Female genital cutting

Female genital cutting (FGC), also known as female genital mutilation (FGM), female circumcision or female genital mutilation/cutting (FGM/C), refers to "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons."^[1] The term is almost exclusively used to describe traditional, cultural, and religious procedures where parents must give consent, because of the minor age of the subject, rather than to procedures generally done with self-consent (such as labiaplasty and vaginoplasty).^[2][3][4] It also generally does not refer to procedures used in gender reassignment surgery, and the genital modification of intersexuals.^[5][6][7]

FGC is practiced throughout the world, with the practice concentrated most heavily in Africa. Its practice is extremely controversial. Opposition is motivated by concerns regarding the consent (or lack thereof, in most cases) of the patient, and subsequently the safety and long-term consequences of the procedures. In the past several decades, there have been many concentrated efforts by the World Health Organization (WHO) to end the practice of FGC. The United Nations Population Fund (UNFPA) has also declared February 6 an "International Day Against Female Genital Mutilation."^[8]

Contents 1 History of terminology 1.1 Female circumcision 1.2 Female genital mutilation 1.3 Female genital cutting 2 FGC Procedures 3 World Health Organization categorization 3.1 Type I 3.2 Type II 3.3 Type III: Infibulation with excision 3.4 Type IV: Other types 4 Prevalence 5 Cultural and religious aspects 5.1 Islam 5.1.1 Sunni View 5.2 Judaism 5.3 Christianity 6 Medical consequences 7 Sexual consequences 8 Attempts to end the practice of FGC 9 Laws and prevalence 9.1 Africa 9.2 Asia 9.3 Other regions 10 See also 11 References 12 Further reading 12.1 Bibliography 12.2 Print 13 External links

History of terminology

Different terms are used to describe female genital surgery and other such procedures. The procedures were once commonly referred to as female circumcision (FC), but the terms female genital mutilation (FGM) and female genital cutting (FGC) are now dominant throughout the international community. Opponents of the practice often use the term female genital mutilation, whereas groups that oppose the stigma of the word "mutilation" prefer to use the term female genital cutting. A few organizations have started using the combined term female genital mutilation/cutting (FGM/C). All three terms are currently still actively used.

Female circumcision

Several dictionaries, including medical dictionaries, define the word circumcision as applicable to some procedures performed on females.^[9][10][11] Cook states that historically, the term female circumcision was used, but that "this procedure in whatever form it is practised is not at all analogous to male circumcision and so the term 'female circumcision' gave way to the term 'female genital mutilation'"^[12] Shell-Duncan states that the term female circumcision is a euphemism for a variety of procedures for altering the female genitalia.^[13] Toubia argued, in 1995, that the term female circumcision "implies a fallacious analogy to nonmutilating male circumcision, in which the foreskin is cut off from the tip of the penis without damaging the organ itself."^[14] However, in a radio interview from December 1996, when asked to explain the difference between female and male circumcision in support of the interviewer's comment that the term female circumcision "implies an analogy with male circumcision, which is not the case", Toubia responded "I disagree with you that it’s not the case. I think there are similarities and then there are differences. I think the people who say that there are no similarities are people who don’t want to address male circumcision basically."^[15]

Female genital mutilation

The term female genital mutilation gained growing support in the late 1970s. The word "mutilation" not only established clear linguistic distinction from male circumcision, but it also emphasized the gravity of the act. In 1990, this term was adopted at the third conference of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) in Addis Ababa. In 1991, the World Health Organization (WHO), a specialized agency of the United Nations (UN), recommended that the UN adopt this terminology; subsequently, it has been widely used in UN documents.^[16]

In this context, the term female circumcision was thus predominantly replaced by the term female genital mutilation:

The extensive literature on the subject, the support of international organizations, and the emergence of local groups working against the continuation practices appear to suggest that an international consensus has been reached. The terminology used to refer to these surgeries has changed, and the clearly disapproving and powerfully evocative expression of "female genital mutilation" has now all but replaced the possibly inaccurate, but relatively less value-laden term of "female circumcision".^[17]

Female genital cutting

Because the term female genital mutilation has been criticized for increasing the stigma associated with female genital surgery, some groups have proposed an alteration, substituting the word "cutting" for "mutilation." According to a joint WHO/UNICEF/UNFPA statement, the use of the word "mutilation" reinforces the idea that this practice is a violation of the human rights of girls and women, and thereby helps promote national and international advocacy towards its abandonment. They state that, at the community level, however, the term can be problematic; and that local languages generally use the less judgmental "cutting" to describe the practice. They also state that parents resent the suggestion that they are "mutilating" their daughters. In 1999, the UN Special Rapporteur on Traditional Practices called for tact and patience regarding activities in this area and drew attention to the risk of "demonizing" certain cultures, religions, and communities. As a result, the term "cutting" has increasingly come to be used to avoid alienating communities.^[18]

In 1996, the Uganda-based initiative REACH (Reproductive, Educative, And Community Health)began using the term "FGC", observing that "FGM" may "imply excessive judgment by outsiders as well as insensitivity toward individuals who have undergone some form of genital excision."^[19] The UN uses "FGM" in official documents, while some of its agencies, such as the UN Population Fund, use both the terms "FGM" and "FGC".^[20][21]

FGC Procedures

FGC consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away.

