change or endorse a particular norm. Arianne Shahvisi claims that the different moral and political treatment of these types of female genital alteration rely on a racist distinction about the consent-capacities of white women versus those of women of colour (Shahvisi 2021). She suggests that there is a white Western and liberal tendency to view people from marginalised cultural and racial groups as lacking autonomy. Shahvisi’s argument is convincing given the racial demographics of the respective groups, and further highlights the normative urgency of the issue.

Following this trend of questioning the legal and moral distinction between the levels of autonomy shown by women from dominant and marginalised groups, I re-emphasise the idea that all people are culturally embedded, and so all people’s preferences are inevitably shaped and affected by their cultural contexts. All people are subject to influence from the prevailing norms of their cultural groups, whether dominant or marginalised. As such, the claim that FGC is impermissible because the girls and women have had their autonomy impaired by their socio-cultural context loses its normative thrust because we all have our autonomy shaped by our cultural contexts, and we are all embedded in contexts that include norms and practices that are arguably harmful and unequal. Girls and women in Western liberal societies marked by beauty norms expecting thinness, strength, fitness, firmness, large and pert breasts, tattooed eyebrows, or pouty lips, also have their preferences shaped and autonomy developed within the context of these expectations.Footnote 7 Thus, when women from dominant groups in Western societies choose beautification procedures, they have also had their preferences influenced by a set of cultural norms. Western women choosing FGCS have also been raised within societies marked by patriarchal influence, violence, and disadvantage.Footnote 8

I do not want to suggest that women who decide to have cosmetic procedures should be considered to lack autonomy relative to women who do not, but rather, I want to undermine the idea that women from groups that practise FGC for reasons of ‘custom’ are more influenced by cultural norms than women who seek FGCS for ‘self-improvement’ (Townsend 2022). Andrea C. Westlund proposes that relational autonomy is a procedural capacity in which the relational component has both a ‘constitutive’ and a ‘causal’ quality (Westlund 2009, pp. 26-27, my emphasis). Autonomy is developed in dialogue with others; it relies on us being predisposed to questioning about our choices and being ‘answerable to external critical perspectives’ (Westlund 2009, pp. 26-27). Westlund claims that this account remains neutral with regard to the kinds of relationships that one has and offers no qualitative view on the nature of the relationships that women have with others. This enables her to avoid a ‘suspect perfectionism about the human good’ (Westlund 2009, p. 27). What this means is that Westlund wants to avoid claiming that only particular ways of living should be characterised as good or autonomous.

I follow Westlund in holding a view of autonomy that avoids taking the content of a particular choice as evidence of a person’s autonomy (or lack thereof), and instead emphasise the idea that a person’s autonomy is developed relationally within the distinct context of their lives. No two people have the exact same experiences; neither do individuals experience the same events in the same way, even when their social contexts are very similar. Understanding the cultivation of autonomy to be a dialogical process between the individual and their social and material context means taking seriously the role of that person’s internal engagement with their external conditions, rather than simply looking at their external conditions. As a person learns about the norms and values of their cultural context through familial-cultural values, and the norms and values they encounter outside the family unit, they engage in a dialogical exchange with those norms and values by either affirming, revising, or rejecting them. An external observer cannot know exactly what internal processes were involved in a person’s decision to affirm, revise, or reject an inherited norm or value. But all people who are assumed to be able to make autonomous choices about their bodies have developed their preferences relationally and in dialogue with the norms, practices, and values of their cultural context in a way that procedurally mirrors the development of preferences by people whose decision-making capacities are dismissed within many Western contexts. Since FGC and FGCS are materially very similar, the policy inconsistency is based on the idea that women from marginalised FGC-practising groups do not have the same internal capacities for developing autonomy as women from dominant groups. Many women from cultural groups who have traditionally practised FGC for ‘reasons of custom’ are actively resisting and rejecting the practice for new generations of girls within their groups.Footnote 9 This implies that the internal group structure contains voices and ideas that resist the practice, and implies that uncut women from the practising groups have the option not to conform. The aim of defending a universalist policy on adult genital modification is to treat women from marginalised groups as equally capable of affirming, rejecting, or revising the norms and values of their cultural contexts.

