From Intimate Exams to Ritual Nicking: Interpreting Nonconsensual Medicalized Genital Procedures as Sexual Boundary Violations

Abstract

Abstract Purpose of Review This review seeks to integrate scholarly discussions of nonconsensual medicalized genital procedures, combining insights from the literature on obstetric violence with critiques based on children’s rights. In both literatures, it is increasingly argued that such interventions may constitute, or be experienced as, violations of patients’ sexual boundaries, even if performed without sexual intent. Recent Findings Within the literature on obstetric violence, it is often argued that clinicians who perform unconsented pelvic exams (i.e., for teaching purposes on anesthetized patients), or unconsented episiotomies during birth and labor, thereby violate patients’ bodily integrity rights. Noting the intimate nature of the body parts involved and the lack of consent by the affected individual, authors increasingly characterize such procedures, more specifically, as sexual boundary violations or even “medical sexual assault.” Separately, critics have raised analogous concerns about medically unnecessary, nonconsensual genital cutting or surgery (e.g., in prepubescent minors), such as ritual “nicking” of the vulva for religious purposes, intersex genital “normalization” surgeries, and newborn penile circumcision. Across literatures, critics contend that the fundamental wrong of such procedures is not (only) the risk of physical or emotional harm they may cause, nor (beliefs about) the good or bad intentions of those performing or requesting them. Rather, it is claimed, it is wrong as a matter of principle for clinicians to engage—to any extent—with patients’ genital or sexual anatomy without their consent outside of certain limited exceptions (e.g., is not possible to obtain the person’s consent without exposing them to a significant risk of serious harm, where this harm, in turn, cannot feasibly be prevented or resolved by any less risky or invasive means). Summary An emerging consensus among scholars of obstetric violence and of children’s rights is that it is unethical for clinicians to perform any medically unnecessary genital procedures, from physical examination to cutting or surgery, without the explicit consent of the affected person. “Presumed” consent, “implied” consent, and “proxy” consent are thus argued to be insufficient.