World Health Organization categorization

The WHO uses the term Female Genital Mutilation, and classifies FGM into four major types^[22] (see Diagram 1), although there is some debate as to whether all common forms of FGM fit into these four categories, as well as issues with the reliability of reported data.^[23]

Type I

The WHO defines Type I FGM as the partial or total removal of the clitoris (clitoridectomy) and/or the prepuce (clitoral hood); see Diagram 1B. When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris with the prepuce.^[22] In the context of women who seek out labiaplasty, Stern opposes removal of the clitoral hood and points to potential scarring and nerve damage.^[24]

Type II

The WHO's definition of Type II FGM is "partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora. Note also that, in French, the term ‘excision’ is often used as a general term covering all types of female genital mutilation.^[22]

Type III: Infibulation with excision

The WHO defines Type III FGM as narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)."^[1] It is the most extensive form of FGM, and accounts for about 10% of all FGM procedures described from Africa.^[25] Infibulation is also known as "pharaonic circumcision."^[26]

In a study of infibulation in the Horn of Africa, Pieters observed that the procedure involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora. The labia majora are then held together using thorns or stitching. In some cases the girl's legs have been tied together for two to six weeks, to prevent her from moving and to allow the healing of the two sides of the vulva. Nothing remains but the walls of flesh from the pubis down to the anus, with the exception of an opening at the inferior portion of the vulva to allow urine and menstrual blood to pass through; see Diagram 1D. Generally, a practitioner recognized as having the necessary skill carries out this procedure, and a local anesthetic is used. However, when carried out "in the bush," infibulation is often performed by an elderly matron or midwife of the village, with no anesthesia used.^[27]

A reverse infibulation can be performed to allow for sexual intercourse or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation is opened completely and may be restored after delivery. Again, the legs are sometimes tied together to allow the wound to heal. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again.^[27]

Women who have been infibulated face a lot of difficulty in delivering children, especially if the infibulation is not undone before hand, which often results in severe tearing of the infibulated area, or fetal death if the birth canal is not cleared (Toubia, 1995). The risk of severe physical, and psychological complications is more highly associated with women who have under gone infibulations as opposed to one of the lesser forms of fgm. Although there is little research on the psychological side effects of fgm, many women feel great pressure to conform to the norms set out by their community, and suffer from anxiety and depression as a result (Toubia, 1995). “There is also a higher rate of post traumatic stress disorder in circumcised females” (Nicoletti, 2007, p. 2). ^{[28] [29]}

This practice increases the occurrence of medical complications due to a lack of modern medicine and surgical practices.

A five-year study of 300 women and 100 men in Sudan found that "sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally bound to hide these experiences."^[30]

Most advocates of the practice continue to perform the procedure in adherence to standards of beauty that are very different from those in the west. Many infibulated women will contend that the pleasure their partners receive due to this procedure is a definitive part of a successful marriage and enjoyable sex life.

Type IV: Other types

There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. The WHO defines Type IV FGM as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization."^[22] This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.^[22] Type IV is found primarily among isolated ethnic groups as well as in combination with other types.

Prevalence

Amnesty International estimates that over 130 million women worldwide have been affected by some form of FGM, with over 2 million procedures being performed every year. FGM is mainly practiced in African countries. It is common in a band that stretches from Senegal in West Africa to Ethiopia on the East coast, as well as from Egypt in the north to Tanzania in the south; see Map. It is also practiced by some groups in the Arabian peninsula. The country where FGM is most prevalent is Egypt, followed by Sudan, Ethiopia, and Mali. Egypt recently passed a law banning FGM.^[31]

Whilst FGM is widely practiced out in the open by Africans of varied faiths, it is practiced in secrecy in some parts of the Middle East. In the Arabian peninsula, Types I and II FGM is usually performed, often referred to as Sunna circumcision especially among Afro-Arabs (ethnic groups of African descent are more likely to prefer infibulation). The practice occurs particularly in northern Saudi Arabia, southern Jordan, and northern Iraq . In the Iraqi village of Hasira, a recent study found that 60 percent of the women and girls reported having undergone FGM. Before the study, there had been no solid proof of the prevalence of the practice. There is also circumstantial evidence to suggest that FGM is practiced in Syria, western Iran, and southern Turkey.^[32] In Oman, a few communities still practice FGM; however, experts believe that the number of such cases is small and declining annually. In the United Arab Emirates and Saudi Arabia, it is practiced mainly among foreign workers from East Africa and the Nile Valley.

The practice can also be found among a few ethnic groups in South America. In Indonesia, the practice is not uncommon among the country's rural women; almost all are Type I or Type IV, the latter usually involving the pricking of blood release. Sometimes the procedures are merely symbolic, and no actual cutting is done.^[33]

As a result of immigration, the practice has also spread to Europe, Australia and the United States. Some tradition-minded families have their daughters undergo FGM whilst on vacation in their home countries. As Western governments become more aware of FGM, legislation has come into effect in many countries to make the practice of FGM a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter.

