Special Section on Sex and Surgery: ‘Doing’ sex and feminist theory

In her classic essay ‘Women and the Knife’, Kathryn P. Morgan (1991) highlights a set of paradoxes in the use of cosmetic surgery by adult women. On the one hand, women may choose to undergo cosmetic surgery after thorough deliberation and for the sake of their own pleasure or well-being: surgery may be conceived as a tool for liberation from the results of ageing, childbirth and breastfeeding. On the other hand, the use of cosmetic surgery may strengthen narrow cultural norms about female beauty or sexuality and transform the woman’s bodily self-awareness: she may come to engage in a thorough self-surveillance of her body that can be far from liberating. Furthermore, cosmetic surgery makes possible new treatments that make possible new needs. Numerous feminist theorists have engaged with these issues. They have discussed the potentially subversive power of using cosmetic surgery in order to question narrow norms about ideals of feminine beauty and sexuality (Morgan, 1991; Balsamo, 1996; Negrin, 2002) and destabilise connections between (female) passivity and beauty (Holliday and Sanchez Taylor, 2006), and they have examined rhetoric that pathologises ageing bodies and figures surgery as the solution to the ‘problem’ of ageing (Sobchack, 2009). They have listened to the voices of women and men who undergo cosmetic surgery, examined oppressive ideals of beauty and sought to make sense of self-presentations where individuals explain that they use surgery in order to have a body with which they feel comfortable (Bordo, 1993; Davis, 1995; Dolezal, 2010). They have also examined presentations of female cosmetic genital surgery as a means to enhance female sexual pleasure (Braun, 2005; Gimlin, 2007) or to transform oneself in accordance with one’s own likings (Banet-Weiser and Portwood-Stacer, 2006), debated what qualifies as medical, cosmetic, necessary and/or normalising surgery (Holmes, 2002), examined similarities and differences between for example cosmetic surgery, male or female circumcision and surgery on children born with intersex anatomies (Meyers, 2000; Chase, 2002; Njambi, 2004) and discussed how some such comparisons may reproduce problematic interrelations between gender and race (Pedwell, 2007). Furthermore, feminist and intersex scholars’ analyses of the medical management of children born with intersex anatomies have led to intense debates about such treatment, particularly the production of trauma as a result of repeated medical examinations and surgery (Kessler, 1990, 1998; Dreger, 1998a, 1998b; Feder, 2002; Holmes, 2008; Karkazis, 2008; Zeiler and Wickström, 2009). Such work has also led to critical examinations of genital ideals (Morland, 2005) and to a call for rethinking the concepts of sex and gender, their relation, and the relation between sex and genitals (Fausto-Sterling, 1993, 2000; Dreger, 1998a, 1998b; Kessler, 1998; Hird, 2000; Morland, 2001).

This Special Section on Sex and Surgery examines the physical and discursive shaping of sexed bodies, and indeed sexed bodily subjectivity, by individuals and in interaction with others in operating theatres, clinical encounters and everyday life. It examines how individuals seek, through surgery, to make their own or others’ bodies appear desirable, sexually attractive and/or as functioning in accordance with specific norms concerning female or male embodiment; it also examines how surgery can create, enforce and question these norms when shaping bodies. More precisely, the Special Section investigates cosmetic surgery in Brazil and teaching programmes for intersex surgery in West Africa, where European paediatric surgeons come to revise their previous focus on surgery as the ‘solution’ to the ‘problem’ of intersex because of poorer socio-material conditions at rural clinics in this region. It also explores how young women in Sweden, after having been informed that they have no or a ‘small’ vagina, describe vaginal surgery as a means to hetero-relational and bodily normality, and how this normative ideal informs and promotes practices of vaginal surgery.

The term sexed bodily subjectivity is designed to highlight that sexed embodiment is not merely deeply connected with, but is indeed a dimension of, the subject’s being-in-the-world. The term also refers to the processes that shape individuals’ self-understanding, and their ways of engaging with others and the world, as bodily subjects. Furthermore, the term is intended to draw attention to recent debates about the entanglement and non-separability of ‘biology with/in sociality’ (Davis, 2009: 67) within feminist theorisation, where scholars have debated the extent to which certain strands of feminist thinking have been anti-biological in remaining committed to a conceptual divide between the biological and the social (Ahmed, 2008; Davis, 2009). ¹ The Special Section takes as its starting-point the conviction that bodies need to be understood as cultural-biological, as always already physical and social (never separate objects ‘outside’ the realm of the social), that bodies as sites of subjectivity are continuously shaped in response to and shaping others and the world, and that it is relevant to examine how human agency may be enabled and limited by discursive and institutional powers as well as biosocial modes of existence.

