In many cultural traditions, body modification rituals are performed on children. Among the most common of these rituals are those involving cutting the genitals of children. These rituals, female genital cutting (FGC) and male genital cutting (MGC), damage the sexual organs and have many complications.
FGC, also called female circumcision, is practiced by diverse peoples, including Muslims and Christians, on girls ranging in age from infancy to the late teenage years.1 Specifics of the practice vary more by tribal/cultural affiliation than by national border. FGC is usually a ritual of great cultural significance performed by an older woman in the community.
An estimated 130 million women and girls alive today have been subjected to FGC.2 Eight to ten million girls and women in the Middle East and Africa, and thousands in the U.S., are currently at risk for FGC.
There are three main types of FGC. Type I, also called Sunna circumcision, is the amputation of the tip or hood of the clitoris.1 (This procedure is often represented as removal of the entire clitoris due to a misconception of clitoral anatomy.) This form of FGC is the most widely practiced, and accounts for about 80% of FGC incidents.3
Type II FGC is the amputation of part or all of the clitoris and scraping away of parts of the labia majora and labia minora.1 This form is practiced mostly in regions where infibulation is becoming illegal or discouraged.3
Type III FGC, also called infibulation or pharaonic circumcision, is the complete amputation of the clitoris, labia majora, and labia minora, and sewing together of the sides of the vulva with thorns, catgut, or some other suturing material. A small opening is left for the passage of menstrual fluids and urine. According to one estimate, in 1992 infibulation was universal throughout Somalia and in populations of ethnic Somalians in Ethiopia, Kenya and Djibouti; throughout the Nile Valley, including Southern Egypt; and along the Red Sea Coast.4
Consequences of MGC and Type I FGC can include scarring, loss of blood, infection, shock, and death, and later, painful intercourse for both partners and reduced ability to experience sexual pleasure.1 MGC and FGC are also potential vectors of disease transmission, including HIV, since the instruments (such as razor blades, scissors, or pieces of glass) in many cases are not sterilized and may be used on several children in succession.1
Additional long-term complications of Type II and III FGC can include delayed menarche, chronic pelvic problems, damaged birth canal, and recurrent urinary retention and infection. Women who have been infibulated may experience yet more severe complications and must undergo an operation to allow the passage of the child during labor.1
One of the few doctors in the U.S. who has experience treating complications of FGC, Dr. Nahid Toubia, has written a guide to caring for women subjected to FGC.5
Anecdotal accounts indicate that FGC can lead to long-term physical and psychological harm.
The U.S. Federal Prohibition of Female Genital Mutilation Act of 1995 illegalizes any surgical procedure on the sexual organs of a girl before age 18, regardless of cultural or religious beliefs, unless the procedure is deemed "medically necessary" and performed by a licensed physician. FGC is punishable by a fine or prison sentence up to 5 years. Sixteen states have passed additional laws against circumcision of female minors.6 Some activists and lawyers note that these laws, which offer no protection to male minors, are sex-discriminatory.
FGC is still practiced in the U.S., primarily within certain recently immigrated groups.2 On January 9, 2004, the Associated Press reported the arrest of a California couple who allegedly have performed numerous female circumcisions. The case is the first to be filed under the federal 1995 law.7
There are laws against FGC in Australia, Britain, Canada, France, Sweden, Switzerland, New Zealand, Burkina Faso, Cote d'Ivoire, Kenya, Sudan, and Senegal. Some of these laws forbid only certain forms of FGC and many are not enforced.5 Immigrants are known to practice FGC in Australia, Canada, New Zealand, the U.S. and in European nations.2 In Egypt, FGC is legal only when performed by medical professionals in a hospital setting. Hospital FGC may remove more tissue.1
Ritual alteration of children's bodies has been a common phenomenon throughout history, from footbinding to head flattening, to various forms of scarification. However, genital cutting may be the only such ritual to have become incorporated into mainstream medical practice.
In the late 1800's, the practices of MGC and type I FGC rapidly gained popularity in the medical institutions of English speaking countries.8 Circumcision and other procedures were performed on boys and girls with the explicit purpose of causing pain to the genitals and diminishing sexual pleasure.
Physicians recognized that the foreskin of the penis and the clitoral tip of the vulva are dense concentrations of specialized, erogenous nerves. Sexual excitation was at the time considered a dangerous form of nervous excitement, responsible for many ailments. As one physician wrote, voicing increasingly popular medical opinion in 1891, more radical procedures would "be a true kindness to many patients of both sexes."9
FGC eventually lost popularity. However, mainstream medical journals published articles advocating adult FGC as late as 1959 ("Female Circumcision: Indications and a New Technique").10
Male genital cutting, also called male circumcision, continues to be performed in the U.S., principally on infants.
Genital alteration surgeries also continue to be performed on children with intersex conditions. Intersex is a catchall term for several conditions in which an individual is born with atypical reproductive or sexual anatomy. Children identified as intersex are not protected by the 1995 FGC law and may be subjected to clitoral reduction or other forced gender assignment surgeries in an attempt to normalize their appearance.
Internationally, MGC occurs almost everywhere FGC occurs, while the reverse is not true. Two percent of the world's women, and fifteen percent of the world's men have been subjected to genital cutting. Within a given culture, both procedures tend to take place under similar conditions, such as the use of unhygienic instruments, lack of anesthetic, and the discouragement or shaming of emotional expressions.