Cultural and religious aspects

The traditional cultural practice of FGC predates both Islam and Christianity. A Greek papyrus from 163 B.C. mentions girls in Egypt undergoing circumcision and it is widely accepted to have originated in Egypt and the Nile valley at the time of the Pharaohs. Evidence from mummies have shown both Type I and Type III FGC present.^[34] While the spread of the practice of FGC is unknown, the procedure is now practiced among Muslims and Animists.^[35]

Medical justifications offered by cultural tradition are regarded by scientists and doctors as unsubstantiated. Some African societies consider FGC part of maintaining cleanliness as it removes secreting parts of the genitalia. Vaginal secretions, in reality, play a critical part in maintaining female health. Some Bambara and Dogon believe that babies die if they touch the clitoris during birth.^[36] In some areas of Africa, there exists the belief that a newborn child has elements of both sexes. In the male body the foreskin of the penis is considered to be the female element. In the female body the clitoris is considered to be the male element. Hence when the adolescent is reaching puberty, these elements are removed to make the indication of sex clearer.^[36]

In years past, doctors advocating or performing these procedures sometimes claimed that girls of all ages would otherwise engage in excessive masturbation and be "polluted" by the activity, which was referred to as "self-abuse".^[37]

C.F. McDonald wrote in a 1958 paper titled "Circumcision of the Female"^[38] "If the male needs circumcision for cleanliness and hygiene, why not the female? I have operated on perhaps 40 patients who needed this attention." The author describes symptoms as "irritation, scratching, irritability, masturbation, frequency and urgency," and in adults, smegmaliths causing "dyspareunia and frigidity." The author then reported that a two-year-old was no longer masturbating so frequently after the procedure. Of adult women, the author stated that "for the first time in their lives, sex ambition became normally satisfied." Justification of the procedure on hygienic grounds, or to reduce masturbation, has since declined. The view that masturbation is a cause of mental and physical illness has dissipated since the mid-20th century.^[39]

Clitorecdomy in its less invasive form, removal of the prepuce alone, also called a hoodectomy. It is an elective surgery undertaken by mature consenting adults. Some doctors^[40] and other advocators^[41] believe that hoodectomy can help to increase and improve sexual sensitivity and sexual pleasure in cases where the hood of the clitoris is too tight.

There are websites promoting the practice like Circlist, BMEzine (Body Modification E-Zine), and the Clitoral Hood Removal Information Page contain testimonials and citations of medical studies, which support this claim (for example a study done in 1959 Rathmann et al claim that 87.5% of women saw an improvement in sexual pleasure following a hoodectomy,^[42] with 75% in a study by Knowles et al).

Social justifications similarly lack scientific evidence. FGC advocates have claimed the practice cures females of a myriad of psychological diseases including depression, hysteria, insanity and kleptomania. FGC is often used as a means of control over female virtue. FGC is often used as a means of preservation and proof of virginity, and is regarded in many societies as a prerequisite for honorable marriage. Type III FGC is often used in these societies, and the husband will sometimes cut his bride's scar tissue open after marriage to allow for sexual intercourse. Heavy stigma lies on men who marry an uncircumcised woman. Women who have had genital surgeries are often considered to have higher status than those who have not and are entitled to positions of religious, political and cultural power.^[43] Removal of the clitoris is often cited as a means of discouraging promiscuity, as it eliminates the motivating factor of sexual pleasure. Feminists and human rights activists disapprove of this practice because it presupposes that women lack the self control or the right to decide when and with whom they engage in sexual activity.

Aesthetic reasons are also cited. Some societies believe that FGC enhances beauty. This stems from their belief that male foreskin is removed for aesthetic reasons, and that the clitoris thus should be removed for the same reason since it is the counterpart to the penis. FGC is believed to prolong sexual pleasure of men, because it is believed that the clitoris increases sexual stimulation.

There are no scientific or medical studies that support any of these viewpoints. While there is a correlation between FGC prevalence and religions like Islam and Christianity, prevalence rates vary by culture. These variances preclude an unequivocal link between religion and FGC.^[44] However there is debate as to whether or not FGC constitutes a religious practice in particular religious subcultures.

Islam

Female genital cutting predates Islam.^[44]In Saudi Arabia, in the area known as the Hijaz, where Islam originated, FGC was already being practiced during the lifetime of Muhammad. To call a man a "circumciser of women" was an insult among the pagan Arabs at the time. Female genital cutting is not commanded by the Qur'an^[45] and is not practiced by the majority of Muslims.^[44] In Egypt, mufti Sheikh Ali Gomaa stated: "The traditional form of excision is a practice totally banned by Islam because of the compelling evidence of the extensive damage it causes to women's bodies and minds." ^[46]

Sunni View

There are differences of opinion among Sunni scholars in regards to female genital cutting. These differences of opinion range from forbidden to obligatory. The debate focuses around a hadith from the Sunni collections. One narration states that "a woman used to perform circumcision in Medina. Muhammad said to her, 'Do not cut severely as that is better for a woman and more desirable for a husband.'"^[47]Abu Dawood, who relates the narration in his collection, states the hadith is poor in authenticity. ^[48] Ibn Hajar al-Asqalani describes this hadith as poor in authenticity, and quotes Imam Ahmad Bayhaqi’s point of view that it is "poor, with a broken chain of transmission" ^[49] Zein al-Din al-Iraqi points out in his commentary on Al-Ghazali’s Ihya ulum al-din (I:148) that the mentioned hadith has a weak chain of transmission."^[50] Yusuf ibn Abd-al-Barr comments: "Those who consider (female) circumcision a sunna, use as evidence this hadith of Abu al-Malih, which is based solely on the evidence of Hajjaj ibn Artaa, who cannot be admitted as an authority when he is the sole transmitter. The consensus of Muslim scholars shows that circumcision is for men".^[51]

