Female Genital Cutting Martin Donohoe Female Genital Cutting

Female Genital Cutting Martin Donohoe

Female Genital Cutting n 200 million girls and women affected worldwide (3 million girls/year) n 30 countries n ½ in Egypt, Ethiopia, and Indonesia n Many in Africa (e. g. 98% of women in Somalia, 90% in Sudan, 27% in Kenya) n Outlawed in Egypt – 2007 (was 80%, still 70%) n 2016: 27 sub-Saharan countries have banned

Female Genital Cutting All socioeconomic strata and all major religions n Reasons: gender/cultural identity, hygiene, fertility, child survival, maintain virginity, enhance male sexual pleasure n Formerly used in U. S. and U. K. as treatment for hysteria (“floating womb”), epilepsy, melancholy, lesbianism, and excessive masturbation n

Female Genital Cutting n Has been called female genital mutilation n Not female circumcision n i. e. , male equivalent would be penectomy n Ranges from clitoridectomy to total infibulation (removal of clitoris and labia minora, removing labia majora and stitching rough edges together, and leaving a small opening posterior for urine and menstral blood)

Female Genital Cutting n Represents cultural control of women’s sexual pleasure and reproductive capabilities n surgical “chastity belt” n c. f. virginity exams by physicians in Turkey

Female Genital Cutting n Type I - removal of clitoris n Type II - removal of clitoris and part of labia minora (80% of procedures) n Type III - modified infibulation - 2/3 of labia majora sewn together n Type IV - total infibulation – labia majora cut, rough edges sewn together (15% of procedures)

Female Genital Cutting n Procedures sometimes include: n Incisions/scarification of perineum and vaginal walls n Introduction of corrosives and herbs into vagina

Female Genital Cutting n Most commonly carried out between ages 4 and 10 nphysicians perform about 12% of operations n. Midwives, barbers, relatives n Often done under non-sterile conditions and without anesthesia

Female Genital Cutting Complications/Sequelae n bleeding n infection n dyspareunia n painful neuromas n keloids n dysmenorrhea n infertility childbirth complications n decreased sexual responsiveness n shame n fear n depression n

Female Genital Cutting n 500, 000 women and girls in US affected/at-risk n Some women choose, for beauty’s sake, the “Barbie” (surgery to fuse the outer and inner labia, to create a clamshell-type effect) n Sensitivity/understand cultural identity issues n Immigration Issues

Management of Female Genital Cutting n Deinfibulation n Clitoral reconstructive surgery (breaking scar, pulling the remaining clitoris, the majority of which lies below the surface, back out) – associated with complications without conclusive evidence of benefit

Female Genital Cutting n UN, WHO, and FIGO have condemned n AAP initially supported “ritual clitoral nick, ” then reversed position

Female Genital Cutting n Illegal to perform in U. S. under child abuse statutes before 1996 and by federal ban since then n ? “cultural imperialism”? n 2013: U. S. criminalizes transport of underage girls out of country for FGC (“vacation cutting”) n Fear of FGC can be the basis for an asylum claim

? Cultural Imperialism? n Other outlawed “cultural practices”: n Slavery n Polygamy n Child labor n Denial of appropriate, lifesaving medical care to sick

References n Adams KE. What's Normal: Female Genital Mutilation, Psychology, and Body Image. JAMWA 2004; 59(3): 168 -170. Available at http: //jamwadoc. org/index. cfm? objectid=2 A 3 A 132 AD 567 -0 B 25 -5985 AC 5574 B 1 C 538

References n n Donohoe MT. Individual and societal forms of violence against women in the United States and the developing world: an overview. Curr Women’s Hlth Reports 2002; 2(5): 313 -319. Donohoe MT. Violence and human rights abuses against women in the developing world. Medscape Ob/Gyn and Women’s Health 2003; 8(2): posted 11/26/03. http: //www. medscape. com/viewarticle/464255

Contact Information: Martin Donohoe, MD, FACP martindonohoe@phsj. org http: //www. phsj. org