Female genital surgery in the United States can easily be seen as a bygone practice of a less enlightened medical past, especially since attention today has largely shifted to so-called female genital cutting or female genital mutilation in African countries. Yet this assumption obscures the long and ongoing tradition of clitoral surgeries in the United States, which Sarah B. Rodriguez explores in this thoroughly researched and engagingly written book. As she states, “far from being examples of misogyny or aberrations in medical practice, female circumcision and clitoridectomy were and remain intimately part of American culture” (11). Ambitious in scope, Female Circumcision and Clitoridectomy in the United States charts the shifting debates and practices surrounding female genital surgery from the mid-nineteenth century to the 1980s, focussing primarily on medical arguments rehearsed in anatomical and gynecological sources, but also taking into account how female sexuality was constructed in marriage manuals and other sexual-advice literature.

In contrast to earlier studies of female genital surgery, Rodriguez distinguishes carefully between different kinds of clitoral surgery: removal of the entire clitoris (clitoridectomy), removal of the clitoral hood (circumcision), removal of smegma, and the separation of adhesions binding the clitoris to its hood. She also examines the range of alleged sexual disorders that medical doctors and their female patients hoped to cure through genital surgeries. The first two chapters explore how surgical treatments were sought to treat masturbation in adult women and children from the mid-nineteenth century to the 1940s. Chapter 3 focusses on the same period and discusses how enlarged clitorises were linked to hypersexuality and homosexuality, often in African American women, and constructed as socially deviant and medically unhealthy. The remaining four chapters investigate how female circumcision was used to enhance female sexual response in marital heterosexual relations. In chapters 4 and 5, Rodriguez offers an interesting discussion of the shifting authority and reception of Freudian vaginal-orgasm theory among the American medical profession and American culture more broadly. She concludes that clitoral circumcision was promoted as a means to improve female sexuality even if the focus of sexual activity was meant to be on the achievement of vaginal orgasm. Chapter 6 examines continuities and changes in the understanding and practice of female genital surgery amid second-wave feminist debates about clitoral stimulation from the 1960s to the late 1980s. The final chapter discusses in detail the controversial “love surgery” promoted by gynecologist James Burt from the 1960s to the 1980s.

Rodriguez argues that the overarching aim of the different surgical interventions she covers was to cure various sexual disorders by directing female sexuality towards heterosexual vaginal intercourse in marriage. As such, female genital surgeries reinforced the normative belief that healthy female sexuality should be focussed predominantly on the vagina. However, Rodriguez also suggest that the very same debates about clitoral stimulation paradoxically drew attention to the significance of the clitoris in facilitating sexual arousal and pleasure. Indeed, her in-depth analysis of anatomical and gynecological sources reveals the complex understanding of clitoral functioning and the cautious approach to clitoral surgery on behalf of at least some members of the medical profession. Doctors “respected the importance of clitoral stimulation for healthy sexuality while simultaneously recognizing its role as cause and symptom in cases of medically, and socially, perceived unhealthy sexual expression” (3).

This nuanced reading of medical views of female genital surgery is one of the major strengths of Female Circumcision and Clitoridectomy in the United States. The author is deeply aware and critical of the ways in which the operations she describes reinforce androcentric and heterosexual norms and values. However, she also goes beyond previous feminist discussions of female genital surgery that flatly condemn as misogynistic male doctors who carried out genital operations on women. Instead, Rodriguez demonstrates the considerable controversies and critical debates surrounding female genital surgery among male medical professionals. She also shows that women and parents actively demanded that operations be performed on themselves or their children in a bid to cure self-perceived sexual disorders or problems.

In paying attention to the multiple male and female agents and voices involved in the history of female genital surgery, Rodriguez successfully interrupts reductive narratives of the medicalization of female sexuality. She offers a rich and balanced understanding of how and why surgical interventions have and continue to be part of American medical practice. In addition to charting the medical history of female genital surgery, the book also explores broader questions about the medical and cultural construction of the female body and female sexuality that will be of interest to medical historians as well as scholars in other fields and disciplines, including the history of sexuality, literary and cultural studies, and gender and sexuality studies. Given that women today continue to seek what is now described as genital cosmetic surgery, this is also a timely book with important political implications that deserve further attention.