Imam Shams-ul-haq Azeemabadi asserts that, "[t]he Hadith of female circumcision has been reported through so many ways all of which are weak, blemished and defective, and thus it is unacceptable to prove a legal ruling through such ways."^[50] While some scholars reject ahadith that refer to FGC on grounds of inauthenticity, other scholars argue that authenticity alone does not confer legitimacy. One of the sayings used to support FGC practices is the hadith (349) in Sahih Muslim: Aishah narrated an authentic Hadith that the Prophet said: "When a man sits between the four parts (arms and legs of his wife) and the two circumcised parts meet, then ghusl is obligatory." Dr. Muhammad Salim al-Awwa, Secretary General of the World Union of the Muslim Ulemas states that while the hadith is authentic, it is not evidence of legitimacy. He states that the Arabic for "the two circumcision organs" is a single word used to connote two forms; however the plural term for one of the forms is used to denote not two of the same form, but two different forms characterized as a singular of the more prominent form. For example, in Arabic, the word with the female gender can be chosen to make the dual form, such as in the expression "the two Marwas", referring to the two hills of As-Safa and Al-Marwa (not "two of the same hills, each called Al-Marwa") in Mecca.^[52] He goes on to state that, while the female form is used to denote both male and female genitalia, it is identified with the prominent aspect of the two forms, which, in this case, is only the male circumcised organ. He further states that the connotation of circumcision is not transitive. Dr. al-Awwa concludes that the hadith is specious because "such an argument can be refuted by the fact that in Arabic language, two things or persons may be given one quality or name that belongs only to one of them for an effective cause." ^[50] [e.g. the usage in "Qur'an in Surah Al-Furqan(25):53", "bahrayn" is the dual form of "bahr" (sea) meaning "sea (salty and bitter) and river (sweet and thirst-allaying)", and not "two seas".]

In March 2005, Dr Ahmed Talib, Dean of the Faculty of Sharia at Al-Azhar University, stated: "All practices of female circumcision and mutilation are crimes and have no relationship with Islam. Whether it involves the removal of the skin or the cutting of the flesh of the female genital organs... it is not an obligation in Islam."^[53] Both Christian and Muslim leaders have publicly denounced the practice of FGC since 1998.^[54] A recent conference at Al-Azhar University in Cairo (December, 2006) brought prominent Muslim clergy to denounce the practice as not being necessary under the umbrella of Islam.^[55] Although there was some reluctance amongst some of the clergy, who preferred to hand the issue to doctors, making the FGC a medical decision, rather than a religious one, the Grand Mufti Ali Jumaa of Egypt, signed a resolution denouncing the practice.^[56]

One of the four Sunni schools of religious law, the Shafi'i school, rules that trimming of the clitoral hood is mandatory.^[57] Sheikh Faraz Rabbani states, "That which is wajib [obligatory] in the Shafi`i texts is merely slight 'trimming' of the tip of the clitoral hood - prepuce." Contrary to the WHO definition, he states that this practice is not "FGM, nor harmful to the woman or her ability to derive sexual pleasure." He states that "excision, FGM, or other harmful practices" are not permitted.^[58] In 1994, Egyptian Mufti Sheikh Jad Al-Hâqq argued that the procedure may not be banned simply on grounds of improper use.^[59] Al-Azhar University in Cairo has issued several fatwas endorsing FGC, in 1949, 1951 and 1981.^[60]

Judaism

The Oxford Dictionary of the Jewish Religion states that female circumcision was never allowed in Judaism.^[61] Toubia (1995) states that female circumcision is not even mentioned in any religious text.^[62] FGC is practiced by the minority Ethiopian Jewish community (Beta Israel), formerly known as Falasha, most of whom now live in Israel. The operation may only be performed by a Jewish female. Those Ethiopian Jews who have emigrated to Israel no longer practice FGC. ^[63] In general, traditional Judaism maintains that the body of a person belongs not to the person but to God.^[64] Any permanent modification of the body which does not serve the purpose of correcting a deformity is considered to be a defacement of God's property; thus, tattoos and body modifications are forbidden, with the exception of male circumcision, which is mandated. The U.S. Department of Health and Human Services, however, states that the practice of FGC cuts across religions, and lists Jews along with Muslims, Christians, and followers of indigenous religions as being among people who practice it.^[65]

Christianity

FGC has never been part of Christianity as a faith system. There are no scriptural or doctrinal documents existing within the larger Christian tradition that even address the issue. The only contemporary examples of Christians practicing FGC are in Africa. As FGC rituals predated the missionaries work in North Africa, many African tribes continue the practice as a matter of cultural tradition, unrelated to religious belief.

In the United States, as recently as 1938, FGC was advocated by Reverend Oscar Lowry as a method of preventing masturbation: "While incest and illicit commerce of the sexes is abominable, there is another even more so—if that be possible—that is, the heinous sin of self-pollution or masturbation... In some cases where there may be impingement of the clitoris, a slight operation may be necessary to relieve the tension and irritation..."^[66]

Medical consequences

Among practicing cultures, FGC is most commonly performed between the ages of four and eight, but can take place at any age from infancy to adolescence. Prohibition has led to FGC going underground, at times with people who have had no medical training performing the cutting without anesthetic, sterilization, or the use of proper medical instruments. The procedure, when performed without any anesthetic, can lead to death through shock from immense pain or excessive bleeding. The failure to use sterile medical instruments may lead to infections.

Other serious long term health effects are also common. These include urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility. Epidermal inclusion cysts may form and expand, particularly in procedure affecting the clitoris. These cysts can grow over time and can become infected, requiring medical attention such as drainage.^[67] The first time having sexual intercourse will often be extremely painful, and infibulated women will need the labia majora to be opened, to allow their partner access to the vagina. This second cut, sometimes performed by the partner with a knife, can cause other complications to arise.

