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It makes girls grow up craving men, horny, wild, and adulterous. If a baby touches it during the birthing process, he will die. If left intact, it will grow so big it will drag the ground. It will make women undesirable to potential husbands. Remove it to protect family honor. Remove it to cure epilepsy, lesbianism, masturbation, melancholia, and nymphomania. Remove it to liberate the female body from masculine properties. Remove it to give women power and strength. Remove it in the name of God. Perhaps as many as half of all women in Africa have had it removed. What is this mysterious it? It’s external female genitalia. What’s being done about it? Female genital mutilation. Clitoridectomy. Female circumcision. Infibulation. Cutting. Cauterization. Surgical modification of female genitalia. Female genital mutilation, or FGM, is a broad term that encompasses every form of surgical excision of female genitalia for reasons other than medical necessity, ranging in severity from partial removal of the clitoris to full excision of the vulva and sewing the raw edges together so that nothing remains except a small opening that, hopefully, allows passage of urine and menstrual flow. While it is important to understand there are no underlying medical conditions that dictate FGM and that it is a surgical procedure undertaken on a voluntary basis and usually without benefit of anesthesia, it is also important to understand that most patients are between the ages of three and eight, entirely too young to intelligently volunteer for such a dangerous, painful, and life-changing event. The people volunteering the child for the procedure are almost always the girl’s parents, grandparents, or other close adult relatives.
The World Health Organization (WHO) has identified four types of FGM, based on extent of surgery: Type I limits the procedure to removal of all or part of the clitoris (clitoridectomy) and may involve removing the clitoral hood as well. Type II FGM involves the clitoris but also includes the labia majora and/or minora. Type III is infibulation with excision, or pharaonic circumcision. All the external female genitalia is removed, from the pubis to the anus. After excision, the walls of flesh are sewn back together or “stapled” shut with thorns, leaving just a small opening, about the size of a pencil, for release of menstrual flow and urine. After surgery, the girl’s legs are usually tied together for a couple of months, to allow the raw flesh to heal. About 10% of all girls undergoing FGM have the Type III procedure. Type IV FGM encompasses all other forms of mutilation, sometimes in conjunction with Types I, II, or III. Some variations involve cauterization, piercing, scraping, and ripping the vagina. In spite of the extensive degree of surgical alteration the procedure involves, FGM is rarely conducted in a legally recognized, sterile medical facility. Indeed, it is outlawed in many of the countries where it is a common practice. Instead, the surgery is performed by a girl’s mother, grandmother, aunt, a midwife, or female village elder. In some cultures, men perform the surgery. Where professional cutters are employed, the cost per procedure is no more than a few dollars. Regardless of who is doing the surgery, anesthesia is as rare as a sterile environment. Instead of clean surgical instruments, cutters often use broken glass, blunt knives, razors, scissors, or tin can lids instead. The procedure is often performed as a group ritual, with many girls being cut at the same time, using the same tools that are not washed or sterilized from one girl to the next. Wounds are closed with thorns or the intestines of cats or lambs. Antibiotics are virtually nonexistent.
Female genital mutilation today is closely associated with the Islamic faith but there is historic evidence of it in both Christianity and Judaism, too. Its origin, however, is thought to be Egyptian. The earliest known documentation of the practice dates to 163 BC, when a description of the Egyptian procedure was written in Greek on papyrus. From this document, historians believe FGM was common in the Nile Valley during the time of the Pharaohs. Some critics of the procedure cite its ancient Egyptian origin as evidence that it is not sanctioned by any of the major religions practiced today in spite of the common belief that the Koran (Qur’an) advocates it. Some Koranic scholars find no specific mention of it in Muslim scripture but find, instead, the tenets that men should make every effort to ensure their wives enjoy lovemaking and that man is in no position to alter or adulterate any of God’s creations. There is no mention of female circumcision in the scriptures of other major world religions, either. Even though there is no specific mention of FGM in any major religious text, some scholars claim their interpretations of some of these scriptures not only suggest it, they require it. Even if the controversy of religious doctrine is removed from the equation, female genital mutilation is so deeply rooted in the culture and worship of so many peoples that they cannot separate their social rituals and traditions from the practice. It is just one of many customs that define and unite them as a people. While the custom may appear barbaric to outsiders, in many cultures it is an avidly awaited rite of passage. Girls look forward with eager anticipation to the cutting ceremony that will make them a woman. In an effort to avoid offending cultures that celebrate FGM as a positive event, WHO and other organizations generally refer to the practice as female genital cutting (FGC) or female genital mutilation/cutting (FGM/C). The thought is that the term cutting is less judgmental than the term mutilation.
