What is female circumcision?

Indications and Procedures

The various forms of female circumcision and female genital mutilation, although not universal to all cultures, have been practiced in numerous societies of the world for nearly two thousand years. Recorded evidence cites that female circumcision predates the advent of both Christianity and Islam and that early Christians, Muslims, and the Jewish group Falashas practiced circumcision on young girls. Historically, during the nineteenth century and until the 1940s, clitoridectomies were performed in Europe and America as a procedure to “cure” female masturbation, nervousness, and other specific types of perceived psychological dysfunction.

The 1989–1990 Demographic Health Survey of Circumcision stated that circumcision is still performed annually on an estimated 80 to 114 million women; 85 percent of these procedures involve clitoridectomy, while approximately 15 percent involve infibulation. Infibulation, or pharaonic circumcision, is the removal of the clitoris, the labia minora, and much of the labia majora; on occasion, the remaining sides of the vulva are stitched together to close up the vagina, except for a small opening maintained for the passage of blood and urine.

Certain contemporary cultures of Africa, the Middle East, and parts of Yemen, India, and Malaysia continue these practices. Contemporary Middle Eastern countries practicing female circumcision and genital mutilation are Jordan, Iraq, Yemen, Syria, and southern Algeria. In Africa, it is practiced in the majority of the countries, including Egypt, the Ivory Coast, Kenya, Mali, Mozambique, Sudan, and Upper Volta. It has been estimated that 99 percent of northern Sudanese women aged fifteen to forty-nine are circumcised. In and around Alexandria, Egypt, 99 percent of rural and lower-income urban women are circumcised. The World Health Organization estimates that as of 2013, approximately 140 million women worldwide have been circumsized during their childhood, with 101 million of these women in Africa.

Cross-culturally, there are essentially four types of female genital circumcision and female genital mutilation. Circumcision, or sunna circumcision, is removal of the prepuce or hood of the clitoris, with the body of the clitoris remaining intact. Sunna means “tradition” in Arabic. Excision circumcision, or clitoridectomy, is the removal of the entire clitoris (both prepuce and glans) and all or part of the adjacent labia majora and the labia minora. Intermediate circumcision is the removal of the clitoris, all or part of the labia minora, and sometimes part of the labia majora.

All types of female genital mutilation frequently may create severe, long-term effects, such as pelvic infections that usually lead to infertility, chronic recurrent urinary tract infections, painful intercourse, obstetrical complications, and in some cases, surgically induced scars that can cause tearing of the tissue and even hemorrhaging during childbirth
. In fact, it is not unusual for women who have been infibulated to require surgical enlargement of the vagina on their wedding night or when delivering children. Unfortunately, babies born to infibulated women may frequently suffer brain damage because of oxygen deprivation (hypoxia) caused by a prolonged and obstructed delivery. Babies may die during the painful birthing process because of a damaged birth canal. Other physical and psychological difficulties for the circumcised woman may be sexual dysfunction, delayed menarche, and genital malformation.

From a cultural perspective, there are numerous reasons or justifications given for these procedures. They are often described as rites of passage and proof of adulthood, and it is often argued that the procedures raise a woman’s status in her community, because of both the added purity that circumcision brings and the bravery that initiates are called upon to demonstrate. The procedure also is believed to confer maturity and inculcate positive character traits, such as the ability to endure pain and to be submissive. In some cultures, the circumcision ritual is considered to be positive because the girl is the center of attention. She receives presents and moral instruction from her elders, creating a bond between the generations, as all women in the society must undergo the procedure; they thus share an important experience.

Furthermore, it is thought that a girl who has been circumcised will not be troubled by lustful thoughts or sensations or by physical temptations such as masturbation. Therefore, there is less risk of premarital relationships that can end in the stigma and social difficulties of illegitimate birth. The bond between husband and wife may be closer because one or both of them will never have had sex with anyone else. The relationship may be motivated by love rather than lust because there will be no physical drive for the wife, only an emotional one. There is little incentive for extramarital sex for the wife; hence, the marriage may be more secure. Children may be better cared for because the husband can be more confident that he is their father. Generally, a girl who is not circumcised is considered unclean by local villagers and therefore unmarriageable. In some societies, a girl who is not circumcised is believed to be dangerous, even deadly, if her clitoris touches a man’s penis.

All of these arguments for female genital mutilation and female circumcision must be weighed against the pain and terror, the lack of consent, and the subjugation of girls and women that is inherent in the practice. The practice must also be weighed against the medical risks.

