I had the privilege of writing on behalf of myself and the Genital Autonomy Collective to inform the court of the interests of intersex, trans, and/or gender-expansive people in the matter of genital mutilation laws and discrimination on the basis of sex. In this brief, I explain how sex-exclusive genital cutting laws operate in practice, including for intersex children whose legal protection may turn on a sex assignment made by clinicians or parents, the very individuals whose conduct is meant to be regulated by genital cutting bans.

Genital Autonomy Collective Amicus Brief for Hadachek v. Oregon

Introduction

The following sections will explain how the sex-exclusive nature of anti-FGM laws permits doctors and parents to conduct the precise acts named as FGM (circumcision, excision, or infibulation of the whole or any part of the labia majora, labia minora or clitoris of a child) so long as the doctor and parents choose to assign the child male at birth. It also explains how the genital autonomy-based activism of the Genital Autonomy Collective is philosophically distinct from historical, sex-based forms of anti-FGM activism. It describes the consensus that has recently emerged that centers on consent and universal human rights. The new consensus argues that “the right of each person to decide for themselves whether they want to accept the risks, costs, and trade-offs associated with medically unnecessary genital cutting or surgery—and if so, toward what ends—is threatened by the denial of that right to any person” (Brussels Collaboration on Bodily Integrity, 2024).

I. Identity and Expertise of Proposed Amici

A. T. T. Perry, Ph.D.

I, T. T. Perry, Ph.D., am a sensory scientist with expertise in measurement psychology, symptom reporting and assessment, impaired sensory systems, neural prosthetics, and speech communication. I am also a gender nonbinary person (they/them pronouns) and the Science Communicator for the Genital Autonomy Collective which I joined in 2023.

Education: I received my Ph.D. in 2019 from the University of Minnesota’s Department of Speech-Language-Hearing Sciences. My dissertation research was completed in the Center for Applied and Translational Sensory Science under the mentorship of the Center’s co-founder, and my coursework and research training, were interdisciplinary and included neuroscience, psychology, bioengineering, non-human primate research, statistics, and computer programming.

Research experience: I have over eighteen years of experience in sensory research across a broad range of topics, including the perceptual consequences of direct nerve stimulation, subjective and objective outcomes of patient-directed healthcare, and large-scale epidemiological surveys of symptoms and health concerns in U.S. military service members. Following completion of my Ph.D., I worked as a postdoctoral research fellow at Walter Reed National Military Medical Center and the Portland VA. I have authored thirteen peer-reviewed research studies in journals such as The Journal of the Acoustical Society of America, American Journal of Audiology, and Trends in Hearing. I am the lead author of a peer-reviewed collaborative autoethnography written by members of the Genital Autonomy Collective that will soon be published in a 2027 special issue of The Journal of Bodies, Sexualities, and Masculinities. I have presented original research on intersex, trans, and gender-expansive experiences of genital cutting at the GLMA 43rd Annual Conference on LGBTQ+ Health (2025) and the First Symposium of the International Society of Nonbinary Scientists (2025).

B. Genital Autonomy Collective

I am writing on behalf of the Genital Autonomy Collective (“the Collective”), a peer-support group of intersex, trans, and/or gender nonbinary people who experienced violations of our genital autonomy, including intersex “normalizing” surgeries, circumcision, and infibulation. The Collective was founded in Portland, Oregon in 2022 by Alliana Arshad, an intersex trans woman of color, and its membership includes over 400 people across the world, with roughly half of our members living in the U.S. The Collective facilitates support for people who are grieving unwanted genital modifications and for people who are pursuing desired genital modifications (and sometimes these are the same people).

Argument

I. What is intersex?

Intersex traits are “variations in sex characteristics, such as ambiguous external genitalia, ambiguous internal reproductive organs, or uncommon chromosomal patterns” (White, 2013). Intersexuality occurs in about 1.7% of the population (Blackless et al., 2000), and “1 in 1500 births result in an intersex infant who has ambiguous genitalia” (White, 2013). Intersex is a biological description, not a gender identity. Most intersex adults have binary gender identities (e.g., intersex man, woman with intersex traits), and only about a quarter of intersex adults have a nonbinary gender identity (Schweizer et al., 2014). The antonym of intersex is endosex, referring to sex traits that are statistically typical for people of that sex. Gender nonbinary people can have bodies of any sort, though most gender nonbinary people are endosex, and gender nonbinary is a distinct but overlapping category relative to intersex (Ziemińska, 2022).

