By Paul King
APP Treasurer

Considering Female Genital Piercing as “Female Genital Mutilation” in the United Kingdom

The Current UK Situation

On March 19, 2015, the London Evening Standard published Martin Bentham’s article online, “Women with Vagina Piercings to be Classed as FGM.”^[1] The tabloid article is claiming that the United Kingdom’s (UK) Department of Health is requiring that healthcare professionals report known incidences of female genital piercing as “female genital mutilation.” This article was and is still being widely shared in social media and has proliferated through various copycat online articles through sites such as BBC and Huffington Post, etc.^[2] The response has been an incredulous outcry from UK piercers,  other piercers worldwide, piercing enthusiasts, and even UK nurses.^[3]

In this article, I will outline some pertinent history on the topic of “Female Genital Mutilation,” particularly in the UK and how it relates to female genital piercing; explain some key legal definitions and concepts; illuminate legal and ethical concerns; and suggest options for immediate responses and longer range strategies potentially affecting the Association of Professional Piercers (APP), UK piercers, global body altering industries, and other body modification communities.

A Brief Overview of “Female Genital Mutilation

To some degree, most of us have an idea of what “female genital mutilation” is and what it is not. However, “Female Genital Mutilation” (“FGM”) is a very complex subject containing passionate and sometimes conflicting beliefs. Within individuals as well as between groups, “Female Genital Mutilation” includes diverse and sometimes contradictory understandings of “Human Rights,” patriarchy, feminism(s), xenophobia, Islamophobia, sexism, racism, colonialism, Western ideology, economics, etc. I have studied this subject intensely for several years; I  am still learning and therefore I make few claims.^[4] Most of the complexities of “FGM” are outside the scope of this article.

Throughout this paper, I use “FGM” and “female genital mutilation” in quotations. I believe the phrase and acronym are popularly recognized so I perpetuate their usage, however, with great ambivalence. I prefer and generally use “female genital alteration,” (“FGA”), or even more neutral, “genital alteration.”^[5] These are less biased and less reductive ways to talk about diverse procedures of the genitals that contain debated and complicated social meanings and motivations, as well as a wide range of psychological and physical outcomes. Even the term “female genital piercing” carries problems of vagueness, which leads to confusion. As any professional and experienced piercer can tell you, not all piercings are the same; a “clit piercing” is not a “clitoral hood piercing.”^[6]

The language and visual images used by the programs to eradicate “FGM” are so compelling and horrifying for the majority of Westerners that it becomes unimaginable to call into question data, rhetoric, or effects of this authoritative campaign.^[7] Although the United Nations (UN) agencies including the World Health Organization (WHO) have made four separate categories to differentiate the “FGM” practices, their literature describes all “FGM” practices as having the exact same physical and emotional traumas. As a result, the most invasive infibulation with clitoral excision carries the same description of trauma as the most benign prick.^[8] The UN et al. understands what they’re doing, they’re not looking for compromise; they are seeking complete eradication of all practices within one generation.^[9] Setting aside further ethical considerations of UN et al.’s campaign for the eradication of “FGM,” we will only address the repercussions from the overreaching definition of “Type IV female genital mutilation.”

The legal definitions of “FGM” includes: “Type IV is a category that subsumes all other harmful, or potentially harmful, practices that are performed on the genitalia of girls and women.”^[10] The UN and therefore the UK provide no qualitative or quantitative scale for “harm.” A rash, abrasion, puncture, burn, and/or contusion, etc., any injury that is a result of a deliberate action, no matter how temporary or permanent is technically “harm.”^[11] The UN/WHO’s own documents acknowledge their definitional language for “female genital mutilation” was deliberately broad to close any potential legal “loopholes” for the practices they were trying to target.^[12] 