In a growing number of nations, female genital mutilation is a criminal offense. Some countries consider it a sexual crime while others consider it child abuse; in all countries where it is outlawed, it is a crime of violence. In Africa, some parts of the Middle East, and other locales where the act is widespread, the cutting continues in spite of laws against it. Many laws against female genital mutilation/cutting were enacted only during the 1990s, as general public awareness grew. The global outcry against the practice makes it impossible to determine just exactly how prevalent the practice is in any given area, as practitioners, families, and victims all choose silence instead of stigma or persecution but it is widely accepted that the procedure is most common and most widely accepted by the indigenous population in Africa. In the northeastern region of Africa, in an area that includes Egypt, Sudan, Eritrea, Ethiopia, and Somalia, it is believed that as many as 95% to 100% of all females undergo genital mutilation. The practice is common in eastern African coastal countries as far south as Tanzania. From Ethiopia west to Senegal on the western Africa coastline, the peoples who routinely practice FGM span the continent like a band running east to west. The rate of prevalence here is not so high as in northeastern Africa but estimates suggest the FGM rate runs from 25% to 95% in these regions, although the practice in Mali is said to reach almost 100%. North of this band and south of it, FGM is not a widespread practice, isolated instead in smaller, localized communities and tribes. Female genital mutilation is also common among certain peoples inhabiting the Arabian peninsula and parts of the Middle East, especially where tribal peoples can trace their ancestry back to Africa. Of particular note is northern Saudi Arabia, Syria, southern Jordan, and the Kurdistan region of Iraq, where as many as 60% of the female population in some villages is thought to have undergone FGM. In other parts of the Middle East where FGM is noted, the practitioners are thought to be mainly foreign workers of East African nationality. In some rural communities in Indonesia, female genital mutilation is practiced but not to the extent it is practiced in Africa. In these peoples, the act is usually more symbolic than surgical and is usually no more invasive than pricking the genitalia just enough to draw blood. Some South American ethnic groups also practice FGM to some extent. In the Western industrialized world, the practice is less common but still done under clandestine circumstances. Before the medical and legal communities of Western countries accepted the on-going practice in their midst of FGM, it was thought to be an isolated tragedy when a victim was presented at a hospital needing emergency care after a cutting became dangerous. To maintain a veil of secrecy and eliminate the threat of criminal prosecution, many immigrant parents will send their daughters to their homeland for the FGM ritual or include the procedure as part of a family vacation back home.
In cultures where female genital mutilation/cutting is joyously celebrated, women tend to report positive results of the experience, including an enhanced sense of sexual arousal and satisfaction in marriage. In more oppressive cultures, the act can be violently frightening, unthinkably painful, and leave women in fear of both men and sex. Regardless of cultural mindset, the procedure can be the beginning of a lifetime of medical complications and can even result in immediate death. Perhaps the least traumatic of the negative outcomes associated with female genital mutilation is the absence of feeling in the genital area that leads to diminished libido and sexual pleasure. Generally, the more invasive the cutting, the less sensation but some women who’ve undergone infibulation that left the clitoris intact claim to have a perfectly pleasant sexual life that includes orgasm. Where infibulation is practiced, the flow of urine and menstrual fluids can become blocked by an opening too small to accommodate it, scar tissue that blocks it, or tumors and cysts that develop along the surgical site. Later, when a woman marries, it is often customary for the husband to use a special knife to ceremoniously open the infibulation incision to access his new bride’s vagina for consummation of the marriage. In some cultures, the newly opened incision must be sewn shut again should the husband travel for any length of time. This, of course, means he opens it once again each time he returns home and desires his wife’s sexual favors. Should pregnancy occur, the incision must be opened to allow childbirth, which is exceptionally painful. Each time the incision is opened or resewn, thicker and tougher scar tissue develops and the risk for infection, hemorrhage, and other medical complications is reintroduced. Even lesser types of FGM diminish sensation in the genital area but many girls never live through the cutting ordeal to worry about lost sensation. Too often, a girl dies from loss of blood, infection, or shock. Those that survive face a lifetime of urinary tract and pelvic inflammation and infection that can cause sterility. Scar tissue, medical complications, and psychological trauma cause so much pain and anguish that a pleasant sex life is impossible. Beginning immediately after cutting and throughout a woman’s life, she is at increased risk of developing tumors, cysts, abscesses, infections, and other medical complications that severely diminish her quality of life and can become life threatening at any time. Many women never recover from the psychological terror of the ordeal. Women are at an increased risk for infection from HIV and other sexually transmitted diseases (STDs) after undergoing FGM/C. Infection often starts at the time of the procedure, when unclean tools are used, especially in a group ritual setting where multiple girls are getting cut with the same tools that aren’t washed or sterilized between cuttings. This increased risk for HIV and other STDs carries through into adulthood and throughout the woman’s life. Women not rendered infertile due to the surgery or its complications face unthinkable pain during childbirth. Scar tissue from all types of FGM can obstruct the birth canal and prolong the labor process but infibulated women must also be cut open to allow passage of the baby. Perianal tears are common. A woman’s mutilation can have serious consequences to her newborn child, too. The baby is at risk of getting any HIV/STD infections its mother might have. When delivery is slowed due to scarring, cysts, tumors, and other vaginal obstructions caused by FGM, the baby suffers. One WHO study of 28 African obstetric centers found FGM increased the infant mortality rate dramatically: 15% for mothers who’d undergone Type I FGM, 32% if Type II, and 55% if Type III/infibulation had been performed. Mothers with Type III FGM were 30% more likely to need cesarean section deliveries and were 70% more likely to experience dangerous postpartum hemorrhaging than mothers with lesser or no FGM.
From the outside looking in, almost any cultural ritual can appear strange. Sometimes understanding is gained when the outsider learns the history and reasons behind the ritual, what makes it important, and how its practice evolved over time. With female genital mutilation, however, insight into the culture and the customs behind the practice don’t seem to be increasing mankind’s acceptance or understanding of the practice. In fact, as more and more people become aware of it, public outcry grows louder and more vigorous. A growing number of government and non-government agencies, nonprofit and humanitarian organizations, and multinational entities of various natures are working to eradicate the practice of female genital mutilation. Adding to the cause is an ever-expanding and outspoken grassroots movement working where larger entities cannot. Evidence exists that the practice is diminishing but it is still alarmingly widespread, endangering girls and women of all ages, in many areas. Some advocates of eradication fear the publicity is only driving the practice further underground.
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