Genital modification and mutilation

The terms genital modification and genital mutilation can refer to permanent or temporary changes to human genitals. Some forms of genital alteration are performed at the behest of an adult, with his or her full and informed consent. Others are performed by adults on other individuals, often infants or children, without the latter's consent, and often by force. Any of these procedures may be considered modifications or mutilations by different groups of people.

Body modification
Many types of genital modification are performed at the behest of the individual, for personal, sexual, aesthetic or cultural reasons. Subincision, or splitting of the underside of the penis, is widespread in the traditional cultures of Indigenous Australians. This procedure has taken root in Western body modification culture. Meatotomy is a form that involves splitting of the glans penis alone, while genital bisection is a more extreme form that splits the penis entirely in half.

Genital piercings and genital tattooing may be performed for aesthetic reasons, while piercings may have the additional benefit of increasing sexual pleasure for the pierced individual or their sex partners. Similarly, Pearling involves surgical insertion of small, inert spheres around the vaginal or anal opening, often for the purpose of providing sexual pleasure to insertive sex partners.

Clitoris enlargement may be achieved temporarily through the use of a clitoral pump, or it may be achieved permanently through application of testosterone cream to the clitoris, or through injectable testosterone. Penis enlargement is a term for various techniques used to attempt to increase the size of the penis, though the safety and efficacy of these techniques are debated.

Voluntary sex reassignment
Some transsexual people choose to undergo sex reassignment surgery as part of their gender transition. Transwomen may undergo castration, with or without vaginoplasty, while female-to-male transsexuals may undergo phalloplasty or metoidioplasty, with or without oophorectomy or hysterectomy.

Involuntary sex assignment
If a baby is born with ambiguous genitalia due to an intersex condition, it may not be clear whether the child is female or male. In certain cases, the child's chromosomal makeup is neither female nor male, but a combination. In these cases, the baby is usually given a sex assignment, and in many cases, the child's genitals are surgically altered to conform to those of the assigned sex. This practice is met with strong dissent from advocates for genital integrity. As cosmetic surgery is not medically necessary for health, they argue that the individual should be free to make the choice whether to pursue cosmetic surgery upon their genitals. Advocates state that the surgery can damage the individual's ability to experience sexual arousal and can render the individual incapable of orgasm. Another concern is that sex assignment holds a significant element of guesswork, and that an individual's sex assignment may turn out to be incorrect. If, for instance, an individual is assigned female, their phallus is usually surgically reduced in size, and the shape of a vulva may be created. If, upon maturing, the individual identifies as male; their phallus is still gone, and the individual may require further surgery to try to reverse the erroneous sex assignment. Those who oppose medically unnecessary genital surgery, and genital surgery coerced or performed without consent comprise the genital integrity movement. The case of David Reimer, the victim of a botched circumcision who was raised as a girl alongside his twin brother, bears many parallels to this issue.

In the context of disease or medical necessity
If the genitals become diseased, as in the case of Cancer, sometimes the diseased areas are surgically removed. Biological females may undergo vaginectomy, while males may undergo penectomy. Reconstructive surgery may be performed to restore what was lost, often with techniques similar to those used in sex reassignment surgery.

Similarly, during childbirth, episiotomy is sometimes performed to increase the amount of space through which the baby may emerge. Advocates of natural childbirth and unassisted birth state that this intervention is often performed without medical necessity, with significant damage to the person giving birth.

Hymenotomy is the surgical perforation of an imperforate hymen. It may be performed to allow menstruation to occur. An adult individual may opt for increasing the size of their hymenal opening, or removal of the hymen altogether, to facilitate sexual penetration of their vagina.

Female genital cutting
Female genital cutting, also known as female genital mutilation or female circumcision, refers to "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons." It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. FGC is practiced throughout the world, but the practice is concentrated more heavily in Africa, Indonesia, and the Middle East. The World Health Organization (WHO) separates FGC procedures into four categories: Type I, II, III, and IV. There is much controversy surrounding Type III (Infibulation) due to concerns regarding the safety and consequences of the procedure. In the past several decades, there have been pushes by global health organizations, such as the WHO, to end the practice of FGC. However, due to its importance in traditional and religious life, the practice remains in many societies.

Hymenorrhaphy
Hymenorrhaphy refers to the practice of thickening the hymen, or, in some cases, implanting a capsule of red liquid within the newly created vaginal tissue. The newly created hymen is created to cause physical resistance, blood, or the appearance of blood, at the time that the individual's new husband inserts his penis into her vagina. This is done in cultures where a high value is placed on female virginity at the time of marriage. In these cultures, a woman may be punished, perhaps violently, if the community leaders deem that she was not virginal at the time of consummation of her marriage. Individuals who survive rape‏‎, who were virginal at the time of their rape, may elect for hymenorrhaphy.

Vaginoplasty
Genetically, females who are displeased with the shape of their vulvas may choose to undergo vaginoplasty or labiaplasty. The concept of a "designer vagina" is one that has been surgically altered to meet aesthetic standards. The surgery itself is controversial. Opponents view the demand for this type of surgery as being driven by unattainable bodily ideals, perhaps popularized by the appearance of the genitals of performers in pornography.

Labia pulling
See labia stretching and elongated labia.

Male circumcision
Male circumcision involves the removal of the foreskin. It may also involve frenectomy, the removal of the frenulum. A related procedure is preputioplasty, which is used as a treatment for phimosis. This procedure is most often performed upon infant boys. It has religious significance in the Jewish religion and in Islam. It spread into Western culture, and peaked in the early 80s. The bioethics of neonatal circumcision are a subject of intense debate, with circumcision advocates promoting it as beneficial, and supporters of genital integrity opposing it as a violation of the individual's human rights. Some adults who were circumcised as infants engage in foreskin restoration, a method of stretching the penile skin in order to partially recreate the foreskin. Autocircumcision is a related practice of training the foreskin to remain in a retracted position, giving the look of a circumcised penis to one which is intact.