Part III: Children and Influential Cultural Norms

Larissa Remennick has recently conducted a study that helps to show how norms and practices are maintained within groups, and how influential figures within the wider group can impact on parental decision-making when it comes to genital cutting (Remennick 2022). Remennick discusses accounts given by Jewish men who regret being circumcised when they returned to Israel from the Soviet Union (Remennick 2022). The state sponsored voluntary mass circumcision of migrant teenagers to enhance their sense of belonging. The project leaders attained consent from the parents of the men, who were teenagers at the time:

They [the interviewees] described the context surrounding mass brit operations as one of ideological or religious compulsion targeting both their parents (who had to give a formal consent) and themselves. In most cases, the parents remained passive, perceiving the ritual as inevitable and not giving it too much thought, nor discussing it with their sons. (Remennick 2022, pp. 10-11)

Many of the men experienced it as traumatic and reported being ‘pissed off’ about not being properly consulted (Remennick 2022, pp. 11-12). Ilya, who was 12 when cut, recalled a sense of ‘helplessness in the face of the Hebrew-speaking authoritative adults in white coats, a doctor and a rabbi, who took control of your body and basically harmed it’ (Remennick 2022, pp. 11-12). The accounts convey a cultural context in which the child’s parents’ decisions were heavily influenced by the norms and expectations of authority figures within the broader community. They reveal some of the contextual complexity around who makes decisions to cut and modify children’s genitalia, and why.

Intersex genital modification (IGM) receives considerably less media and political criticism than FGC, and it remains legal in most Western liberal states (Mestre 2022). It is a medical norm in the United Kingdom and in the United States to advise surgery in cases of a child being born with variations in their sex development (Dalke et al. 2020; Horowicz 2017; Newbould 2017; de Maria Arana 2005; Creighton 2001). In the US, IGM is recommended and supported by medics in order to help children conform to the male–female sex binary (‘Evaluation of the Newborn With Developmental Anomalies of the External Genitalia’ 2000; Dalke et al. 2020). In Italy, where FGC is prohibited even for consenting women in medical settings, some 450–500 medical interventions on intersex children occur each year (Balsamo and Crocetti 2017, p. 12).

It is accepted by many medical professionals that invasive surgery should be performed on intersex children, though the debate about precisely when surgeries should be conducted continues (Dalke et al. 2020; The Royal Society of Medicine 2022). It is commonly practised and recommended by most paediatric surgeons, and there are few European states that have laws against the practice of IGM (EU Rights Agency 2015; Agius 2015; Yankovic et al. 2013; Dalke et al. 2020).Footnote 10 An anti-IGM movement is making an impact on human rights discourses, but it is yet to have had a profound impact on dominant cultural knowledge and understanding, and ‘children with intersex conditions continue to be managed using a medical model’ (Newbould 2017). International organisations including the World Health Organisation (WHO), Human Rights Watch, and the United Nations now take seriously the argument that IGM is a violation of human rights in general, and children’s rights in particular. WHO identifies IGM as a violation of human rights, and associates it with enforced sterilisation, which in some cases is a consequence of the medical attempt to ‘normalise’ the infant’s genitalia: ‘intersex persons may be involuntarily subjected to so-called sex-normalizing or other procedures as infants or during childhood, which, in some cases, may result in the termination of all or some of their reproductive capacity’ (WHO team; Sexual and Reproductive Health and Research 2014, p. 7). There is some precedent in English law that might be used to argue against the forms of IGM that result in sterilisation of the child. During the case of Re B (a minor) Lord Templeman stressed that without approval of the High Court in England and Wales, sterilisation of a child without their informed consent could be found unlawful (Re B (A Minor) (Wardship: Sterilisation) A C 199 1988). But at the time of writing, there have not been any successful cases against surgeons or parents who performed and arranged medically unnecessary surgery on intersex children (Mestre 2022).

Different treatment of intersex children and female children is usually justified by claiming that intervention is in intersex children’s ‘best-interest’ (Ehrenreich and Barr 2005; Kessler 1990; Klein 2011; Dalke et al. 2020; Mestre 2022). The idea is that if intersex children’s genitalia are not modified to conform to the male–female sex category binary, they will be bullied, or struggle to accept their bodies due to their variations. The main motivations for medical practitioners suggesting surgery emphasise the psychological impact of having a body that does not fit with the cultural norms of the society (The Royal Society of Medicine 2022; Tamar-Mattis 2017; Dreger and Herndon 2009; Yankovic et al. 2013; Creighton 2001; Klein 2011; de Maria Arana 2005). Medics, and parents, fear that the child will grow up feeling as though they are abnormal misfits and that they will be socially stigmatised (The Royal Society of Medicine 2022; Hegarty and Smith 2023). This anxiety to be ‘normal’, medical practitioners have advised parents, may cause them to be depressed or even commit suicide, unless their bodies are changed (‘Evaluation of the Newborn With Developmental Anomalies of the External Genitalia’ 2000; Creighton 2001; Kessler 1990; Dalke et al. 2020). But increasing numbers of adults whose bodies were transformed in infancy and childhood are voicing their anger at the doctors and surgeons who performed the procedures, and the parents who gave their consent for them in the UK and the US (The Royal Society of Medicine 2022). Intersex activists objecting to IGM argue that the surgeries are more about maintaining particular norms than the individual child’s best interests (see for instance: Rice 2017; McNamara 2017; Viloria 2017).

