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.
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.
Several dictionaries, including medical dictionaries, define the word circumcision as applicable to some procedures performed on females. 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' Shell-Duncan states that the term female circumcision is a euphemism for a variety of procedures for altering the female genitalia. 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. 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.
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".
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. 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".
FGC consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away.
The WHO uses the term Female Genital Mutilation, and classifies FGM into four major types (see Diagram 1), although there is some debate as to whether all common forms of FGC fit into these four categories, as well as issues with the reliability of reported data.
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.
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.
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."
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.
Whilst FGC 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 FGC is usually performed, often referred to as Sunna circumcision especially among Arabs (ethnic groups of African descent are more likely to prefer infibulation). The practice occurs particularly in northern Saudi Arabia, southern Jordan, and Iraq. In the Iraqi village of Hasira, a recent study found that 60 percent of the women and girls reported having undergone FGC. Before the study, there had been no solid proof of the prevalence of the practice. There is also circumstantial evidence to suggest that FGC is practiced in Syria, western Iran, and southern Turkey. In Oman, a few communities still practice FGC; 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 and very rarely in India (Dawoodi Bohra community). 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.
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 FGC whilst on vacation in their home countries. As Western governments become more aware of FGC, legislation has come into effect in many countries to make the practice of FGC a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter.
Although FGC is practiced within particular religious subcultures, FGC transcends religion as it is primarily a cultural practice. UNICEF stated that when "looking at religion independently, it is not possible to establish a general association with FGM/C status. The arguments used to justify FGC vary; they range from health-related to social benefits:
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. 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.
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".
C.F. McDonald wrote in a 1958 paper titled "Circumcision of the Female "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.
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 and other advocators 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, 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. 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. However there is debate as to whether or not FGC constitutes a religious practice in particular religious subcultures.
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." 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. 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." [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. Both Christian and Muslim leaders have publicly denounced the practice of FGC since 1998. 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. 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.
One of the four Sunni schools of religious law, the Shafi'i school, rules that trimming of the clitoral hood is mandatory. 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. In 1994, Egyptian Mufti Sheikh Jad Al-Hâqq argued that the procedure may not be banned simply on grounds of improper use. Al-Azhar University in Cairo has issued several fatwas endorsing FGC, in 1949, 1951 and 1981.
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...
A June 2006 study by the WHO has cast doubt on the safety of genital cutting of any kind. 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.
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.
A study in 2007 found that in some infibulated women, some erectile tissue fundamental to producing pleasure had not been completely excised. 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' and for the women she interviewed, it is a source of empowerment and strength".
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, 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. 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. 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. 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.
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