FGC and MGC typically serve parallel social functions, such as rites of adulthood, preparation for marriage, and responses to myths that the genitals are unclean and cause disease. Usually the rituals are administered by practitioners of the same gender as the child.
Both MGC and FGC remove healthy, sexually specialized tissue from children, have short-term risks such as infection, and have long-term sexual complications. People subjected to child genital cutting have publicly denounced the practices and asserted that they cause psychological harm.
Comparisons of MGC and FGC are difficult. Male circumcision removes an adult equivalent 12-15 square inches of epidermis, the subcutaneous dartos muscle, and 10,000-20,000 nerve endings. Type I FGC removes several thousand nerve endings but far less tissue. Typical Type II FGC removes much of the external tissue, 10,000-20,0000 nerve endings, and may result in additional complications related to childbirth. Type III FGC, castration, and subincision (a type of MGC involving a cut from the head of the penis toward the base), can have severe reproductive consequences and the greatest risks for infection and hemorrhage. All of these procedures are performed with instruments ranging from aseptic scalpels to rusted blades.
Hanny Lightfoot-Klein pioneered the first in-depth study of the widespread practice of infibulation in Sub-Saharan Africa. During her six year study, she lived with families and interviewed over 400 people in all social levels about FGC. At the Third International Symposium on Circumcision, she compared the practice and its motivations to infant circumcision in the U.S.:
...the more insight I gained into the various forms of genital mutilation of children, both in the pre-scientific societies I studied in Africa and the technologically advanced United States, the more I was struck by the similarities in rationale structures invented and proliferated by both ... to trivialize and justify the damage they contrived to perpetrate upon the bodies and psyches of their non-consenting and defenseless offspring.11
Child genital cutting violates the individual's rights to physical and mental health, self-determination, bodily integrity, and freedom from sex discrimination. However, only FGC is acknowledged as a serious human rights violation by the United Nations, UNICEF, the World Health Organization, and Amnesty International.1
U.N. resolutions establishing these rights include:
In addition, when performed as a medical procedure, genital cutting typically violates the right to informed consent because the sexual effects of the surgery are usually ignored, the potential complications minimized, and dubious benefits emphasized.
Within cultures practicing FGC or MGC, attention is diverted from children's rights to the parent's right to choose, to a collection of medical or hygienic myths, to freedom of religion, or the issue is taboo or simply ignored. Human rights are seen as inapplicable to the local genital cutting ritual.
Outlawing common practices such as FGC is problematic and has not proven successful. A more successful approach has been to introduce alternative rituals that address cultural needs but do not involve bloodletting and to offer practitioners, whose income may be largely from FGC, jobs as health educators in exchange for ceasing to perform FGC.
Challenges to ending FGC are presented by the cultural biases of the activists who target the issue. Outsiders can be perceived as insulting and confusing when they speak without understanding the relevant cultural framework, when they hold a viewpoint in which tribal beliefs are less significant than their own religions, or when they deal with FGC while ignoring MGC. Even parents who have immigrated to the U.S. may have trouble understanding prohibitions against FGC partly because mainstream religions and medical practices call for the circumcision of boys.
Describing FGC and MGC as "mutilation" is counterproductive because it tends to polarize discussion and be seen as culturally bigoted. People who have been subjected to these procedures also may not prefer to identify as "mutilated." Further, those taking part in FGC do not see themselves as mutilators, and the inherent blaming connotations of the word mutilation can shut down discussion.
Grassroots education appears to be key to eliminating child genital cutting.1 There can be strong resistance to ending practices that have always been presented as positive, or at least benign. However, a personal, informative, non-threatening approach that encourages self-empowerment can be effective. Educators can raise awareness about the harmful aspects of genital cutting, debunk myths about genital cutting, provide accurate medical information, and encourage people to change social pressure by supporting human rights. Framing the discussion so that the benefits of ceasing the practice outweigh the costs from the decision maker's point of view is essential.
Gerry Mackie asserts FGC has such a high level of social importance that "an individual in an intramarrying group that practices FGC can't give it up unless enough other people do too." Mackie suggests that the three steps to ending FGC are to provide an alternative ritual fulfilling the same social roles, publicize the health benefits of naturalism and the risks of FGC, and form societies that pledge not to perform FGC.12
An International Coalition for Genital Integrity has formed to provide a resource and common voice to organizations opposing non-consenting child genital surgeries.
For more information about FGC, see the following:
Prisoners of Ritual: An Odyssey into Female Genital Circumcision in Africa (1989), and Secret Wounds (2003). These books by Hanny Lightfoot-Klein, a leader in the movement to end genital cutting, describe her first-hand experiences working with populations in Africa over a period of more than 20 years.
Center for Reproductive Rights (CRLP), International Program. For legal help regarding FGC. 212-514-5534.
National Women's Health Information Center. Ask for a copy of "Caring for Women with Circumcision," by Dr. Nahid Toubia. 1-800-994-9662.
PATH (Program for Appropriate Technology in Health). "Female Genital Mutilation."
The Population Information Program of the Johns Hopkins Center for Communications Programs. The FGM Resource Group, POPLINE. 410-659-6300.
Reproductive Health Outlook Harmful Health Practices Annotated Bibliography. Covers topics about harmful traditional practices including female and male genital mutilation, dry sex and vaginal drying agents, and virginity testing.
RAINBO (Research, Action and Information Network for the Bodily Integrity of Women). 212-477-3318.