Dalke, Baratz, and Greenberg focussed on the treatment of intersex children and demonstrated that their genitalia are often modified in ways that are similar to FGC for ‘psychosocial’ reasons (Ehrenreich and Barr 2005; Dalke et al. 2020). The aim is to weigh up the evidence concerning the ‘best interests’ of the intersex child in question, and to offer a guide to surgeons that may be assigned to work with a child with variations in their sex development. They conclude that until there is substantial and uncontroversial evidence to suggest that surgery is more beneficial than leaving the child intact, then surgeons should avoid intervention, and try to ensure that parents fully understand their child’s difference with education and support:

as cultural norms around sex and gender shift, so too does the likelihood that parents have the resilience to adapt to and even celebrate differences that a generation ago would have been intolerable. Education, time, and psychosocial support can facilitate this process by helping parents work through their value judgements and emotions. (Dalke et al. 2020, p. 219)

Here, the authors show understanding that parental decisions to change their children’s bodies are influenced by the dominant norms of their cultural group—as cultural understanding shifts away from ‘unthinkingly’ expecting all bodies to conform to a rigid sex binary, IGM should reduce. Dalke et al. allude to the moral parallels between IGM and FGC, but avoid making a direct and sustained comparative analysis. Other scholars have argued explicitly that IGM is ‘mutilation’ and equivalent to ‘female genital mutilation’ (Ehrenreich and Barr 2005). Nancy Ehrenreich with Mark Barr state that intersex children ‘[l]ike FGC recipients… are sometimes physically restrained. Moreover, the combined effect of parental control, physician authority, and anaesthesia effectively makes any resistance, even by those who are beyond infancy, very difficult’ (Ehrenreich and Barr 2005, p.114). Melinda Jones claims unapologetically that IGM is mutilation by another name, and argues that the difference between female and intersex modification practices is not ‘real’, they are Western constructions intended to disguise the harm done to intersex children as something that is in their ‘best-interest’ (Jones 2017, p. 5). All of these authors, directly or indirectly, contribute to undermining the narrative that only groups practising FGC do so for cultural reasons.

Some interventions can be understood as medically necessary, that is, some children require surgery ‘to correct problems that cause physical harm’ (Dalke et al. 2020, pp. 207–208). These surgeries include ‘relief of urinary tract obstruction, repair of exposed internal organs’, and treatment for children born with congenital adrenal hyperplasia (CAH) who require medical treatment due to low levels of hormones that regulate their blood pressure—this condition poses a life-threatening risk to affected children, and so medical intervention is necessary (Dalke et al. 2020). Dalke et al. go on to list several variations of development that do not pose an immediate risk of physical harm, but state that even though there is no danger to life or of physical harm in most cases, often surgeons will ‘suggest’ surgery ‘to reduce the size of a clitoris and reshape the vulva, or vaginoplasty to create or lengthen a vagina’ (Dalke et al. 2020, pp. 208–209). The kind of intervention I am interested in for this discussion is the kind that is conducted to ‘normalise’ the child’s body to conform to the male–female sex binary and thus to maintain norms about the body (Dalke et al. 2020, pp. 207-208). These surgeries both follow and maintain norms that expect bodies to be compatible with heterosexual penetrative intercourse. Normative expectations like this are a form of unthinking heteronormativity that is used as a justification for serious bodily interventions (Cloward 2016; Townsend 2021a). This suggestion is explicitly confirmed by numerous surgeons:

According to one 2016 expert clinician consensus, the goals of these surgeries are to create anatomy enabling penovaginal intercourse, to facilitate future reproduction, to reduce the risk of urinary tract infections, to allow exit of menstrual blood, to avoid development of unwanted traits at puberty, to reduce the risk of gonadal cancers, to foster identity development, to avoid stigma, and to respond to the parents’ desire to bring up a child in the best possible conditions. (Dalke et al. 2020, p. 208)

