Medical professionals often have the final say in deciding what counts as a “defect.” Often, their decisions exceed the bounds of medicine, addressing bodies that may deviate from “normal” or “average,” but do not actually cause medical problems.
An alternative might be to allow the patient to decide if his or her body is acceptable, but in doing so they risk allowing people’s deeply subjective and often dysmorphic perceptions of their own bodies determine whether they undergo a risky procedure.
Is there another way?
Pediatric surgeon Norma Ruppen-Greeff and hers colleagues thought so. Pediatric physicians often correct hypospadias, a condition in which the meatus, or opening of the urethra, doesn’t quite make it to the top of the penis during fetal development, such that the urethra exits the penis somewhere along the shaft. This is generally corrected surgically, but physicians found that some men returned to them as adults with concerns that their penis still appeared abnormal.
Instead of dismissing men’s concerns or jumping with a knife, they decided to ask women if they noticed. They had 105 women fill out a questionnaire and rate which aspects of penile appearance were important to them. And, lo and behold, the shape and placement of the meatus was the least important. No need for surgery, plus they can reassure the guys that they’re OK. (Someone should follow up and ask gay and bisexual men; anyone for an awesome senior thesis?)
This is a great way to measure the sociocultural value of a surgery. Whereas we’re used to thinking about surgical issues as psychological (someone wants it) or medical (someone needs it), these physicians asked a distinctly sociological question. They measured how penises are widely perceived and which parts are socially constructed as important. That’s a pretty neat way to incorporate sociological realities into surgical practice.