II. What are intersex genital mutilation and genital exceptionalism?

Intersex bodies challenge socially-constructed definitions of sex and gender as exclusively binary (female or male). Children with ambiguous genitalia sometimes endure medically unnecessary genital surgeries to “normalize” their appearance to be closer to that of an endosex male or female. Intersex human rights activists have focused intense efforts to end such surgeries, referring to them as intersex genital mutilation because the surgeries are non-consensual from the perspective of the child, performed for social reasons rather than the child’s health, and can “result in loss of sexual function and sensation, a need for repeat surgeries, incorrect legal sex assignment, infertility and lifelong need for hormone replacement, genital examinations, loss of bodily integrity, and trauma” (Carpenter, 2018). Unwanted genital surgery is just one injustice faced by intersex people due to genital exceptionalism, which is “the importance that society places on genitalia as the determinative variable in establishing an individual’s gender, regardless of the individual’s identity and gender performance. So understood, genital exceptionalism assumes a strict binary view of gender and insists that all genitalia must conform to what society deems ‘normal’ for a male or a female” (Walker, 2019).

III. How sex-exclusive anti-FGM laws permit FGM on intersex children assigned male at birth

Due to the sex-exclusive construction of anti-FGM laws, a doctor performing genital surgery on an intersex child could simply evade the reach of a sex-exclusive genital cutting ban by assigning the child a male sex. This is not a hypothetical situation for the Collective’s peer support group. Julia Black (shi/hir pronouns) is an androgynous intersex person and co-author of the aforementioned collaborative autoethnography (Perry et al., In Press). Julia was born in the U.S. to Jewish parents. At birth, Julia had ambiguous sex traits, including both a vulva and a penis. As an adult, Julia menstruates and produces semen. When shi was born, the doctors and hir parents made a choice to raise Julia as a male. Because of the pervasive influence of genital exceptionalism, Julia was subjected to “normalizing” genital surgery. Because a vulva is considered to be non-normative genitalia for a boy, the doctor infibulated Julia’s vulva. Because an intact penis is considered to be non-normative genitalia for a Jewish boy, the doctor circumcised Julia’s penis.

Julia is an example of a person assigned male at birth who experienced circumcision of hir penis and excision and infibulation of hir labia. Had Julia been assigned female at birth, the acts done to hir genitals would plainly be FGM. “The tolerance of procedures performed on intersex children when the same procedures would be prosecuted if performed on non-intersex children is discrimination” (Fraser, 2016).

IV. History of anti-FGM activism

In the past, most anti-FGM activists were uninterested in pursuing legal bans of intersex genital mutilation or male genital mutilation. The discourse of criminalizing FGM originates from second-wave feminists who held up the female genital cutting rituals of women of color in the Global South as the epitome of patriarchal oppression of women. In response, “African activists and postcolonial feminists called out the ethnocentrism, sensationalism, and racism embedded in this narrative” (Van Bavel & Gibson, 2024). “Anti-FGM activists and NGOs have received their share of critique against what is considered to be a stigmatizing and simplistic discourse. Policies to tackle FGM/C in Europe have also been accused of being inefficient and discriminatory against minority communities” (Florquin & Richard, 2020).

Over the past 50 years, anthropological and sociological work has produced an understanding that childhood genital cutting practices of all kinds “are often tightly symbolically linked, serving complementary or mutually reinforcing social functions. These functions—for example, maintaining gendered social divisions and associated power hierarchies—cannot adequately be understood, much less appropriately addressed, by studying each practice in isolation” (Earp, 2022). “Scholars, including anthropologists, have emphasized that the societies in which FGM/C is practiced are widely different and that there is no clear relationship between the status of women and men in a society and whether it practices FGM/C, particularly since the practice is generally managed by women” (Florquin & Richard, 2020).

Taking on these critiques, some anti-FGM activists have adopted a wider, systemic lens that contends FGM “has far less to do with how men oppress women than with how a system of gender-asymmetric values and constraints is internalized by both, with their active participation, and thus becomes self-sustaining, naturalized, indeed unselfconsciously ‘real’” (Boddy, 2016).

