Discussion

In The Netherlands, the distinction between FGM/C and FGCP is portrayed as relatively easy to maintain. Professional associations of plastic surgeons and gynaecologists rely on widely accepted assumptions that frame FGM/C as inherently oppressive, performed on non-consenting children by untrained practitioners, and fundamentally different from FGCP. However, this narrative simplifies FGM/C as a practice that does not represent FGM/C as it is practised today. There is limited public awareness of medicalised FGM/C. As a result of this limited awareness, the double standard – where FGM/C is criminalised and FGCP are permitted – remains largely uncontested in public discourse.

In contrast, in Kenya, maintaining this binary distinction requires greater effort. The dominant narrative of FGM/C as universally oppressive is challenged by the presence of medicalised FGM/C and by adult women who advocate for their right to undergo circumcision. These realities complicate the assumption that FGM/C is always non-consensual and harmful. As a result, the double standard becomes more visible and harder to justify. Unlike in The Netherlands, where FGM/C can be positioned as ‘Other’ and fundamentally distinct from FGCP, in Kenya the lived realities expose the inconsistencies in how these practices are treated. This tension was acknowledged by the judges in the Kamau lawsuit, who recognised the discrepancy and called for the criminalisation of all forms of female genital surgery. In their ruling, the judges explicitly noted that the current legal framework ‘favoured women who could afford labiaplasty’, thereby acknowledging the class-based discrimination inherent in the legislation. This recognition suggests that both Kamau and, to some extent, the judges were among the first to explicitly address the racial, cultural, and class-based biases embedded in the differential treatment of genital surgeries. Their call for consistency marked an important legal consideration of these intersecting forms of discrimination.

In Egypt, the double standard is challenged in practice, as (what anti-FGM/C activists call) medicalised FGM/C is increasingly described as ‘cosmetic surgery’ within practising communities. Healthcare providers examine girls’ genitalia and classify cases as either ‘indicated’ or ‘non-indicated’ for cosmetic correction to achieve a ‘normal’ shape. There is thus a clear overlap between medicalised FGM/C and FGCP in terms of their intent, desired outcomes, and the fact that both are carried out by medical professionals. This trend clearly challenges the argument that FGM/C and FGCP differ in intent and outcomes.

Across all three contexts, the concepts of harm and consent played key roles in justifying or challenging the differential treatment of genital surgeries. However, various actors put forward differing interpretations of what constitutes harm. In The Netherlands, there is a prevailing assumption that FGM/C is inherently harmful, even in its least invasive forms, such as pricking the clitoral hood. Conversely, FGCP are framed as acceptable and generally harmless, unless they involve ‘health risks beyond the normal surgical risks’. This framing conveniently excludes the usual harms associated with surgery – such as bleeding, infection, scarring, and keloids – which are considered routine in the context of FGCP but are framed as unacceptable and defining features of harm in the context of FGM/C.

In Kenya, the debate focused on which option causes the least harm: FGM/C itself, its criminalisation, or its medicalisation? Dr Kamau argued that criminalisation drives the practice underground, increasing health risks and deterring women from seeking medical care due to fear of prosecution. She further contended that medicalised FGM/C could reduce harm by ensuring safer conditions – a justification also common in Egypt (El-Gibaly et al. 2019). To date, no research has systematically compared the health risks associated with FGM/C, medicalised FGM/C, and FGCP. A systematic comparison of these procedures, along with a deeper reflection on what constitutes harm, is crucial. The same health risks that render FGM/C unacceptable are often dismissed in the case of FGCP, while the same clinical procedures used to justify the safety and acceptability of FGCP are not extended to (medicalised) FGM/C.

With regard to consent, the prevailing assumption among the Dutch healthcare associations reflects a colonial mindset: that African women are incapable of giving genuine consent, while Dutch women – including minors – are presumed to have full bodily autonomy. In the Kenyan court case, however, this colonial configuration is reconfigured along socio-economic and cultural lines. The distinction is no longer drawn between African and Western women but between women from cutting communities – typically rural, lower socio-economic groups – and those from non-cutting communities, often urban, educated, and from higher socio-economic classes. In this context, the ability to consent is tied to class, education, and cultural affiliation rather than race. This mirrors Mahmood Mamdani’s (1996) argument that colonial power structures persist in postcolonial contexts, with paternalistic authority merely shifting from white rulers to Black elites.

In both the Dutch and Kenyan cases, there is broad acknowledgment that autonomy, choice, and consent are heavily influenced by socio-cultural factors when it comes to women from cutting communities. It is also recognised that these influences do not simply disappear when a woman reaches the age of eighteen. However, this level of scrutiny is less frequently applied when it comes to FGCP. The Egyptian case, however, offers insight into where the distinction might lie: who drives the decision? In the Dutch context, women seeking FGCP are typically the primary agents in making the decision, even though they are undoubtedly influenced by prevailing socio-cultural beauty standards. For minors, while family members or peers may reinforce these insecurities, the expectation is that the girl herself must express a clear and persistent desire for the procedure. In contrast, the Egyptian case suggests that the decision-making process is more externally driven. It appears that mothers often initiate the procedure, and healthcare professionals reinforce the necessity, positioning the girl as a passive recipient rather than an active decision-maker.

In conclusion, our research shows how the double standard applied to FGM/C and FGCP is challenged in real-world practice. Moreover, it pinpoints the ongoing inconsistencies in how harm and consent are defined and applied to female genital surgeries across different contexts. We argue that to move beyond these double standards, we must adopt a more consistent definition of harm that applies equally across cultural and geographical contexts, alongside a nuanced understanding of consent that accounts for socio-cultural pressures, decision-making dynamics, and access to alternatives. Further research is needed to systematically compare the health risks associated with FGM/C, medicalised FGM/C, and FGCP, as well as to examine the growing acceptance of FGCP in contexts where FGM/C is practised and how its boundaries with medicalised FGM/C are negotiated.