Female genital mutilation (FGM) involves a handful of surgeries performed on girls, and is performed ritualistically in some areas and communities. Female genital modification involves several other practices that are not considered to be detrimental to a girl’s health or wellbeing.
Whether a practice is considered a mutilation or a modification really depends on who you speak to, but the World Health Organisation generally has something to say about it all as a guideline. Informed consent is usually the parameter, along with ongoing damage to the body (especially using violence).
Clitoridectomy (removing the clitoris)
This is the partial or complete removal of the clitoris, also known as female ‘circumcision’, which is a misnomer, since it is not anywhere near the male equivalent of removing a small piece of skin from the end of the penis. This practice is common in some African, Middle East and Southeast Asian countries on girls aged from just a few days up to age 15. Amnesty International sets the annual figure at over two million clitoridectomies.
Luckily, the clitoris has many ways and wiles, and cutting off the glans does not stop a woman from being able to be sexually fulfilled and orgasming. Most of the time. (Read more about clitoridectomies.)
Infibulation (cutting off the vulva and sewing the vagina up)
Infibulation is the most extreme form of FGM (Type III), and involves removing the entire vulva (inner and outer labia and clitoris), and closing the vagina up almost completely, leaving just a small hole for urine and menstrual blood. The vagina is opened after the girl’s wedding for sex and childbirth. This practice is undertaken most commonly in Djibouti, Eritrea, Somalia and Sudan, and despite efforts by the WHO, the practice is important for traditional Africans, and shows no signs of abating.
Gishiri cutting (slicing the back wall)
Gishiri cutting is only performed in certain parts of Niger and Nigeria, and involves inserting a knife into the vagina and slicing cuts down the back wall to the perineum to treat various reproductive disorders. There is no evidence that it helps any of the listed conditions.
Piercing of the actual clitoral shaft is rare, but not unheard of, since only a few women actually have enough clitoris sticking out to pierce. The Isabella piercing aims for deep at the base of the clitoris, but again require enough clitoris out to pierce. Most genital piercings around the clitoris are actually the hood, which is a piece of skin. There is a risk of infection and other nerve pains from these types of piercings, however there is also often an increase in sexual stimulation.
Genital tattooing doesn’t have any sexual benefits, and is done purely for aesthetic reasons.
If taking female-to-male hormone treatments, the clitoris is likely to enlarge significantly but will never reach the size of a normal penis. A metoidioplasty (clitoral release) can be performed in place of a phalloplasty (the creation of a penis), allowing one to maintain sexual sensation in the clitoris.
This is called gender reassignment surgery, and is designed to match the person on the inside with the body on the outside, though not all transgender people undergo surgery.
Anabolic steroids and testosterone to increase clitoris size
Body builders and some other athletes sometimes use anabolic steroids to improve their physical performance, while at the same time in women enlarging the clitoris. Some may use a clitoral pump to increase size and pleasure in the clitoris.
Some African women practice labia pulling to elongate the labia for perceived improvements in sexual pleasure, and to enhance female ejaculation. (Read more about labia pulling.)
Surgery on ambiguously gendered or genitally injured children
A child born intersex or with ambiguous genitals (or having suffered an accident) may undergo surgery to ‘normalise’ them aesthetically, despite funtion being present most of the time. These surgeries are often damaging sexually to the child, and may render them infertile, such as in times gone by a boy with a micropenis may have his penis removed and be ‘reassigned’ to being a girl.
This is objectionable, since the child didn’t get to choose what they would prefer, and subject them to unknown risks to their sexuality and fertility. This doesn’t happen much anymore in western countries due to the known risks.
Self-inflicted genital wounds, Skoptic syndrome
A person may self-inflict any variation of genital wounds, including removal of tissue. This can be due to Skoptic syndrome, mental illness, gender identity crisis, or body dysmorphia (or other reasons).
Labiaplasty, elective genitoplasty
The advent of the ‘designer vagina’ is a set of vagina modifications that tend to reduce labia minora size, remove part of the clitoral hood, or otherwise adjust the size and shape of the vulva. (Read about the labiaplasty operation and the discussion.)
Hymenorrhaphy (altering the hymen)
A hymenorrhaphy includes thickening the hymen, and sometimes implanting a liquid-filled capsule with red dye so that when the newly-married woman is penetrated by her husband, she bleeds, there is some resistance to the penis, and the virginity can be determined (rightly or wrongly) as being intact. Women who may have been raped or otherwise do not have an intact hymen may choose this surgery, since the punishment for not being a virgin can be severe in some countries.