The UN/WHO have identified “female genital mutilation” as occurring in ethnic groups in or immigrated from 28 African countries as well as Iraq, Israel, Oman, United Arab Emirates, the Occupied Palestinian Territories, India, Indonesia, Malaysia and Pakistan. I would assert that the UN/WHO never intended or considered for their definitions to include Western “normal” personal grooming practices on adult female bodies that frequently result in injuries. The UN/WHO’s stance on Western women altering their genitalia for aesthetics using cosmetic surgical procedures was intentionally left ambiguous.^[13] To further complicate the ethics in this issue, other  UN policies do not consider “traditional” genital modifications of the male body as “mutilation,” in fact, the UN agencies UNAIDS and WHO, fund and promote medicalized male genital alteration in the same African communities in which they seek to eradicate female genital alteration.^[14]

Important History Relevant to the UK

The trending tabloid articles take out of context an issue with a long history. For perspective, Ioffer some background on the development of the UK’s “FGM”campaign. This historical timeline is by no means exhaustive:

In 1985, the UK passed its first regulation on the prohibition of mutilating female genitalia. “Mutilation” is never defined.^[15]

In 1987, UK authorities conducted “Operation Spanner.” This investigation targeted adult male homosexuals engaged in consensual BDSM.^[16] Among the arrested was one of the UK’s most prominent and historically important professional body piercers, Alan Oversby, a.k.a. “Mr. Sebastian.” His criminal activity included, “performing a [Prince Albert] piercing for the purposes of sexual pleasure….”^[17] All defendants pled guilty and lost all appeals, both in the UK and EU courts.^[18] For this article, the crucial point to understand is that UK law will disregard adult consent to criminally convict a body piercer. In the Spanner Case, guilt was determined on the subjective ideas of “harm.” Current understandings are that one can pierce at least male genitals for adornment, but not for sexual gratification.^[19]

In 2003, the UK replaced its first anti-“FGM” law of 1985, with the “Female Genital Mutilation Act 2003,” but they still did not clearly defined “mutilation.” In addition, the act refers to “child abuse” and the protection of “girls” throughout the document, then concludes under the definitions section 6 (1), “Girl includes woman.”^[20] Obviously, this muddles the understanding of what constitutes “child,” “girl,” “child abuse” as well as a consenting (female) adult.^[21] 

In 2008, The United Nations (UN) and the World Health Agency (WHO) released an UN inter-agency seminal work on the subject of “FGM.”^[22] This document contains their standpoint on the issue, definitions, and candid rationale for their language choices. This is the document that most national governments refer to when considering definitions and implementing their own programs. It is the source document from which the National Health Services (NHS) and the Information Standards Board’s program ISB 1600 draw their global statistics, UK statistical projections, and legal definitions.^[23] 

UN et al.’s Type IV female genital mutilation is defined as “All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping, and cauterization.” This is where Western-style female genital piercing would be classed. The term “Medical” includes any procedure not necessary for physical and psychological health. Cultural and religious necessities are explicitly excluded as medically necessary. The UN et al. also specifically includes “stretching” and “harmful substances.” It also states “herbs” as well as implying chemical bleaches, depilatory creams, hot waxes, etc. when they cause any injury fall into this category.^[24] The UN explains that they use such broad language to “close loopholes” in their campaign against “FGM.”^[25] Of course the problem of this slippery slope argument is that they have included ANYTHING that causes ANY degree of injury to the female genitalia.  This includes female genital body piercing and potentially the reinsertion or stretching of a female genital piercing.^[26] Looking through medical reports for the US and Europe reveals thousands of female genital injuries, annually. Research reveals that most of these emergency room visits and treatments are for procedures we would never label “mutilation”such as “personal grooming” with razors, scissors, and clippers; skin bleaching; electrolysis; “Brazilian” waxing; pubic hair dyeing; and pubic hair removal with lasers or depilatory creams; etc.^[27] Presented this way, Type IV’s all inclusiveness may seem absurd. However, the UN categories were not intended to understand and document “our” bodies and practices; this descriptive system was intended to scrutinize “their” bodies and practices. For the law to make any sense, the allegation of “female genital mutilation” must be kept in context with the bodies being targeted as “FGM-affect.”