V. Anti-FGM resistance to intersex justice

Activists pushing for an end to the practice of FGM have had little involvement in past efforts to end unnecessary and harmful genital surgeries on intersex children. From an insider’s perspective at an anti-FGM organization, anti-FGM activists have identified four likely factors to explain the disinterest in addressing intersex genital cutting: “(1) a lack of information and knowledge on what intersex entails and which ‘treatments’ are imposed on intersex persons, (2) an unwillingness to recognize that ‘Western medicine’ could be wrong or even harmful, (3) the fact that intersex persons are seen as too small a minority for their cause to be important, (4) a discomfort in thinking outside of the gender binary” (Florquin & Richard, 2020).

There is a subset of anti-FGM activists who conceptualize the harm of FGM as being primarily gender oppression—that FGM is bad because it is violence that men do to women and girls. This is an ideological view that is predicated on sex-based distinctions about who counts as a proper sufferer of harm within feminist theories (Hemmings, 2011). These distinctions require specific investments in genital exceptionalism and related beliefs about binary sex, beliefs which intersex people and trans people destabilize and threaten (Walker, 2019). This subset of anti-FGM activists believes that intersex people do not have the same claim to harm as endosex women or girls because this subset believes intersex people are not the proper subjects of feminist theories of gender oppression. This same logic about anti-FGM activists who overlook claims of harm made by intersex people extends to failures to recognize the harms of penile circumcision.

VI. The new consensus on childhood bodily integrity

As an alternative conception to the gender oppression paradigm, bioethicists have introduced a new paradigm grounded in sex- and gender-neutral principles, namely, the human right to bodily integrity and genital autonomy. This new paradigm first observes that childhood genital cutting practices are a diverse category of practices which have significant physical overlaps in terms of adverse consequences and invasiveness across male, female, and intersex bodies. Similarly, the symbolic meaning and rationalizations justifying these genital cutting practices also “overlap considerably between sexes, when the full complement of such procedures across societies is taken into account” (Earp & Steinfeld, 2017). The physical and symbolic overlapping of male, female, and intersex genital cutting means it is not possible to coherently distinguish these practices on the basis of sex or gender.

Instead of distinctions based on sex or gender categorization, the new paradigm argues that the distinction should be consent-based. This argument is supported by observing that some people experience genital cutting as inherently harmful regardless of the degree of severity of the cutting, then observing the asymmetry in enfranchisement between people with intact and modified genitals; while people with unmodified genitals who wish to have modified genitals can always opt for modification, the irreversibility of genital amputation and modification means that people who resent forced genital cutting have no similar remedy (Earp & Steinfeld, 2017). This sex-inclusive paradigm is reflected in the Collective’s advocacy for genital autonomy for all children.

To the extent that there is any consensus among people working to end the various forms of childhood genital cutting, it is best represented by the Brussels Collaboration on Bodily Integrity, a diverse group of “physicians, ethicists, nurse-midwives, public health professionals, legal scholars, human rights advocates, political scientists, anthropologists, psychologists, sexologists, sociologists, philosophers, and feminists from Africa, Asia, Australasia, Europe, the Middle East, and the Americas with interdisciplinary or experiential expertise in child genital cutting practices across a wide range of cultural contexts” (Brussels Collaboration on Bodily Integrity, 2024). These experts affirmed that “as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter’s sex traits or gender assignment, unless urgently necessary to protect their physical health” (Brussels Collaboration on Bodily Integrity, 2024).

References

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Boddy, J. (2016). The normal and the aberrant in female genital cutting: Shifting paradigms. HAU: Journal of Ethnographic Theory, 6(2), 41–69. https://doi.org/10.14318/hau6.2.008

Brussels Collaboration on Bodily Integrity. (2024). Genital modifications in prepubescent minors: When may clinicians ethically proceed? The American Journal of Bioethics, 1–50. https://doi.org/10.1080/15265161.2024.2353823

Carpenter, M. (2018). The “normalization” of intersex bodies and “othering” of intersex identities in Australia. Journal of Bioethical Inquiry, 15(4), 487–495.

Earp, B. D. (2022). Genital cutting as gender oppression: Time to revisit the WHO paradigm. Frontiers in Human Dynamics, 4, 778592.

Earp, B. D., & Steinfeld, R. (2017). Gender and genital cutting: A new paradigm. Gifted Women, Fragile Men. Brussels: ALDE Group-EU Parliament.

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Fraser, S. (2016). Constructing the female body: Using female genital mutilation law to address genital-normalizing surgery on intersex children in the United States. International Journal of Human Rights in Healthcare, 9(1), 62–72. https://doi.org/10.1108/IJHRH-05-2015-0014

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