Female Genital Mutilation (FGM): Why??

Blog # 143   Andrew Siegel MD

The juxtaposition of the words “genital” and “mutilation” disturbs me greatly. Regardless of gender, the concept of inflicting serious damage on a person’s genitals or, for that matter any body part, conflicts strongly with the Hippocratic oath that physicians pledge, and is incompatible with the tacit oath of humanity that each of us incorporates during our actualization process as human beings.

You probably cannot imagine the scenario of having non-medical personnel come into your home and use crude and unsterile equipment to cut off some or all of the penis and scrotum of your young sons, on the basis of tradition and ritual.  Sadly, however, the practice of the female equivalent of this is precisely what happens to young girls in many African nations.

Female Genital Mutilation (FGM) is an ancient cultural ritual currently practiced in 28 African nations, Yemen, Iraqi Kurdistan, and within immigrant communities. Certain countries have an extremely high prevalence of this, involving more than 90% of their female population: Djibouti; Egypt; Eritrea; Guinea; Mali; and Somalia.

It is thought that FGM originated millenniums ago in ancient Egypt and thereafter became an entrenched social-cultural-religious tradition. Religion is most often invoked as the underlying explanation for this practice; however, cleanliness and “improved” health are other justifications that are often touted. Additionally, removing the clitoris is seen to be a means of curbing a woman’s libido. The most extreme form of FGM, infibulation (see below), is seen as proof of virginity, the presence of which is of significant importance in many of the countries where FGM is practiced.

The practice was known as female circumcision until the 1980s and gradually the more appropriate term female genital mutilation took hold—a descriptive moniker—because it is truly a genital-deforming “operation.”  Because of emigration to Western nations in Europe and the USA, physicians are now confronting women who have undergone these ritual procedures and suffer with medical complications.

FGM is defined by the World Health Organization (WHO) as “a procedure that involves partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons.”

FGM is classified into 4 types:

(In boldface I have delineated the male equivalent of the FGM procedures—can you imagine for one moment these being cultural norms?)

Type Ia-removal of clitoral hood (Male equivalent is a circumcision.)

Type Ib-partial or total removal of the clitoris and hood (Male equivalent is partial or total removal of the penis.)

Type II: in addition to the type I surgery on the clitoris, parts of the labia minora  (inner lips) or the entire labia minora are removed. At times, this involves removing all of the labia majora  (outer lips).  (Male equivalent is removal of the penis and partial removal of the scrotum.)

Type III: This is known as infibulation—cutting the labia minora and majora and sewing them together with or without removal of the clitoris, thereby sealing the vulva, leaving only a tiny opening for urination/menstruation. (Male equivalent is total removal of the penis and total removal of the scrotum.)

When infibulation is performed, the closure must ultimately be re-opened to allow for sexual intercourse and for childbirth. Pregnancy in women who have undergone infibulation represents a difficult challenge.

Type IV: this includes all other kinds of female genital circumcision done for nonmedical reasons including pricking, piercing, scraping, and burning the labia or the vagina.

FGM is most often carried out by nonmedical staff and occurs outside the confines of a hospital setting without anesthesia or hygienic conditions. The procedure is typically performed in the home setting by a village elder experienced in performing the procedure. Most of the time, it is done in early childhood, commonly before age 5. Unsterile, crude objects are routinely used as cutting implements. Wounds are often closed with thread or with agave or acacia thorns. Uniquely, medical professionals most commonly perform the procedure in Egypt, the country that has the highest prevalence of FGM.

In 2012, the U.N. General Assembly voted unanimously to condemn this practice. It is actually outlawed in most of the countries in which it is practiced, but the laws are poorly enforced. Fortunately, there has been a gradual but steady movement to stop this practice in many countries, but the procedure is far from being extinct. The most common reason given for continuing the practice today is for purposes of “social acceptance.”

The medical complications of FGM include recurrent urinary infections; difficulties with urination, menstruation and possibly pregnancy; and abnormal, debilitating connections between the vagina and the urinary bladder (fistula). FGM can lead to heavy bleeding, severe pain, painful sexual intercourse and the potential for transmission of infections, hepatitis, and HIV. Psychological problems are another major potential consequence of FGM.

If one objectively considers male circumcision, it is nothing other than a form of male genital mutilation (Yes, I have been mutilated). It is well adopted among the Jewish and Muslim populations for religious/cultural reasons and has been practiced for so many generations such that it is considered a meme and a cultural norm, and for many an aesthetic necessity with the natural, uncircumcised penis appearing unattractive to those whom accept circumcision as a convention (however, it is worth mentioning that there are some true, significant health benefits to circumcision, which is not the case with FGM). My point is that I can come to understand “strange” ritual practices that we are socialized to accept; however, my limit of tolerance is at circumcision. I might, perhaps, be able to accept circumcision’s female equivalent—removal of the clitoral foreskin—if it was a time-honored societal norm. That stated, any form of FGM beyond this should never be condoned by society—it is nothing short of assault and battery with potentially horrific physical and psychological consequences.

References: Female Genital Circumcision/Mutilations: Implications For Female Uro-Gynecological Health.   International Uro-gynecological Journal “2013” 24:2021–2027

Andrew Siegel, MD

For more info on Dr. Siegel: http://www.about.me/asiegel913

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in April 2014.


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