Female circumcision

Circumcision of  females: cultural and medical rationales

female circumcision

Most societies that practise circumcision of boys as a religious or customary rite also practice circumcision of girls or women, also known as female genital mutilation or female genital cutting. Like its male counterpart, circumcision of females has two histories. First it is a ritual or customary practice among tribal societies (mostly in Africa) and some Islamic communities. Secondly it is a medical intervention, justified by Victorian (and, in the USA, some twentieth century) doctors in exactly the same way as they rationalised circumcision of boys: to deter masturbation, to treat obscure nervous disorders such as hysteria, neurasthenia and epilepsy, and thereby to promote health.

MGM and FGM

Given the similarities between the male and female genitals, the nature of the surgery and the justifications offered, it is surprising that male and female circumcision enjoy such strikingly different reputations, at least in Anglophone societies: the first, a mild and harmless adjustment which should be tolerated, if not actively promoted; the second, a cruel abomination which must be stopped by law, no matter how culturally significant to its practitioners. If you call circumcision of boys male genital mutilation, you are accused of emotionalism; if you fail to call circumcision of women or girls female genital mutilation you are accused of trivialising the offence. While the United Nations, Amnesty International and other international agencies spend millions on programs to eradicate FGM, they have never uttered a word against circumcision of boys.

It might be thought that the reason for this double standard lies in the greater physical severity of female circumcision, but this is to confuse cause with effect. On the contrary, it is the tolerant or positive attitude towards male circumcision and the rarity of female circumcision in western societies which promote the illusion that the operation is necessarily more sexually disabling, and without benefit to health, when performed on girls or women. It is, of course, also true that the term female circumcision is vague, referring to any one or more of a number of surgical procedures. These have been defined by the World Health Organisation as follows:

Female Genital Mutilation comprises all procedures that involve partial or total removal of female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reason.

Classification

Type 1:

Excision of the prepuce with or without excision of part or all of the clitoris Type

Type 2:

Excision of the clitoris together with partial or total excision of the labia minora Type

Type 3:

Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)

Type 4:

Unclassified (but may include):

  • pricking, piercing or incision of the clitoris and/or labia;
  • stretching of the clitoris and/or labia;
  • cauterization by burning of the clitoris and surrounding tissue;
  • introcision; scraping (angurya cuts) or cutting (gishri cuts) of the vagina or surrounding tissue;
  • introduction of corrosive substances or herbs into the vagina;
  • any other procedure that falls under the definition of female genital mutilation given above.
Source:

Female Genital Mutilation: Report of a WHO Technical Working Group, Geneva, July 1995. (World Health Organization: Geneva, 1996)

The severity of female circumcision depends on which of these operations are performed (as well as how roughly), and it is true that the most extreme forms (involving the amputation of the external genitalia, with or without infibulation) are significantly worse than even the most radical foreskin amputation. But it should be remembered that the most extreme forms of FGM are rare, and that male circumcision in general is far more common on a world scale than female: about 13 million boys, compared with two million girls annually. [1] On top of this, it should be appreciated that the effects of male circumcision are also highly unpredictable, depending on how much penile tissue is removed, on the skill of the surgeon, on the precise configuration of penile blood vessels and nerve networks, and on the eventual size attained by the penis at puberty and maturity. The more tissue excised, the greater the damage to the penis, the greater the effect on sexual functioning and capability; the same quantity of tissue lost will be worse in cases where the penis is programmed to grow larger in maturity, or where the location of blood vessels and nerves (always variable) means that important connections are severed. Because the slack tissue is needed to accommodate the enlarged penis when tumescent, a really severe circumcision will make erections painful or even impossible. [2]

Further discussion of classification of male and female genital mutilation

Further discusson of this issue at Hstory of Circumcision.

Given the respective numbers of victims involved and the fact that some circumcisions are worse than some instances of FGM, there is no justification for perpetuating the gender discrimination which has characterised discussion of these issues. Indeed, a female victim of circumcision during a "holy war" by Islamic extremists in Indonesia recently commented afterwards that what was done to the men was worse than what the women suffered: "I know the men suffered more than us women. The circumcision hurt them more that it did to us because their scars could not heal fast. Several of the men I knew got serious infections after suffering from severe bleeding." (See Christina's story.)