        

The 2013 UK Intercollegiate FGM report instructs authorities, including healthcare professionals, on how to identify, record, and report “FGM.”^[28] This includes explanations for “FGM-affected” immigrant communities from the previously mentioned UN/WHO listed countries. The UK draws from this list for their statistics of probable “FGM” risk in the UK, since authorities admit there had been no prosecutions and little actual evidence to support concerns of widespread “female genital mutilation.”^[29]

On April 1, 2014, the Information Standards Board released directive ISB 1610. This document detailed information on standardized codes and procedures for healthcare workers to report incidences of “female genital mutilation” in the UK. This guide includes UN/WHO definitions for Type I, II, and III. However, Type IV, which covers anything else, now includes “unknown” as ISB Type 9. “Type 9” mutilation means some sort of injury and/or scarring has occurred but it can’t be identified or there isn’t a clear ISB code for it. Type 9 is how “piercing” should be categorized.^[30]

In July 2014, the Department of Health issued “Recording FGM in the Patient Healthcare Record” reminding healthcare providers, particularly General Practitioners, that ISB 1610 requires mandatory reporting of “FGM” byall healthcare staff effective Sept. 1, 2014. The Department of Health has been collecting and reporting this data since then.^[31]

In Jan 2015, the Secretary of State and Parliament released a comprehensive report, in response to a July 2014 summit, requesting greater cooperation between the departments of law enforcement, education, and healthcare to escalate the campaign against FGM in the UK.^[32]

On March 10, 2015, the House of Commons released a report titled, “Female Mutilation: Follow Up.” The Home Affairs Committee demanded that laws be clarified to include all UK female genital cosmetic surgeries on the grounds that it is hypocritical to specifically target the eradication of female genital procedures of “FGM” -identified communities both located inside and outside the UK, while allowing the rest of UK females to modify their genitals.^[33] This report is likely the impetus for the Evening Standard’s article of March 17, 2015.

On March 17, 2015, The London Evening Standard’s website posted the article “Women with Vagina Piercings to be Classed as FGM.” This article appears to have ignited the current public awareness that female genital piercing could be, and perhaps have been, categorized as “female genital mutilation.” Requests have been made of the author and the paper to see if they have knowledge of any evidence that the government specifically addresses Western-style practices of female genital piercing, so far, without reply. Most likely, the author was drawing from previous documents that generally include “piercing” as a standard example of the UN Type IV / ISB Type 9 “FGM.”^[34]

Concluding Thoughts

At the time of this writing, I have no evidence that UK authorities would interpret the piercing of a white indigenous adult female’s genitals for adornment as “female genital mutilation.” The protection of the genitals of all minors under the age of 16 is already enforced by strict regulations. The UK has cultural views and therefore legal guidelines on young persons that differ from many states in the US. In the UK, persons 16 and older can consent to sex and medical treatments, without the necessity of parental consent.^[35]Although, internationally, there exists a widely held professional ethical standard that only persons considered adults, at the “age of majority,” should have their genitals pierced. However, if a UK body piercer performed a female genital piercing on an adult woman from a UN/WHO/UK recognized “FGM-affected community” the legal outcome gets trickier to predict.^[36] If the piercing were discovered by a healthcare provider, the situation would create an ethical dilemma for the healthcare worker, compelled by law to report any alterations. If the reported incident were investigated by law enforcement, it could lead to criminal prosecution of the body piercer, counter staff, shop owner, and/or a friend(s) that accompanied the piercing client (anyone that “aids, abets, [counsels] or procures”) for violation of the Female Genital Mutilation Act 2003 carrying a penalty of a fine with up to 14 years imprisonment.^[37] To mitigate risk, a UK piercer could refuse to pierce female genitalia, while continuing to pierce male genitalia. As another option, UK piercers could sort clients by using the same geographical criteria as the National Health Services and law enforcement; however, in practice, I doubt denying services based on country of origin would go  over well. It would probably lead to accusations of xenophobia and racism.

Therein lies the crux of an ethical dilemma. Most people will not believe that every injury of the female genitals is “mutilation.” “Female genital mutilation” is understood to only happen in “FGM-affected communities.” It’s common sense that Janet Jackson’s, Christina Aguilera’s, or Lady Gaga’s pierced genitalia is not “female genital mutilation,” and as such the definitions of and rules for “female genital mutilation” should not apply.^[38] However, “common sense” is not universal; it is influenced by life experience, education, class, economics, religion, ethnicity, sex, gender, country of origin, etc. Healthcare workers, police, legislators, and the public operate under this blind bias.^[39] Few want to admit that they see and treat others differently, that is because it directly clashes with other deeply held Western values of tolerance, decency, and fairness.

