As a matter of medical-ethical consistency, selectively excluding some children from equal respect for their bodily integrity and future genital and sexual auton- omy risks undermining the force of those concepts as they apply to other cases (Van Howe and Cold 1997; Davis 2003a; Steinfeld and Earp 2017; O’Neill et al. 2020; Lewis 2021a). Consequently, the hard-won pro- tections that have been put in place for girls with ana- tomically normative genitalia, and now increasingly for children with certain intersex traits, will not be secure against objections and countervailing pressures as long as nonvoluntary clitoral reduction surgeries on chil- dren with CAH, “cosmetic” hypospadias surgeries, medically unnecessary removal of internal gonads, and nontherapeutic, nonreligious penile circumcision of newborns continue in healthcare settings unrestrict- ed.46 The right of each person to decide for themselves whether they want to accept the risks, costs, and trade-offs associated with medically unnecessary genital cutting or surgery—and if so, toward what ends—is threatened by the denial of that right to any person.
Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed
When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (“children”).
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