To compare female and male circumcision is not to trivialize the enormity of the first, as some feminists seem to fear, but to recognise that the physical and moral similarities between the two are very real. (See the insightful analysis by R. Charli Carpenter.) Since many of them come from countries where male circumcision is tolerated or even the norm, such as the USA, campaigners against FGM are inclined to stress how much worse it is than male circumcision, and in the process they tend to excuse or even affirm the latter. Although they do not realise it, in this manoeuvre they are treading directly in the footsteps of the opponents of Isaac Baker Brown, the mid-Victorian exponent of clitoridectomy as a cure for masturbation and nervous complaints. They could not disagree with Brown that masturbation was an evil that had to be stamped out; indeed, the man who brought him down actually wrote: "If the habit [masturbation] could be overcome, if the mind could be restored to its purity by any mutilation of the person, one would feel that no penalty would be too great to pay for such a boon." Nor did they question the emerging consensus that circumcision of boys was desirable for reasons of health and morality. They thus found it necessary to quarantine the case against clitoridectomy from the case for circumcision, playing up the harm of the former while minimising the impact of the latter; the result was a double standard on genital alteration that has endured to this day. (See the editorial, Clitoridectomy and medical ethics.)

Where does female circumcision occur?

Various forms of female genital cutting are common in the Middle East, northern and western Africa, and among Muslim communities in Malayasia and Indonesia. In Africa, the operations are usually performed as part of adult initiation rites among tribal groups that also practise circumcision of boys for the same reason. There is some debate as to which came first, but one thing is pretty clear: there are some tribal and religious groups that practise male circumcision but not female, but none that practise female circumcision but not male. All the groupings that practise female circumcision also practise male circumcision.

The following map shows the distribution of female genital cutting in Africa today - generally the parts of Arica closest to and most influenced by the Arab and Muslim cultures of the Middle East.

Anthropological explanations

Unlike male circumcision, which was familiar from Jewish practice, female circumcision was an exotic custom about which Europeans knew very little until the explorations of the eighteenth century. Because the phenomenon was first studied by sceptical anthropologists and naturalists who had little regard for religion, there was no attempt to explain female circumcision in religious terms as a divine command or a ritual requirement; on the contrary, from the very first, explanations for such a bizarre and horrific mutilation were sought in materialist terms, particularly in relation to some possible advantage to human health in peculiar physical environments.

The most popular explanation was that the hot climate of Egypt and Africa caused the labia and clitoris to grow to an inordinate length, thus necessitating their reduction or removal in order to permit intercourse. While the French traveller C.S. Sonnini explained male circumcision in Egypt purely as an initiation into the Mahometan religion, he accounted for the female operation in terms of the hypertrophy of the parts allegedly common in hot regions, and the consequent need to avoid both reproductive difficulties and the disgust of the husband. [3] The great French naturalist Georges-Louis de Buffon, in his Natural History, also offered the climatic explanation for male circumcision among the Jews and Arabs: in the heat of the desert the foreskin grew so long that it hindered procreation. [4] Rumours about the "Hottentot apron", the supposedly hypertrophic labia found among "Hottentot" women, fed these speculations, which were further stimulated by the public exhibition of one unfortunate native in London and Paris in 1810. [5] Variants of these stories filtered through the nineteenth century medical world and often turned up as "well known facts" in journal articles.

Other explanations for female circumcision stressed protection against disease or parasites, and one reported by John Davenport cited the necessity to prevent the accumulation of secretions and smegma:

Cleanliness has rendered it necessary. In some climates the nymphae, from their great length, become inconvenient, for in the vicinity of the clitoris of women is collected an acrid and stimulating humour called smegma (from its resemblance to soap), and this secretion is partly covered by the nymphae. This white saponaceous and almost foetid substance is one of the most powerful stimuli of the sexual organ. Thus, such persons as observe great cleanliness are generally less given to venery than those who are negligent in this respect. In cold or even temperate regions this secretion becomes less abundant, and, as it is consequently less active in its effects, the sexual organs are more quiescent than in southern regions. [6]

Similar comments were made by Dr Kellogg in the 1880s.