In March 2015, the UK Home Affairs Committee recognized the “double standard” of pressuring other communities to stop their “mutilation” practices while allowing UK females to have genital cosmetic surgeries. They have appealed to parliament to amend the 2003 law in order to criminalize female genital cosmetic surgery.^[40] This action will likely meet allegations of patriarchy and sexism. Many Westerners fail to realize that our understandings of medicine and science (such as “necessary” or “not necessary”) as well as violence, mutilation, harm, pain, etc. are always shaped by culture. Ones most deeply held religious and moral beliefs, including notions of what is “right” or “wrong” are shaped by the culture one is born into. The dominant culture within any particular nation is in a more powerful position to propagate its beliefs.

The UK government and anti-“FGM” organizations genuinely desire to protect immigrant women and their daughters. Most Westerners, this author included, would find it repugnant to defend the most commonly told story of a practice that physically restrains a very young girl crying against her will, to have her clitoris cut out and her vagina sewn shut, a procedure that endangers her life, sexual pleasure, and ability to procreate. However, the anti-“FGM” campaigners risk weakening their public support when they overreach their claims to consider all practices regardless of invasiveness, all females regardless of age, and all physical and psychological consequences regardless of the wide range of experiences and perceptions, as the same. Once the UN et al. labels a community as practicing “FGM,” then at the international level, those community adult women’s legal “rights” to consent to any genital alteration are stripped away.^[41] 

I’m not saying we should do nothing for individuals that want to be helped, or that we should not impose policies to protect minors, particularly in our own countries, but I do believe definitions and regulations that could specifically deny a female adult the choice to consent or not to consent to altering her genitals, whether by: piercing the genital tissue; or shaving, trimming, bleaching, dyeing, lasering, or waxing the pubic hair; or surgically altering the appearance, etc., violate current commonly-held notions of sexual equality and fairness. 

So what can be done in the UK?  Ultimately, the course of action is best decided by the piercers and the women of the UK, although international piercing communities should assist when asked. Currently, an e-petition is circulating that UK citizens can sign requesting that the government legally recognizes female genital piercing is not mutilation.^[42] UK citizens can write and call their elected officials. They can email responses to all names and department heads associated with the anti-”FGM” regulations.Everyone can email news agencies that spread the story. At its source, this is an international issue that will keep occurring as a result of the definitions and policies of United Nations and the World Health Organization. Since the medical field and personal grooming industries may be affected, alliances should be sought. Body piercing communities and their allies should simultaneously apply pressure for legislative changes at both the local as well as the international levels.

As I conclude this article, I am reminded of the small group of piercers that came together in 1994, to stand up against a misguided California state bill that was going to unnecessarily burden our industry. The Association of Professional Piercers was born from this handful of determined activists. Twenty years later, the APP has educated thousands of piercers and has helped shaped numerous city, county, state/province, and national regulations around the world. My concerns about this current issue in the UK are somewhat eased by the excitement of what the future may hold with this opportunity for the UK piercing community to unite behind a common cause.

Author’s note: This article was written on a very tight deadline. I am filled with deep gratitude for Nici Holmes, Kendra Jane, Marina Pecorino, and Elayne Angel for their incredible assistance during this process, filled with last-minute questions and requests.