A June 2006 study by the WHO has cast doubt on the safety of genital cutting of any kind.^[1] This study was conducted on a cohort of 28,393 women attending delivery wards at 28 obstetric centers in areas of Burkina Faso, Ghana, Nigeria, Kenya, Senegal and The Sudan. A high proportion of these mothers had undergone FGC. According to the WHO criteria, all types of FGC were found to pose an increased risk of death to the baby (15% for Type I, 32% for Type II, and 55% for Type III). Mothers with FGC Type III were also found to be 30% more at risk for cesarean sections and had a 70% increase in postpartum hemorrhage compared to women without FGC. Estimating from these results, and doing a rough population estimate of mothers in Africa with FGC, an additional 10 to 20 per thousand babies in Africa die during delivery as a result of the mothers having undergone genital cutting.

In cases of repairing the damage resulting from FGC, called de-infibulation when reversing Type III FGC, this is usually carried out by a gynecologist. See also Pierre Foldes, French surgeon, who developed modern surgical corrective techniques.

A 12-year-old Egyptian girl, Badour Shaker, died in June, 2007 during or soon after a circumcision, prompting the Egyptian Health Ministry to ban the practice. She died from an overdose of anesthesia. The girl's mother, Zeinab Abdel Ghani, paid $9.00 [or 5 Pounds Sterling] to a female doctor, in an illegal clinic in the southern town of Maghagh, for the operation. The mother stated that the doctor tried to give her $3,000 to withdraw a lawsuit, but she refused.^[68]

Sexual consequences

The effect of FGC on a woman's sexual experience varies depending on many factors. FGC does not eliminate sexual pleasure for all women who undergo the procedure. Although sexual excitement and arousal for a woman during intercourse involves a complex series of nerve endings being activated and stimulated in and around her vagina, vulva (labia minora and majora), cervix, uterus and clitoris, psychological response and mindset are also important.^{[69] [70]}

Lightfoot-Klein (1989) studied circumcised and infibulated females in Sudan, stating, "Contrary to expectations, nearly 90% of all women interviewed said that they experienced orgasm (climax) or had at various periods of their marriage experienced it. Frequency ranged from always to rarely." Lightfoot-Klein stated that the quality of orgasm varied from intense and prolonged, to weak or difficult to achieve.^[71]

A study in 2007 found that in some infibulated women, some erectile tissue fundamental to producing pleasure had not been completely excised.^[72] Defibulation of subjects revealed that a part of or the whole of the clitoris was underneath the scar of infibulation. The study found that sexual pleasure and orgasm are still possible after infibulation, and that they rely heavily on cultural influences — when mutilation is lived as a positive experience, orgasm is more likely. When FGC is experienced as traumatic, its frequency drops. The study suggested that FGC women who did not suffer from long-term health consequences and are in a good and fulfilling relationship may enjoy sex, and women who suffered from sexual dysfunction as a result of FGC have a right to sex therapy.

A study by Anthropologist Rogaia M. Abusharaf, found that "circumcision is seen as 'the machinery which liberates the female body from its masculine properties'^[73] and for the women she interviewed, it is a source of empowerment and strength". ^[74]

Attempts to end the practice of FGC

Despite laws forbidding the practice, FGC remains an enduring tradition in many societies and cultural groups. Political leaders have found FGC difficult to eliminate on the local level because of its cultural and sometimes political importance.^[75] For instance, in Kenya, missionaries present in the 1920s and 1930s forbade their Christianised adherents to practice clitoridectomy. In response, FGC became instrumental to the ethnic independence movement among the Kikuyu, the most populous ethnic group of Kenya - indigenous people reacted against what they perceived as cultural imperialistic attacks by Europeans.^[76] Likewise, prohibition by the British of the procedure among tribes in Kenya significantly strengthened the tribes' resistance to British colonial rule in the 1950s and increased support for the Mau Mau guerrilla movement.^[77]

Because the practice holds much cultural and marital significance, FGC opponents recognize that in order to end the practice it is necessary to work closely with local communities. In order to leave no individuals handicapped, as what happened with the rapid abandonment of foot binding among the Chinese early in the 20th century,^[78] members of a marriage network must all give up the practice simultaneously.

Despite the close tie between FGC and cultural and, sometimes, religious tradition, there are cases where attempts at ending FGC have been successful. One example is in Senegal, where initiative was taken by native women working at the local level in connection with the Tostan Project.^[79] Since 1997, 1,271 villages (600,000 people), some 12% of the practicing population in Senegal, have voluntarily given up FGC and are also working to end early and forced marriage. This has come about through the voluntary efforts of locals carrying the message out to other villages within their marriage networks in a self-replicating process. By 2003, 563 villages had participated in public declarations, and the number continues to rise. By then, at least 23 villages in Burkina Faso had also held such community wide ceremonies, marking "the first public declaration to end FGC outside of Senegal and showing the replicability of the Tostan program for large-scale abandonment of this practice". Molly Melching of TOSTAN believes that in Senegal the practice of female genital mutilation could be ended within 2–5 years. She credits education, instead of cultural imperialism, for the rapid and significant changes which have occurred in Senegal.

