# Two recent international sexual/ethical issues: Menstrual precariousness for female prisoners (France), and forced sterilization in Japan for the LGBT community

P. Charlier, S. Deo

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P. Charlier, S. Deo. Two recent international sexual/ethical issues: Menstrual precariousness for female prisoners (France), and forced sterilization in Japan for the LGBT community. Ethics, Medicine and Public Health, 2019, 10, pp.27-28. 10.1016/j.jemep.2019.06.003. hal-04508774

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# Two recent sexual/ethical international issues: menstrual precariousness for female prisoners (France), and forced sterilization in Japan for the LGBT community

## *Deux problèmes internationaux sexuels / éthiques récents : la précarité menstruelle pour les détenues (France) et la stérilisation forcée pour la communauté LGBT (Japon)*

### Authors

Philippe Charlier (1,2), S Deo (1)

### Affiliations

1. Section of Medical Anthropology (EA 4498, UVSQ), UFR of Health Sciences, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France.

2. IPES, 203 avenue de la République, 92000 Nanterre, France.

### Corresponding author

Philippe Charlier MD PhD LittD

Section of Medical Anthropology (EA 4498 DANTE Laboratory, UVSQ), UFR of Health Sciences, 78180 Montigny-Le-Bretonneux, France.

Tel. +33(0)156610000

Email. [philippe.charlier@uvsq.fr](mailto:philippe.charlier@uvsq.fr)

### Conflicts of interests: none

### Keywords

Human body; Medical anthropology; Penitentiary medicine; Sex.

### Mots-clés

Corps humain ; Anthropologie médicale ; Médecine pénitentiaire ; Sexe.
## Menstrual precariousness for female prisoners

In France, theoretically, the rules of penitentiary administration dictate that no woman is to be left in the state of menstrual precariousness. And so, theoretically, each woman, on her arrival in the prison, must receive a hygiene kit irrespective of her financial resources [1]. The quality of the hygiene kit often suffers from disdain and indifference of the concerned officials, for example, the kit does not always include sanitary towels which are sometimes replaced only by toilet paper.

It is important to note that, in February 2019, women represent in 3.6% of the prison population (i.e. 2558 detainees) [2] and access to female hygiene products is made difficult either by a higher cost in commerce, or by a sparse and delayed delivery (in the name of solidarity for the so-called "indigent" individuals). In the meantime, female detainees have to get by, and in absence of proper products, more and more prisoners have to resort to unhygienic methods such as forging menstrual cups with bottoms of bottles whose edges are filed by rubbing against the walls of cells. The risk of uro-genital superinfection is greatly increased by dangerous practices like these.

It must be brought to notice that the hygiene conditions in French prisons are a real threat particularly to women's health, and public health, in general [3]. Prisons should ideally not contribute to the mounting health problem and instead place detainees on the road to rehabilitation but that is seldom the case. This is another health emergency for the public authorities to take note of. Women detainees should not be stigmatized because of their physiology and should not be forced to live an invisible, unwritten secondary sentence adding to the deprivation of their liberty and putting them at greater risk for infections and poor health. This neglect amounts to an act of barbarism, akin almost to torture.

## Forced sterilization in Japan for the LGBT community: which position for MDs?

A new ruling by the supreme court of Japan has recently upheld a law (Law #111, dated 2003) that requires transgender people to be sterilized before their gender can be changed on official documents. The important question before the medical community is that who will be the doctors that will accept to perform this questionable surgery? How can forced sterilization, which recalls the darkest period of the 20th century, still exist in 2019? How can a seemingly liberal law that permits sex-change be contingent upon the horrific system of sterilization?

The court has expressed doubts over whether this law reflects changing social values, but upheld its constitutionality. It must be pondered upon that by what logic, according to what reasoning is this sterilization being forced upon a community already wary of discrimination. In 2003, the need to avoid parent / child issues in LGBT families was addressed in the service of social cohesion [4] (a position based on the Confucian tradition of Japan inherited from its Chinese neighbor from as early as the 6th c. AD). Is not it really to “prevent the transmission” to the next generation of what outdated and conservative values consider intolerable?

The final legal gender recognition decision is made by the Family Court. An applicant to the court must, in addition to providing a certificate established by a psychiatrist attesting
to the fact that the individual has been diagnosed with Gender Identity Disorder (GID) [5], meet the following qualifications: be 20 years old or older; be presently unmarried; not presently have any underage children; not have gonads or permanently lack functioning gonads; have a physical form that is endowed with genitalia that closely resemble the physical form of an opposite gender. In its judgment of January 25, 2019, the Supreme Court confirmed the constitutionality of Law #111, while recognizing its mutilating nature and calling for its revision. This is a first step, but it is insufficient because by not suspending its application immediately, other patients will continue to be mutilated (7,000 since the publication of the law). It's not even stigma or discrimination against the LGBT community anymore, it's a lot worse: legal mutilation, if not legal torture. Who will be held responsible for the consequent physical and psychological trauma?

The situation begs us to revisit the idea of infallible sanctity of law, and forces us to ask bigger questions on morality and human values, especially for physicians. History has demonstrated repeatedly that what is right sometimes falls outside the law, and legal clauses cannot be the sole benchmark of larger human morality. Physicians must make this difficult choice. It may be they who will change the law, in addition to the consciousness of the young (non-conservative) Japanese generation.

## References

[1] https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT00002333257&categorieLien=id (accessed May 26, 2019)

[2] http://www.justice.gouv.fr/art.pix/mensuelle_fevrier_2019.pdf (accessed May 26, 2019)

[3] Charlier P. Border line medicine. *Ethics Med Public Health* 2019;**8**:18-21.

[4] https://www.hrw.org/news/2016/04/01/hrw-allegation-letter-un-special-rapporteurs (accessed May 26, 2019)

[5] The Japan Society for Psychiatry and Neurology, Diagnosis and treatment guidelines for gender identity disorder (4th edition), 2012, https://www.jspn.or.jp/uploads/uploads/files/activity/journal_114_11_gid_guideline_n04.pdf (accessed May 26, 2019)