 

 

Bibliography

1. Ahmadu, Fuambai S. and Richard A. Shweder. “Disputing the myth of the sexual dysfunction of circumcised women: An interview with Fuambai S. Ahmadu by Richard A. Shweder.” Anthropology Today, 25 (2009): 14–17.
   DOI: 10.1111/j.1467-8322.2009.00699.x
2. American Academy of Pediatrics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice by the Committee on Bioethics.”Pediatrics 95, no. 2, (1995): 314-317.
   http://www.cirp.org/library/ethics/AAP/
3. Bibbings, Lois, and Peter Alldridge. “Sexual Expression, Body Alteration, and the Defence of Consent.”Journal of Law and Society 20,no. 3 (1993): 356-370. Retrieved from http://www.jstor.org/stable/1410312
4. Bjerring, Peter, Henrik Egekvist, and Thomas Blake. “Comparison of the Efficacy and Safety of Three Different Depilatory Methods.”Skin Research and Technology4, no. 4 (1998): 196-199. DOI: 10.1111/j.1600-0846.1998.tb00110.x
5. Brunn Poulse, Pia, and Maria Strandesen. “Survey and Occurrence of PPD, PTD and Other Allergenic Hair Dye Substances in Hair Dyes.” The Danish Environmental Protection Agency. 2013.
   http://www2.mst.dk/udgiv/publications/2013/02/978-87-92903-92-1.pdf
6. Christoffersen-Deb, Astrid. “’Taming Tradition’: Medicalized Female Genital Practices in Western Kenya.”Medical Anthropology Quarterly 19, no. 4 (2005): 402-418. http://www.jstor.og/stable/3655495.
7. Coleman, Doraine L. “The Seattle Compromise: Multicultural Sensitivity and Americanization.” Duke Law Journal 47, no. 4 (1998): 717-783. http://www.jstor.org/stable/1372912
8. Darby, Robert, and J. Steven Svoboda. “A Rose by Any Other Name?: Rethinking the
9. Similarities and Differences between Male and Female Genital Cutting.”Medical Anthropology Quarterly 21, no. 3 (2007): 301-323.
   DOI: 10.1525/MAQ.2007.21.3.301.
10. Delanty, Gerard. “Habermas and Occidental Rationalism: The Politics of Identity, Social Learning, and the Cultural Limits of Moral Universalism.”Sociology Theory 15, no. 1 (1997): 30-59.
    http://www.jstor.org/stable/202134
11. Eyal, Nir. “Informed Consent.” In The Stanford Encyclopedia of Philosophy,edited by Edward N. Zalta  (Fall 2012 Edition).
    http://plato.stanford.edu/archives/fall2012/entries/informed-consent/.
12. Filc, Dani. “The Medical Text: between Biomedicine and Hegemony.”Social Science & Medicine 59, (2004).
    DOI:10.1016/j.socsimed.2004.01.003
13. Glass, Allison S., Herman S. Bagga, Gregory E. Tasian, Patrick B. Fisher, Charles E. McCulloch, Sarah D. Baschko, Jack W. McAninch, and Benjamin N. Breyer. “Pubic Hair Grooming Injuries Presenting to US Emergency Departments.”Urology 80, no. 6 (2012): 1187-1191.
    DOI: 10.1016/j.urology.2012.08.025.
14. Hastings Center. “Seven Things You Should Know About Female Genital Surgeries in Africa.”Hasting Center Report 42, no. 6 (2012): 19-27.
    DOI: 10.1002/hast.81
15. Herbenick, Debby, Venessa Schick, Michael Reece, Stephanie A. Sanders, and J. Dennis Fortenberry. “Pubic Hair Removal among Women in the United States; Prevalence, Methods, and Characteristics.”Journal of Sexual Medicine 7, no. 10 (2010): 3322-30.
    DOI: 10.1111/j.1743-6109.2010.01935.x
16. Johnsdotter, Sara, and Birgitta Essén. “Genitals and Ethnicity: the Politics of Genital Modifications.”Reproductive Health Matters Journal 18, no. 35 (2010): 29-37. http://www.ncbi.nlm.nih.gov/pubmed/20541081
17. Kelly, Brenda, and Charles Foster. “Should Female Genital Cosmetic Surgery and Genital Piercing Be Regarded Ethically and Legally as Female Genital Mutilation?”International Journal of Obstetrics & Gynaecology (BJOG). 2012.
    DOI: 10.1111/j/1471-0528.2011.03260.x