In some countries females are also circumcised by removal of the nymphae [i.e. the labia]. The object is the same as that of circumcision in the male. The same evils result from inattention to personal cleanliness, and the same measure of prevention, daily cleansing, is necessitated by a similar secretion. Local cleanliness is neglected by both sexes. Daily washing should begin with infancy, and continue through life, and will prevent much disease. [7]

It is an interesting comment on changed attitude to both cleanliness and sexuality that in the late twentieth century the smell of smegma was regarded not as a stimulant, but as a sexual turn-off, at least by such luminaries as Morris Fishbein and David Reuben - who seem, however, to be so obsessed with imaginary male smells that they have completely forgotten that uncircumcised women also produce smegma. Off course, the mere possibility of the existence of smegma in males has been the basis of most justifications for routine circumcision, from Lallemand and William Acton to Gerald Weiss and Brian Morris.

There is now a vast literature and constant controversy over the history and current practice of female genital cutting (which now seems to be the preferred term). What most anthropological sources agree on is that the cultural significance of female circumcision is usually the same as for male: it represents the transition from girlhood to womanhood, and the entry into a new set of adult rights and responsibilities, the most important of which relate to sexual relations, marriage and child-bearing. There is also wide agreement that circumcision was introduced to males first and only later extended to females, often in an attenuated form. [8] As the Encyclopaedia of Religion and Ethics put in 1910, female circumcision "evolved much later than male circumcision", of which it was "but a pale shadow"; Ernest Crawley (in The mystic rose, p. 138, 309) "is doubtless right in tracing it to the same origin as the analogous operation in the male". [9] It is a striking fact that while there are cultures which practise male but not female circumcision (most notably the Jewish), there are no societies which practise female but not male circumcision.

The medical or health case

Although the health advantages of or medical justifications for clitoridectomy were similar to those offered for male circumcision (cleanliness, deterrence of masturbation, control of nervous diseases) the practice remained rare in Britain and never became a routine precaution. Doctors generally held that women's lower sex drive meant they were less given to self abuse than males, and thus that drastic surgery was rarely necessary. There are occasional reports of masturbating girls being subjected to involuntary clitoridectomy, but it was only in the late 1850s that a few doctors started to apply to women the theories of nervous disease which already legitimised circumcision in boys.

Britain

The most famous of these was the prominent London obstetrician, Isaac Baker Brown, who specialised in the surgical treatment of disorders such as epilepsy, catalepsy and hysteria induced by "irritation of the pudic nerve" (that is, masturbation). Although he attracted considerable interest at first, his procedures fell rapidly into disfavour, and he was expelled from the London Obstetrical Society in 1867. While his critics condemned clitoridectomy as a "questionable, compromising, unpublishable mutilation" which would ruin the women's sex lives, leave them permanently maimed and cast an indelible slur on their honour, Brown defended himself by claiming that masturbation caused hysteria, epilepsy, mania, insanity and death, and argued that clitoridectomy was no more mutilating than male circumcision, as proved by the subsequent pregnancy of several of his patients. As he wrote in reply to his attackers:

Clitoridectomy is neither more nor less than circumcision of the female; and as certainly as that no man who has been circumcised has been injured in his natural functions, so it is equally certain that no woman who has undergone the operation... has lost one particle of the natural function of her organs. [10]

His critics did not dissent from the proposition that masturbation could provoke the ills he mentioned, but they insisted that the practice was so rare in women that radical interventions of this kind were not necessary.