Some countries which have prohibited FGC still experience the practice in secrecy. In many cases, the enforcement of this prohibition is a low priority for governments. Other countries have tried to educate practitioners in order to make it easier and safer, instead of outlawing the practice entirely. However, with pressure from the WHO and other groups, laws are being passed in regards to FGC. On June 28, 2007 Egypt banned female genital cutting after the death of 12-year-old Badour Shaker during a genital circumcision. The Guardian of Britain reported that her death "sparked widespread condemnation" of the practice.^[68] However, Britain has had its own problem confronting cases of FGC, as immigrants from Africa have been known to send their daughters to their home nations to undergo the procedure before returning to Britain.

The United Nations Population Fund (UNFPA) has declared February 6 as the International Day Against Female Genital Mutilation.^[80] The UNFPA has stated that [the] practice violates the basic rights of women and girls, [...]" and "[...] female genital mutilation or cutting is not required by any religion."

FGC can now be partially reversed via a surgical technique, which gives back certain sensation to the genitalia. Clitoraid, a non-profit international organization, is in the process of building a hospital in Burkina Faso, West Africa, where women who have undergone FGC will be able to receive this procedure free of charge. The hospital will be staffed with volunteers, including surgeons who specialize in this area.

There are two main anti-FGC frameworks: the health model and the human rights-based model. The health model campaign defines FGC as harmful to women's health (physical and psychological trauma, sterility, damage to the urethra and anus, tetanus, child and maternal mortality and more recently HPV and HIV infection). This approach has failed to bring about large scale behavioural change. And although the health model is against FGC and the adverse effects associated, they often reject methods to provide medical support to minimize FGC health risks (i.e. medicalization). The human rights-based model has in more recent times replaced the health based model as the preferred approach in anti-FGC campaigns. The human rights model encompasses four important human rights discourses: violence against women, rights of the child, freedom from torture and rights to health and bodily integrity.

Laws and prevalence

Africa

The countries where FGC is commonly practiced were identified by the US State Department.^[81] Other information in this section is from Skaine (2005), Appendix I.^[34]

Burkina Faso (71.6% prevalence, Type II)

A law prohibiting FGC was enacted in 1996 and went into effect in February 1997. Even before this law, however, a presidential decree had set up the National Committee against excision and imposed fines on people guilty of excising girls and women. The new law includes stricter punishment. Several women excising girls have been handed prison sentences.^[82]

Central African Republic (43.4% prevalence, Type I and II) 

In 1996, the President issued an Ordinance prohibiting FGC throughout the country. It has the force of national law. Any violation of the Ordinance is punishable by imprisonment of from one month and one day to two years and a fine of 5,100 to 100,000 francs (approximately US$8-160). No arrests are known to have been made under the law.

Côte d'Ivoire ( 44.5% prevalence, Type II)

A December 18, 1998 law provides that harm to the integrity of the genital organ of a woman by complete or partial removal, excision, desensitization or by any other procedure will, if harmful to a women's health, be punishable by imprisonment of one to five years and a fine of 360,000 to two million CFA Francs (approximately US$576-3,200). The penalty is five to twenty years incarceration if a death occurs during the procedure and up to five years' prohibition of medical practice, if this procedure is carried out by a doctor.

Djibouti (90-98% prevalence, Type II)

FGC was outlawed in the country's revised Penal Code that went into effect in April 1995. Article 333 of the Penal Code provides that persons found guilty of this practice will face a five year prison term and a fine of one million Djibouti francs (approximately US$5,600).

Egypt (78-97% prevalence, Type I, II and III)

Egypt's Ministry of Health and Population has banned all forms of female genital cutting since 2007. The ministry's ban order declared it is 'prohibited for any doctors, nurses, or any other person to carry out any cut of, flattening or modification of any natural part of the female reproductive system'. Islamic authorities in the nation also stressed that Islam opposes female circumcision. The Grand Mufti of Egypt, Ali Gomaa, said that it is "Prohibited, prohibited, prohibited."^[83] The June 2007 Ministry ban eliminated a loophole that allowed girls to undergo the procedure for health reasons. ^[84] There had previously been provisions under the Penal Code involving "wounding" and "intentional infliction of harm leading to death," as well as a ministerial decree prohibiting FGC. In December 1997, the Court of Cassation (Egypt's highest appeals court) upheld a government banning of the practice providing that those who did not comply would be subjected to criminal and administrative punishments. This law had proved ineffective and in a survey in 2000, a study found that 97% of the country's population still practiced FGC. In light of the widespread practice of FGC, even after the ban in 1997, some Egyptian villages decided to voluntarily give up the practice, as was the case with Abou Shawareb, which vowed in July of 2005 to end the practice. However, it remains a culturally accepted practice, and a 2005 study found that over 95% of Egyptian women have undergone some form of FGC.^[85]

Eritrea (90-95% prevalence, Type I, II and III)

Eritrea has outlawed all forms of female genital cutting since 2007.^[86] There have been no arrests made yet under the new law.

Ghana (9-15% prevalence, Type I,II and III)

In 1989, the head of the government of Ghana, President Rawlings, issued a formal declaration against FGC. Article 39 of Ghana's Constitution also provides in part that traditional practices that are injurious to a person's health and well being are abolished.

Guinea (98.6% prevalence, Type I, II and III)

FGC is illegal in Guinea under Article 265 of the Penal Code. The punishment is hard labor for life and if death results within 40 days after the crime, the perpetrator will be sentenced to death. No cases regarding the practice under the law have ever been brought to trial. Article 6 of the Guinean Constitution, which outlaws cruel and inhumane treatment, could be interpreted to include these practices, should a case be brought to the Supreme Court. A member of the Guinean Supreme Court is working with a local NGO on inserting a clause into the Guinean Constitution specifically prohibiting these practices.

