Posted on September 17, 2019 at 1:46 PM
Quality of life transplantations (e.g. hand, face, etc.), in contrast to life-saving transplantations (e.g. heart, lungs, etc.), have become increasingly popular and have gained more acceptance in the medical and lay communities. In the last two decades transplants for sexual and reproductive organs—specifically allogenic transplantations of the uterus, ovary, and penis—have emerged as yet another type of quality of life transplants. The purpose of uterus transplantations is to allow cisgender women with absolute uterine factor infertility to experience pregnancy. Although the first uterus transplantation took place in 2000, it was not until 2014 that there was a successful live birth baby gestated in a transplanted uterus. As of this year, 60 transplants have been reported worldwide with 13 children born as the result. In contrast to women seeking uterus transplantations, those who undergo ovary transplantations have a functioning uterus but lack functioning ovaries. Rather than using IVF to conceive, women can receive an ovary transplant (usually just a slice of ovary rather than an entire ovary) so that they begin ovulating and can conceive via heterosexual intercourse or intrauterine insemination. Shockingly, the first performed ovary transplantation occurred in 1895 and that there was even a reported birth in 1906, though it is unclear if this birth was a direct result of the ovary transplant. Ovary transplants were neglected for about a century until the early 2000s and since then there have been at least a dozen ovary transplants and births. For cisgender men, the emerging transplantation surgery for sexual and reproductive organs is penis transplantation, which has been used for men who have sustained genitourinary injuries (e.g. a botched circumcision, penile cancer, and war injuries). As of this year there have only been four successful penis transplants worldwide with the first unsuccessful attempt in 2006 and the first successful one in 2015.
These three transplantations involving sexual and reproductive organs raise numerous ethical issues. However, rather than delving into these ethical issues, I want to highlight an omission. I have extensively searched the medical literature, the news media, and social media and not seen anything about clitoris transplantation.
One might propose that the reason there isn’t anything out there about cultural transplants is because surgery involving the external female genitalia and vagina are rare or don’t exist. Yet this is not the case. Certain genital surgeries, though not common, are considered the standard of care such as the creation of a neovagina for ciswomen and intersex women with vaginal aplasia (i.e. an undeveloped vagina). The goal of this surgery is to allow for “normal” sexual activity which is typically seen as heterosexual intercourse. Additionally, cosmetic female genital surgery is increasingly common and in fact is the fastest-growing type of cosmetic surgery. The main cosmetic genital surgeries are either geared at enhancing the aesthetics of the external genitalia (e.g. labiaplasty to reduce the size of the labia minora) or aimed at “tightening” the vagina presumably for the sake of a male partner (e.g. vaginal “rejuvenation” surgery).
One might propose that the reason clitoris transplantations are not being discussed is because there is no need for them. Yet, this is also wrong and the need for clitoris transplantations far exceeds the need for other types of sexual and reproductive transplantations. There are over 200 million women and girls who have experienced female genital cutting and 3 million girls undergo it each year. Even if many, and even most, of the women who have undergone female genital cutting are not interested in restorative surgery like clitoris transplantation, this number still far exceeds the one in 500 women who have absolute uterine factor infertility (and consequently may be interested in uterus transportation) and the number of men who have injuries that would warrant a penis transplantation (for instance, one study put the number of traditional ritualistic circumcisions that result in penile amputation in the hundreds annually).
So why then is no one discussing clitoris transplantation? Unfortunately I believe the answer is simply that culturally we discount women’s sexuality. In other words, the idea of clitoris transplantation has not been explored because we as a society do not value women’s sexual pleasure. We do, in contrast, strongly value women’s fertility (hence the attention to uterus and ovary transplantation) and women’s sexual appeal for the male gaze (hence the genital surgeries focused on improving the aesthetics and experience for men). Furthermore, men’s virility and the existence of “normal” male genitalia is extremely important on the social level, which is why penis transplants have received so much attention. There is growing attention to female sexuality (dys)function as well as continuing global advocacy against female genital cutting. Perhaps clitoris transplantation will become something more than a figment of my imagination if we as a society place more value on women’s sexuality and sexual pleasure.
This blog is based on a talk I gave, “The Ethics of Clitoris Transplantations: A Constructive Response to Female Genital Cutting” at the European Conference on Philosophy of Medicine and Health Care in August 2019). For references, please contact me.