Brown's disgrace put a stop to clitoridectomy in Britain, and there are no reliable reports of its performance after the 1860s. Looking back on the controversy, his principal antagonist, Charles West, commented that "all right-minded men" were compelled to reject both the operation and its leading proponent, but that "happily we need not now dwell further on the subject, for all practitioners are agreed that the only indication for removal of the clitoris is furnished by the disease of the organ itself". It was a long time before doctors reached the same conclusion about the foreskin. Since the debate had been fought largely on the question as to whether the clitoris was the functional equivalent of the foreskin, and thus whether clitoridectomy was the female version of circumcision (as Brown insisted and his opponents denied), the effect of the negative decision on these points was to clear the way for circumcision of boys at the same time as it protected the genitals of women. The outcome has been the tenacious double standard on genital mutilation which still dominates discussion of this subject.

Female circumcision in the USA

Clitoridectomy and other circumcision-like operation on girls and women had a longer career in United States, where doctors deplored Baker Brown's disgrace and The Medical Record defended him with the question "What now will be the chance for recovery for the poor epileptic female with a clitoris?" [11] There was also a vigorous attempt to apply the theories of Lewis Sayre - that many nervous diseases were caused by a tight or non-retractable foreskin - to women, and a number of doctors urged that girls also should have their clitoral hoods excised if there was any suspicion of adhesions of the accumulation of "secretions". In 1892 another defender of Brown (he was "almost on the right track"), Dr Robert Morris, went so far as to suggest that, since 80 per cent of American women suffered from preputial adhesions, all schoolgirls should be inspected to ensure that proper separation between prepuce and clitoris had occurred. He was apparently confident that most of the girls would require surgery, and added: "The separation of adhesive prepuces in young unmarried women should be done by female physicians anyway, and such physicians can be abundantly occupied with this sort of work". [12] It was a valiant effort to expand the market for medical services, and he must have been disappointed that his suggestions were not more widely taken up. Even so, articles on the virtues of female circumcision continued to appear sporadically in American medical journals until the 1960s, and there are regular reports of girls or women being subjected to various procedures, particularly the shortening of their labia or clitoris when parents or a husband judged them "too long" [13]. As with circumcision of boys, the medical case for female circumcision has always contained a strong element of cultural or aesthetic preference.

Notes:
  1. George C. Denniston, Frederick Hodges and Marylin Milos (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem (London and New York: Kluwer Academic and Plenum Press, 2001), Introduction, p. v
  2. As nineteenth century circumcisers such as Dr Spratling realised. See also Shane Peterson's account of his own terrible experiences.
  3. C.S. Sonnini, Travels in upper and lower Egypt, trans. Henry Hunter (3 vols, London: John Stockdale, 1799), Vol. 2, pp. 29-33
  4. Georges-Louis Leclerc, Comte de Buffon, Barr's Buffon: Buffon's natural history, Containing a theory of the earth, a general history of man, of the brute creation, and of vegetables, minerals etc, trans. from the French (10 vols, London, 1797), Vol. 4, p. 25
  5. The "Hottentots" were actually the Khoikhoi people of what are now Cape Province and Namibia, South Africa. They were a nomadic, pastoral people, related to the San, or Bushmen. See Stephen Jay Gould, "The Hottentot Venus", in The flamingo's smile: Reflections in natural history (Penguin 1986)
  6. John Davenport, "Circumcision", in Aphrodisiacs and love stimulants, with other chapters on the secrets of Venus, edited by Alan Hull Watson (New York: Lyle Stuart, 1966), p. 189. John Davenport (1789-1877) was an unsuccessful businessman and amateur scholar of erotic subjects. Publication of his books, originally entitled Aphrodisiacs and anti-aphrodisiacs and Curiositates eroticae physiologiae, or Tabooed subjects freely treated, was financed by Henry Spencer Ashbee. See Ian Gibson, The erotomaniac: The secret life of Henry Spencer Ashbee (New York: Da Capo Press, 2001), pp. 24 and 54.
  7. J.H. Kellogg, Plain facts for young and old: Embracing the natural history of hygiene and organic life, 2nd edition, Burlington (Iowa), 1888, facsimile reprint (New York: Arno, 1974), pp. 106-7
  8. In his study of circumcision rituals among the Kuguru people of central Tanzania, T.O. Beidelman notes the mildness of contemporary female circumcision practices (usually no more than a nick on part of the vulva) compared with the severity of the procedure on boys - amputation of the entire foreskin. His impression was that the female version used to be more radical. See The cool knife: Imagery of gender, sexuality and moral education in Kuguru initiation ritual (Washington: Smithsonian Institution, 1997), p. 167
  9. Encyclopaedia of Religion and Ethics, ed. James Hastings (Edinburgh: T. & T. Clark, 1910), Vol. 3, p. 669
  10. "Replies to the remarks of the Council", Medical Times and Gazette, 13 April 1867, p. 391
  11. "Clitoridectomy" (Editorial), Medical Record, Vol 2, 1867, p. 71; cited in Frederick Hodges, "A short history of the institutionalization of involuntary sexual mutilation in the United States", in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York: Plenum Press, 1997), p. 21
  12. Robert T. Morris MD, "Is evolution trying to do away with the clitoris?", Transactions of the American Association of Obstetricians and Gynecologists, Vol. 5, 1892, pp. 288, 293
  13. Patricia Robinett, The Rape of Innocence: One Woman’s Story of Female Genital Mutilation in the U.S.A. (Eugene, OR: Aesculapius Press, 2006.)