The first of the articles within the Special Section engages explicitly with the intricate interrelation between socio-cultural-biological aspects of human existence and co-existence. Alex Edmonds examines the social constructions of beauty, sex, race and racial mixture within Brazilian plastic surgery and the limits of such constructions. He analyses how cosmetic surgery can produce ‘problems’ in need of ‘correction’, how Brazilian surgeons discuss whether a particular operation creates enough sexual and aesthetic ‘improvement’ to warrant the risks of surgery and how this presupposes that they first have defined sexual attractiveness. Edmonds discusses how the individual – once she has come to see herself as in need of surgery – may experience surgical effects as positive. He argues that whereas such effects cannot be understood apart from the social and medical contexts that give them meaning, to see them only as discursive would be to ignore biological dimensions of social life and to reinforce mind–body dualism. Edmonds investigates how the biological is represented by biomedicine, is experienced by patients, and is entangled with social constructions of beauty, race and female reproduction.

The second and third articles engage more implicitly with the socio-cultural-biological interrelation in examining the idea that surgery can create ‘normal’ genitals. These articles highlight how men and women may be socialised to specific surgical solutions – such as penile surgery on young boys or men with hypospadias in the article by Cynthia Kraus and vaginal surgery on young women diagnosed with vaginal agenesia in the article by Lisa Guntram – in ways that make the goal behind these surgeries appear desired and natural: to enhance these individuals’ ability to perform manhood or womanhood in accordance with norms concerning male or female embodiment.

Kraus’s contribution examines intersex training programmes in West Africa. She identifies a pre-existing surgical script for hypospadias and examines how this script is operationalised in the context of the ‘surgical missions’ where European surgeons take part in these training programmes. The script establishes hypospadias as a gender disability and surgery as a treatment that enhances the boy’s ability to ‘do’ male gender; it also commits certain actors to desiring (parents and patients), promoting (the local medical and NGO staff) and performing (the European surgeons) hypospadias surgery. Kraus also explores how the poorer socio-material conditions for surgical care in West Africa make it necessary for the European surgeons to revise the prevailing surgical script – in ways that imply ‘less cutting and more talking’. Furthermore, she shows how this surgery not only seeks to realise ideal sexed bodies, but also may construct genital ideals after the genitals have been operated on.

In the final contribution, Lisa Guntram investigates how vaginal surgery is presented as a means to achieve a desired hetero-relational and bodily normality by women who have come to know, in their teens, that they have no or a ‘small’ vagina. Guntram examines the strength of this normality ideal. The young women sometimes express the ideal as a taken-for-granted starting-point, as a motivational factor with regard to surgery; and sometimes they question it. Furthermore, Guntram shows how the vagina comes to be regarded as a minimum requirement for securing hetero-relational-bodily normality and how intercourse – when the women have undergone vaginal surgery – becomes a matter of lifelong therapy in order to further enlarge the vagina or to keep it in its post-surgery shape. The new knowledge about their own bodies evokes questions concerning sex, gender and sexuality, especially in relation to treatments designed to create a vagina or to enlarge a vagina which is considered too small, for the young women.

Finally, a few words are needed about the subtitle. The first part of it – ‘Doing’ Sex – can be read in two ways. A first possible reading draws on a phenomenological conception of bodily existence as a style of being, where a style of being refers to a certain manner of engaging with others and the world that emerges from the body’s capacities, from habitual expressive postures, ways of feeling, thinking, acting and responding to others. A style of being gives the subject’s bodily existence stability without stagnation and is the result of a habitual mode of being that gradually feeds into our bodily existence and ‘acquires a favoured status for us’ (Merleau-Ponty, 2006: 513). This conception of bodily existence as a style of being informs both Judith Butler’s (1988) early work on gender as constructed through a stylised repetition of acts over time (the subject ‘does’ her body as an ongoing materialisation of possibilities) and Sara Heinämaa’s (2003: 68) rethinking of sexed embodiment and sexual identity in terms of continuity of a ‘mode of acting’ rather than in terms of constancy of certain organs, of other attributes or of singular events. Thus sexed bodily subjectivity can be understood as continuously shaped and reshaped (‘done’) through the repetition of habitual ways of expressing oneself as a sexed bodily subject, alone and together with others, in everyday interactions and clinical encounters where bodies are examined and diagnosed, and where surgery is presented as an alternative (see also Zeiler and Guntram, forthcoming). Importantly for this Special Section, however, sex is also ‘done’ when individuals’ bodies are shaped through medical treatment and surgery, via hormonal treatments and in operating theatres. Surgery and hormonal treatment target the physical body and produce and strengthen ideals about sexed bodies. ²

The second part of the subtitle – Doing Feminist Theory – emphasises that investigations of these medical practices and clinical encounters where sex is ‘done’ evoke pertinent questions for feminist thinking, such as how ideals concerning sexed bodies (including genital ideals) can both govern surgery and be produced through such surgery, how operations on intersex persons can define and produce genital ideals post-operatively, and what this means for feminist theorising on sexed embodiment, as some examples. All contributions to the Section also engage in feminist theorising in close relation to empirical work. This is particularly important for scholars who wish to engage with voices of women and men who have undergone surgery intended to sex bodies and/or form sexed bodies in particular ways.