18. King, Paul R. “Investigations of Female Genital Alteration in the United States Within Nonimmigrant Communities.” UC Berkeley Undergraduate Journal. 2015. In press.
19. Leonard, Lori. “‘We Did It for Pleasure Only’: Hearing Alternative Tales of Female Circumcision.”Qualitative Inquiry 6, no. 2 (2000b): 212-228.
    DOI: 10.1177/107780040000600203
20. Moyn, Samuel.The Last Utopia: Human Rights in History. Cambridge: Belknap Press. Kindle edition, 2010.
21. Prinz, Jesse. The Emotional Construction of Morals. Oxford University Press. Kindle Edition. 2007.
22. Schramme, Thomas. “Should We Prevent Non-therapeutic Mutilation and Extreme Body Modification?”Bioethics 22, no. 1 (2008): 8-15.
    DOI: 10.1111/j.1467-8519.2007.00566.x
23. Sheldon, Sally, and Stephen Wilkinson. “Female Genital Mutilation and Cosmetic Surgery Regulating Non-Therapeutic Body Modification.”Bioethics, 12 no. 4, (1998): 263–285.
    DOI: 10.1111/1467-8519.00117
24. Smith, Courtney. “Who Defines ‘Mutilation’? Challenging Imperialism in the Discourse of Female Genital Cutting.”Feminist Formations 23, no. 1 (2011): 25-46.
    DOI: 10.1353/ff.2011.0009
25. Trager, Jonathan D.K. “Pubic Hair Removal: Pearls and Pitfalls.”Journal of Pediatric and Adolescent Gynecology19, no. 2 (2006): 117-23. http://www.sciencedirect.com/science/ article/pii/S108331880600060X
26. UNAIDS & World Health Organization. “Male Circumcision.”Technical Guidance Note for Global Fund HIV Proposals, 2011. http://www.unaids.org/en/media/unaids/contentassets/documents/programmes/programmeeffectivenessandcountrysupportdepartment/gfresourcekit/20110831_Technical_Guidance_Male_Circumcision_en.pdf
27. UNFPA-UNICEF. “Female Genital Mutilation/Cutting: Accelerating Change (Joint Funding Proposal).” UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting. E-book. http://www.unfpa.org/publications/female-genital-mutilationcutting-accelerating-change.
28. UNICEF. “Eradication of Female Genital Mutilation in Somalia.” United Nations International Children’s Emergency Fund, 2004.
    www.unicef.org/somalia/SOM_FGM_Advocacy_Paper.pdf‎
29. Wade, Lisa. “The Politics of Acculturation: Female Genital Cutting and the Challenge of building Multicultural Democracies.”Social Problems 58, no. 4 (2011): 518-537. http://www.jstor.org/stable/10.1525/sp.2011.58.4.518
30. Wagner Jr., Richard F., Trudy Brown, Rebecca E. Archer, and Tatsuo Uchida. “Dermatologists’
31. Attitudes toward Independent Nonphysician Electrolysis Practice.”American Society for Dermatological Surgery 24, no. 3 (1998): 357-362.
    http://www.ncbi.nlm.nih.gov/pubmed/9537011
32. World Health Organization. “Eliminating Female Genital Mutilation: an Interagency Statement: UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO.”World Health Organization, (2008). http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/
33. World Health Organization. “Global Strategy to Stop Health-care Providers from Performing Female Genital Mutilation: UNAIDS, UNDP, UNFPA, UNICEF, UNHCR, UNIFEM, FIGO, ICN, IOM, WCPT, WMA, MWIA.”World Health Organization,(2010). http://www.who.int/reproductivehealth/publications/fgm/rhr_10_9/en/
34. Yoder, Stanley P., Noureddine Abderrahim, and Arlinda Zhuzhuni. “Female Genital Cutting in the Demographic and health Surveys: A Critical and Comparative Analysis.”DHS Comparative Reports no. 7, (2004). Calverton, Maryland: ORC Macro.
    http://www.measuredhs.com/publications/publication-cr7-comparative-reports.cfm
35. Young, Cathy, Myrna L. Armstrong, Alden E. Roberts, Inola Mello, and Elayne Angel. “A Triad of Evidence for Care of Women with Genital Piercings.”Journal of the American Academy of Nurse Practitioners, (2010). DOI: 10.1111/j.1745.7599.2009.0479.x

 

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