News about female circumcision (Female Genital Mutilation)

Australia: Rising demand for female circumcision

An article in the February edition the Medical Journal of Australia warns against the rising demand for female circumcision. The article, by law professor Dr Ben Mathews, calls for increased protection of girls and women from this danger. The demand is generated by recent immigrants from Middle Eastern and African countries where circumcision of girls and boys is a common customary or cultural practice. As more immigrants arrive from these places, the demand for circumcision of young girls is rising along with the demand for circumcision of young boys. Female circumcision (also known as Female Genital Mutilation (FGM) or female genital cutting) refers to a wide range of procedures in which parts of the external female genitalia are cut off to satisfy culturally determined requirements of chastity, cleanliness, and aesthetics. FGM is often practiced in poor sanitary conditions, leading to significant complications.

Dr. Mathews writes in response to last year’s controversy over suggestions that the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) might consider the legalisation of so-called "ritual nicking." Considerably less harmful than male circumcision, "ritual nicking" is the practice of scratching the clitoris and extracting a drop of blood in order to satisfy cultural adherents of female circumcision.

In April 2010 the American Academy of Pediatrics (AAP) briefly adopted a policy endorsing the practice of "ritual nicking”, and it was their policy change that led the RANZCOG to consider the issue. The AAP policy recommendation was reversed and the old policy (complete opposition to any form of FGM) restored after widespread outrage from human rights organizations, including Equality Now and Intact America, an organization that also campaigns against male circumcision.

Legal Protection

FGM is legally prohibited in many countries worldwide, including some 16 African countries where it is customary, though in many cases the law makes no difference to local practice. Current human rights statutes protecting girls and women from FGM include the Protocol of the Rights of Women in Africa, the Convention on the Elimination of All Forms of Discrimination against Women, the African Charter on Human and Peoples' Rights, and the United Nations Conventions on the Rights of the Child. The language of the second two of these documents are gender neutral: although the provisions relating to genital integrity have generally been interpreted as applying only to females, the actual words of the text give just as much protection to males.

Any form of FGM is specifically prohibited in most Australian states (usually by provisions in the state crimes act), but in addition to this children in general are currently protected from genital cutting under Australian law:

  • It is illegal to infringe upon a person's right to bodily integrity.
  • Courts have authority over parents who do not act in the child's "best interests."
  • Non-therapeutic operations on children require the consent of the family court.
  • Where parents disagree as to whether a boy should be circumcised, the consent of the family court is required.
  • Parents do not have the right to perform any treatments without a child's consent once the child reaches "sufficient understanding and intelligence."