Nigeria (25.1% prevalence, Type I, II and III)

There is no federal law banning the practice of FGC in Nigeria. Opponents of these practices rely on Section 34(1)(a) of the 1999 Constitution of the Federal Republic of Nigeria that states "no person shall be subjected to torture or inhuman or degrading treatment" as the basis for banning the practice nationwide. A member of the House of Representatives has drafted a bill, not yet in committee, to outlaw this practice.

Senegal (5-20% prevalence, Type II and III)

A law that was passed in January 1999 makes FGC illegal in Senegal. President Diouf had appealed for an end to this practice and for legislation outlawing it. The law modifies the Penal Code to make this practice a criminal act, punishable by a sentence of one to five years in prison. A spokesperson for the human rights group RADDHO (The African Assembly for the Defense of Human Rights) noted in the local press that "Adopting the law is not the end, as it will still need to be effectively enforced for women to benefit from it.

Sudan (91% prevalence, Type I,II and III)

Currently there is no law forbidding FGC, although Sudan was the first country to outlaw it in 1946, under the British. Type III was prohibited under the 1925 Penal Code, with less severe forms allowed. Outreach groups have been trying to eradicate the practice for 50 years, working with NGO's, religious groups, the government, the media and medical practitioners. Arrests have been made but no further action seems to have taken place.

Tanzania (17.6% prevalence, Type II and III)

Section 169A of the Sexual Offences Special Provisions Act of 1998 prohibits FGC. Punishment is imprisonment of from five to fifteen years or a fine not exceeding 300,000 shillings (approximately US$380) or both. There have been some arrests under this legislation, but no reports of prosecutions yet.

Togo (12% prevalence, Type II)

On October 30, 1998, the National Assembly unanimously voted to outlaw the practice of FGC. Penalties under the law can include a prison term of two months to ten years and a fine of 100,000 francs to one million francs (approximately US$160 to 1,600). A person who had knowledge that the procedure was going to take place and failed to inform public authorities can be punished with one month to one year imprisonment or a fine of from 20,000 to 500,000 francs (approximately US$32 to 800).

Uganda (<5% prevalence, Type I and II)

There is no law against the practice of FGC in Uganda. In 1996, however, a court intervened to prevent the performance of this procedure under Section 8 of the Children Statute, enacted that year, that makes it unlawful to subject a child to social or customary practices that are harmful to the child's health.

Asia

Indonesia (No national prevalence figures avail., Type I and IV)

Officials are preparing to release a decree banning doctors and paramedics from performing FGC. Azrul Azwar, the director general of community health, stated that, "All government health facilities will also be instructed to spread information about the decision as well as the redundancy of female circumcision."^[87]

Other regions

Several countries outside areas where FGC is traditionally performed have laws banning the practice.

Australia

In 1994 there were several anecdotal reports of FGC being practised amongst migrant communities in Australia.^[88] By 1997, all Australian states and territories had made FGC a specific criminal offence. It is also a criminal offence to take, or propose to take, a child outside Australia to have a FGC procedure performed.^[89] The incidence of FGC in Australia is unknown as it is unreported to authorities and is often only uncovered when women and girls are taken to hospital due to complications with the procedure.^[90]

Canada

FGC is considered child assault and prohibited under sections 267 (assault causing bodily harm) or 268 (aggravated assault, including wounding, maiming, disfiguring) of the Criminal Code.^[91]

New Zealand

Under a 1995 amendment to the Crimes Act, it is illegal to perform "any medical or surgical procedure or mutilation of the vagina or clitoris of any person" for reasons of "culture, religion, custom or practice". It is also illegal to send or make any arrangement for a child to be sent out of New Zealand for FGC to be performed, assist or encourage any person in New Zealand to perform FGC on a New Zealand citizen or resident outside New Zealand convince or encourage any other New Zealand citizen or resident to go outside New Zealand to have FGC performed.^[92]

United Kingdom

FGC has been a specific criminal offence since the Prohibition of Female Circumcision Act was passed in 1985. This was was superseded by the Female Genital Mutilation Act 2003. The Scottish Parliament also passed the Prohibition Of Female Genital Mutilation (Scotland) Act in 2005.

United States

Federal law prohibiting FGC was enacted in 1996. 17 states enacted similar laws between 1994 and 2006.

See also

• Breast ironing - a practice of flattening the breasts of girls
• Circumcision
• Foot binding - an old, primarily Chinese, practice of constricting feet
• Labiaplasty - a recently developed cosmetic practice
• Vulvectomy