Female genital circumcision and female genital mutilation surgeries are invariably conducted in unsanitary conditions in which a midwife or close female relative uses unsterile sharp instruments, such as pieces of glass, razor blades, kitchen knives, or scissors. The induction of tetanus, septicemia, hemorrhaging, and even shock are not uncommon. Human immunodeficiency virus (HIV) can be transmitted. No anesthesia is used. These procedures usually are experienced by the girl at approximately three years of age, although the actual age depends upon the customs of the particular society or village. To minimize the risk of the transmission of viruses, countries such as Egypt have made it illegal for female genital mutilation to be practiced by anyone other than trained doctors and nurses in hospitals.

Treatment and Therapy

There is no information regarding the surgical restoration of severed or damaged genitals. Because of severe cultural sanctions by the participating groups, which continue to hold tenaciously to such practices, female genital circumcision is seldom discussed with outsiders. Those who follow these customs do not report their occurrence. Consequently, there are few data concerning the frequency of female genital circumcision and female genital mutilation within the United States, despite the knowledge that some immigrant groups from Africa, the Middle East, and Asia continue to practice these surgeries. Health care workers estimate that, within the United States, approximately ten thousand girls undergo these surgical procedures each year. Usually, the procedure is conducted in the home. Those who can pay physicians to perform the surgery may do so; in these cases, local anesthesia is used and the risk of infection is less.

Perspective and Prospects

Because of the high number of female genital mutilations and the deaths that this procedure has caused, it is now prohibited in some communities in the United States, Great Britain, France, Sweden, and Switzerland, and in some countries of Africa, such as Egypt, Kenya, and Senegal. The National Organization of Circumcision Information Resource Centers (NOCIRC) is opposed to the procedures, as well as to male circumcision. The United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) consider female genital mutilation to be a violation of human rights and recommend its eradication. In the United States, former representative Patricia Schroeder had introduced a bill that would outlaw female genital mutilation. The bill, called the Federal Prohibition of Female Genital Mutilation Act of 1995, was passed in 1996. The Canadian Criminal Code was enacted to protect children who are ordinarily residents in Canada from being removed from the country and subjected to female genital mutilation.

Both female genital circumcision and female genital mutilation perpetuate customs that seek to control female bodies and sexuality. It is hoped that with increasing legislation and attitude changes regarding bioethical issues, fewer girls and young women will undergo these mutilating surgical procedures. One problem in this campaign is the conflict between cultural self-determination and basic human rights. Feminists, physicians, and ethicists must work respectfully with, and not independently of, local resources for cultural self-examination and change.

Bibliography

Bacquet-Walsh, Caroline. "Female Genital Cutting Fact Sheet." WomensHealth.gov, Dec. 15, 2009.

Benedek, Wolfgang, et al., eds. The Human Rights of Women: International Instruments and African Experiences. London: Zed, 2002.

"Female Gential Mutilation/Cutting." UNICEF, May 15, 2013.

"Female Genital Mutilation." World Health Organization, Feb. 2013.

“Female Genital and Sexual Mutilation.” WIN News 26, no. 2 (Spring, 2000): 51–59.

Galanti, Geri-Ann. Caring for Patients from Different Cultures. 4th ed. Philadelphia: University of Pennsylvania Press, 2008.

Gruenbaum, Ellen. The Female Circumcision Controversy: An Anthropological Perspective. Philadelphia: University of Pennsylvania Press, 2001.

James, Stanlie M., and Claire C. Robertson, eds. Genital Cutting and Transnational Sisterhood: Disputing U.S. Polemics. Urbana: University of Illinois Press, 2002.

Larsen, Ulla, and Sharon Yan. “Does Female Circumcision Affect Infertility and Fertility? A Study of the Central African Republic, Cote d’Ivoire, and Tanzania.” Demography 37, no. 3 (August, 2000): 313–321.

Sarkis, Marianne. "Female Genital Cutting (FGC): An Introduction." Female Genital Cutting Education and Networking Project, 2003.

"Sexual Problems in Women." MedlinePlus, June 10, 2013.

Walker, Alice, and Pratibha Parmar. Warrior Marks: Female Genital Mutilation and the Sexual Blinding of Women. New York: Harcourt Brace, 1993.

Williams, Deanna Perez, William Acosta, and Herbert A. McPherson, Jr. “Female Genital Mutilation in the United States: Implications for Women’s Health.” American Journal of Health Studies 15, no. 1 (1999): 47–52.