Dr. Mathews stands behind the legal prohibition of all forms of FGM, which currently outlaw even consensual procedures on adults. There are many justifications for these strict legal protections, he writes, based on the following findings:

  • Like male circumcision, FGM predates the Koran and the Bible, and is therefore a cultural more than a religious practice.
  • FGM is a form of direct social control on females' bodies and sexuality.
  • Victims of FGM have a high risk of infection, haemorrhage, and even death.
  • FGM causes complications for intercourse, childbirth, menstruation, including recurrent infections, chronic pain, and perinatal death
  • Infibulation (or FGM type III, the most severe form of FGM, around 10% of all occurrences) requires re-incision for intercourse and childbirth, and includes a higher risk of fatalities during childbirth.
  • FGM causes severe psychological consequences comparable to rape, including post-traumatic stress disorder and a sense of violation.
  • FGM has significant effects on longevity.

Some commentators are in favour of permitting "ritual nicking" in a medical setting, believing it preferable to the risk of girls and women being taken abroad or to underground operators to have FGM performed in non-sterile conditions. Others believe that legalising "ritual nicking" is a shocking concession and the thin end of the proverbial wedge. "To sanction medically performed FGM would leave undisturbed the damaging assumptions motivating it, and would endorse the unjust attitudes to girls' and women's rights embodied in the practice," writes Dr. Mathews.

Recommendations

FGM presents practical challenges for medical practitioners, who must call upon relevant organizations in case they are asked to perform, treat, or give advice about FGM. Current Australian law requires doctors, nurses, school principals, and police officers to report each suspected instance of FGM. Dr. Mathews calls for more research on the incidence (annual rate) of FGM, and on evaluating strategies in Australia in response to the increasing cultural demand for FGM from communities of recent immigrants.

Ben Mathews, Female genital mutilation: Australian law, policy and practical challenges for doctors.  Med J Aust 2011; 194 (3): 139-141.

Ben Mathews, LLB, PhD, is an associate professor of law at the Queensland University of Technology, Brisbane, Queensland, Australia.

Source:  Adapted from “Australia sees rising demand for female genital mutilation”, Intact News, 12 September 2011

Further reading

Anthropology and ethics

Bettina Shell-Duncan and Ylva Hernlund (eds.), Female "Circumcision" in Africa: Culture, Controversy, and Change (Boulder, Colorado: Lynne Rienner Publishers, 2000)  Reviewed on this site

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

Both reviewed briefly by ARCLaw

Books on female genital mutilation reviewed on this site

Amnesty International
Amnesty International correctly defines female genital mutilation as the removal of any part of the female genitalia, by which definition the removal of any part of the male genitalia must similarly be defined as male genital mutilation. Yet Amnesty has been reluctant to take a stand against forcible male circumcision, and you will find nothing about it on their website.

Female Genital Mutilation Education and Networking Project

Forward (UK)

Hanny Lightfoot-Klein

Secret wounds
Prisoners of ritual: An odyssey into female genital circumcision in Africa
A woman's odyssey into Africa

All available directly from her website

FGM in Islam

Sami A. Aldeeb Abu-Sahlieh, "Jehovah, his cousin Allah and sexual mutilations", in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Available online from Nocirc USA

Dr Sami Aldeeb, "To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision", Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Available from CIRP

Christina's story of fundamentalist Islam in Aceh, Indonesia

On Baker Brown

J.B. Fleming, "Clitoridectomy: The disastrous downfall of Isaac Baker Brown FRCS (1867)", Journal of Obstetrics and Gynaecology of the British Empire, Vol. 67, 1960, pp. 1017-34

Ornella Moscucci, "Clitoridectomy, circumcision and the politics of sexual pleasure in mid-Victorian Britain", in Andrew H. Miller and James Eli Adams (eds), Sexualities in Victorian Britain (Bloomington: Indiana University Press, 1996)

Elizabeth A. Sheehan, "Victorian clitoridectomy: Isaac Baker Brown and his harmless operation", in Roger N. Lancaster and Micaela di Leonardo (eds), The gender/sexuality reader: Culture, history, political economy (London: Routledge, 1997)

Further information

Classification of male and female genital mutilation

History of Circumcision

Foreskin is a feminist issue: Why women should be concerned with male circumcision

Malaysian mother's blog about circumcision of her baby daughter

 

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