Female Genital Cutting Martin Donohoe Female Genital Cutting

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Female Genital Cutting Martin Donohoe

Female Genital Cutting Martin Donohoe

Female Genital Cutting n 200 million girls and women affected worldwide (3 million girls/year)

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,

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

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

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 -

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

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

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

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

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

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

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

Female Genital Cutting Illegal to perform in U. S. under child abuse statutes before

Female Genital Cutting Illegal to perform in U. S. under child abuse statutes before 1996 and by federal ban since then n ? “cultural imperialism”? n 2017: First federal charges brought against 2 doctors in MI 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 n

? Cultural Imperialism? n Other outlawed “cultural practices”: n Slavery n Polygamy n Child

? 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

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

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

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