References

Further reading

Bibliography

• Al-Qaradawi, Y. (2004, February 7). Islamic ruling on female circumcision. Retrieved March 29, 2006.
• Al-Qaradawi, Y. (2004, December 13). Circumcision: Juristic, medical & social perspectives. Retrieved March 29, 2006.
• Boyle, E. H. (2002). Female genital cutting: Cultural conflict in the global community. Baltimore: Johns Hopkins University Press. ISBN 978-0-8018-7063-7.
• Dettwyler, Katherine A. (1994). Dancing skeletons: life and death in West Africa. Prospect Heights, Ill.: Waveland Press. ISBN 0-88133-748-X.
• Ferguson, I and Ellis, P. (1995). Female Genital Mutilation: a Review of the Current Literature Department of Justice, Canada. Working document
• Gruenbaum, E. (2001). The female circumcision controversy. Philadelphia: University of Pennsylvania Press. ISBN 978-0-8122-1746-9.
• Hoffman, B. (2002). Womanhood and Circumcision: Three Maasai women have their say. Berkeley: Berkeley Media.
• Hrzán, Daniela. (Re)Discovering FGC: Anthropology, Whiteness, Feminism. In: Tißberger, Martina/ Dietze, Gabriele/ Hrzán, Daniela/ Husmann-Kastein, Jana (eds.). Weiß – Weißsein – Whiteness: Kritische Studien zu Gender und Rassismus/Critical Studies on Gender and Racism. Frankfurt/Main: Peter Lang, 2006, pp. 113-142.
• Johnson, Michelle C. (2000). Becoming a Muslim, Becoming a person: Female 'circumcision', religious identity, and personhood in Guinea-Bissau. In B. Shell-Duncan & Y. Herlund (Eds.), Female circumcision in Africa: Culture, controversy, and change. Boulder: Lynne Rienner Publishers.
• Kandela, P. (1995, January). Egypt sees U turn on female circumcision. British Medical Journal, 310, 12.
• Kassindja, F. (1998). Do they hear you when you cry. New York: Delacorte Press. ISBN 0-38531-832-4.
• Obermeyer, Carla Makhlouf (2003). The health consequences of female circumcision: Science, advocacy, and standards of evidence. Medical Anthropology Quarterly, 17(3), 394-412. PMID 12974204. doi:10.1525/maq.2003.17.3.394
• Pieters, G., & Lowenfels A. B. (1977). Infibulation in the horn of Africa. New York State Journal of Medicine, 77(5), 729-31. PMID 265433.
• Research papers from medical gynecologists, judges, linguistics, and social scientists on the subject (1994). University of Khartoum, Sudan. Umm Atteya Organization website (Arabic). Retrieved March 29, 2006.
• UNICEF (1999). Consultation on the elimination of female genital mutilation: 14 December-16 December 1998. New York: Author. 40 pp.
• World Health Organization. (1996). Female genital mutilation: Report of a WHO Technical Working Group (unpublished document WHO/FRH/WHD/96.10). Geneva: World Health Organization. Retrieved 2007-02-21.

Print

• Aldeeb, Sami (2000). Male and Female Circumcision in the Jewish, Christian and Muslim Communities, Religious debate. Beirut, ISBN 1855134063.
• Daw, E. (1970). Female circumcision and infibulation complicating delivery. Practitioner, 204(222), 559-63. PubMed.
• Dewhurst, C.J., & Michelson, A. (1964). Infibulation complicating pregnancy. British Medical Journal, 2(5422), 1442. PubMed.
• Dirie, Waris (2001). Desert Flower. Autobiography of a Somali woman's journey from nomadic tribal life to a career as a fashion model in London and to the post of special ambassador at the United Nations. Dirie recounts her personal experience with female genital mutilation that began with circumcision at age five.
• Hrzán, Daniela (2006). (Re)Discovering FGC: Anthropology, Whiteness, Feminism. In: Tißberger, Martina/ Dietze, Gabriele/ Hrzán, Daniela/ Husmann-Kastein, Jana (eds.). Weiß – Weißsein – Whiteness: Kritische Studien zu Gender und Rassismus/Critical Studies on Gender and Racism, pp. 113-142. Frankfurt/Main: Peter Lang.
• Leonard, Lori (2000). We did it for pleasure only: Hearing alternative tales of female circumcision. Qualitative Inquiry, 6(2), 212-228.
• Mernissi, Fatima. Beyond the veil: Male-female dynamics in a modern Muslim society. Cambridge, MA: Schenkman Pub. Co. ISBN 0-470-59613-9.
• Mustafa, Asim Zaki (1966). Female circumcision and infibulation in the Sudan. Journal of Obstetrics and Gynaecology of the British Commonwealth, 73(2), 302–306. doi:10.1111/j.1471-0528.1966.tb05163.x.
• Robinett, Patricia (2006). The rape of innocence: One woman's story of female genital mutilation in the USA. N.p.: Aesculapius Press. ISBN 1-878411-04-7.

External links

• ReligiousTolerance.org: Debates about FGM in Africa, the Middle East & Far East
• U.S. State Department estimates of prevalence of FGC in Africa
• World Health Organization: Female genital mutilation
• Columbia University: Circumcised clitoris (Female 'circumcision')?

Urogenital surgical and other procedures (ICD-9-CM V3 55-71) Urinary system kidney: Nephrostomy - Nephrectomy - Kidney transplantation - Nephropexy ureter: Ureteroscopy - Ureterostomy - Urinary diversion - Ureterosigmoidostomy urinary bladder: Cystoscopy - Cystometry - Cystectomy (Suprapubic cystostomy) Reproductive system - male prostate: Prostatectomy (Transurethral resection of the prostate) vas deferens: Vasectomy - Vasovasostomy penis: Circumcision - Penectomy - Penile prosthesis - Preputioplasty testes: Castration (Inguinal orchiectomy) Reproductive system - female (gynecological surgery) ovary: Oophorectomy fallopian tubes: Tubal ligation - Salpingectomy uterus: Hysterotomy - Hysteroscopy - Pelvic exenteration - Hysterectomy - Vacuum aspiration vagina: Colposcopy - Culdocentesis - Hymenotomy - Vaginectomy vulva: Female genital cutting - Vulvectomy