Other recommendations for early surgery are typically grounded in at least one of the following psychosocial concerns voiced by parents and clinical team members: (1) that genital variation might complicate the child’s gender identity, causing gender dysphoria and serious psychological distress; (2) genital difference or the appearance at puberty of unanticipated secondary sex characteristics from retained gonads may lead to social stigma, isolation, and humiliation in the locker room or during romantic relationships; and (3) the parents may not be able to adapt to their child’s difference, impairing bonding (Dalke et al. 2020, pp. 208-209). Physicians may recommend elective, cosmetic surgical interventions, including feminising surgeries to reduce the size of the clitoris, reshape the vulva, or create or lengthen a vagina, masculinising surgeries to reposition a urethra that does not end on the tip of the penis or create a phallus, and gonad removal with subsequent hormone replacement. Importantly for the case at hand, these surgeries are advised by medical professionals on the basis that non-conformity to the cultural norm that expects bodies to look a certain way will be damaging for the child’s self-esteem. Parents are required to consent to these interventions meaning that there is a transferal of norms between medical professionals advising surgery and parents who must consent. The presence of medics who advise parents to have their children’s bodies modified, mirrors the case of migrant parents in Israel who felt pressure to permit the state to perform circumcision on their sons (Remennick 2022). The wider normative expectation is maintained by influential authority figures and passed to parents, who then decide to continue to the practice and maintain the norm (or not).

It is striking that the justifications given by people continuing this practice reveal the idea that intersex children’s bodies should be changed so that they can become adults whose bodies are compatible with ‘penovaginal intercourse’ (Dalke et al. 2020). The practice of IGM shows how norms—in this case, those expecting bodies to engage in ‘penovaginal intercourse’—are passed between social leaders and authority figures, to parents, and to their children. It is an unthinkingly heteronormative practice which parents and medics continue because they subscribe (implicitly or explicitly) to a certain set of heteronormative values.


FGC as a matter of ‘custom’ is prohibited in Western societies and is understood within a narrative that characterises practising groups as ‘barbaric[ally]’ and ‘coercive[ly]’ preventing female group members from developing autonomy (Female Genital Mutilation Act 2003; Buckler 2022; Mazor 2013; Piontek and Albani 2019; Chambers 2019; 2004; Shahvisi and Earp 2019; Shahvisi 2021; Braun 2019; 2009). In this article, I have tried to undermine this narrative by offering an account of culture to interpret GCM practices conducted by diverse groups. Adult FGC and FGCS should be understood as equally culturally influenced; women choosing FGCS have had their autonomy affected and shaped by cultural norms just as much as women seeking FGC for reasons of ‘custom’. I interpreted IGM practices as unthinkingly heteronormative arguing that norms and expectations of the group are passed amongst respected authority figures who influence the decisions made by parents of affected children. My intention is to claim that GCM practices within culturally diverse societies such as the UK, should be understood as equally cultural. Showing that dominant groups also practise GCM for cultural purposes undermines arguments that demonise groups practising FGC.

The difference in attitude and policy on GCM can in part be explained as unconscious bias on the part of the policymaker and casual observer. People who insist that FGC is characteristic of ‘barbaric’ and ‘static’ cultural groups, but that FGCS, intersex, and male child genital cutting and modification are permissible because of people’s autonomous choices in the case of FGCS or because intersex and male child genital modification are less harmful or in the child’s interest, are guilty of bias towards ‘the familiar’ (Galeotti 2007). When the bias is reflected in legislation differences, it is a form of discrimination against marginalised minority groups by characterising groups practising FGC as ‘barbaric’, but women seeking FGCS as conducting self-improvement, and parents and medics practising intersex genital modification as protecting the child’s interest. This bias in favour of the familiar obscures understanding of the similarity between practices that are commonplace or acceptable for dominant group members and those that they view with suspicion. GCM practices affecting children and adults are materially similar and all informed and maintained by the influential cultural norms of the relevant social context. The main difference between the practices is simply that dominant groups in Western societies do not immediately recognise the cultural dimension and influence of their familiar norms and practices.

Policy on genital cutting and modification should be universal across groups within culturally diverse societies and narratives of ‘barbaric’ and ‘coercive’ cultures should be abandoned. There should be a consistent policy on GCM for all children younger than a particular age, and a consistent policy for all adults above a certain age. The normative justification for a universalist policy with regards to GCM comes from a basic commitment to equality. The commitment to equality aims to protect all children from the material harms of medically unnecessary genital modification with equal vigour and not to be unjustifiably permissive or intolerant of a given cultural group’s practices when they are equivalently materially harmful across groups. A universalist policy on GCM would be better suited to showing equal respect for diverse groups than the current moral and political difference in existing culturally diverse societies.