Kelly and Foster1 offer up an astounding discussion of the Female Genital Mutilation (FGM) Act in England and Wales, and we certainly laud the efforts of this Act to ‘protect girls and women from the medical dangers and societal pressures that produce FGM’. The authors’ realistic debate (Case 3) about any relationship between FGM and females with genital piercings (FGP) was good, especially their conclusion that ‘few, if any of the significant ethical or medical objections to female genital cosmetic surgery (FGCS), apply to FGP’.1
We believe that our published research supports Kelly and Foster’s1 beliefs, even for FGM, from evidence obtained in three different cross-sectional studies performed over the past 10 years that included more than 800 national and international FGPs.2 These studies document the motivations for genital piercing as ‘helped improve and express myself sexually’ and ‘helped me feel unique’, rather than being mutilating actions of self-harm or body alteration. Men more frequently obtained genital piercing in the early years of modern body piercing, but now there are more FGPs. Interestingly, over half the FGPs report abuse, and a third describe forced sexual activity against their will, with many illustrating how their genital piercing ‘helped them to take control of (or reclaim) their body after these violations’.2,3 Infibulations for abstinence on women (locked labial rings) and men (passing a fastening device along the foreskin) remain rare.
Of women wearing general body piercings, 1–3% choose genital sites, are older (≥30 years of age), and exhibit more deliberate decision making; they demonstrate effective genital piercing care and suffer few complications.2,3 A recent genital piercing review found numerous uncited, but published, assumptions about genital piercing complications, yet only 17 actual peer-reviewed cases over 35 years were found.2 Certainly we favour regulations to reduce medical risks, such as infectious disease transmission: there should be a requirement for the specific education of genital piercing piercers, and compliance issues regarding piercing jewellery and equipment should also be monitored.
From our perspective, the only commonalities between FGP and the FGM Act seem to be the terms ‘females’ and ‘genitals’. Our evidence reported by consenting adult FGPs is not the same as the permanent mutilating outcome of FGM to young girls or women, nor does it encompass the permanent surgical alternation of FGCS. Not only are there striking intentional differences for FGM but also immediate and major complications, including specific psychological concerns, as well as urinary incontinence, dysmenorrhoea, dyspareunia, infertility, haematocolpos, haematometra, vesicovaginal and rectovaginal fistulas, and increased female/neonatal mortality.4 In contrast, when genital piercing wearers no longer value their piercings as a ‘meaningful part of their lives that enhances sexual satisfaction and self-expression’,2,3 they have the control/ability to remove the genital piercing swiftly, and without anyone’s permission or assistance, with little or no residual scarring.