BIO 226W
Nazareth College

Female Circumcision

          Female circumcision, or Female Genital Mutilation (FGM), is a highly controversial and complex health and humanity issue which, primarily through globalization, has come to the awareness of Westerners.  This web page merely seeks to explain what it is anatomically, who is subject to it, and both physical and mental health-related issues surrounding those affected by it.  A variety of links and related websites have been incorporated in the body of the text and at the end of this page for those interested in finding out more about the issue.

What is female circumcision?

          There are usually different cultural factors that determine which type is performed.  Although there are three main categories, it should be noted that they can occur to many varying degrees.  It is a surgical procedure involving partial or total removal of the secondary (external) female genitalia (for descriptions click here).  There are different levels of circumcision, with different cultural factors that determine which type is performed.  Although there are just a few main "types", it should be noted that they do occur to many varying degrees.         

• Clitoral circumcision- This procedure includes the removal of the females clitoral hood (or the clitoral prepuce) (6).
  
  
• Sunna circumcision- Involves the removal of the tip of the clitoris (1,4,6).  It may or may not include removal of the hood of the clitoris (6).   Sunna and clitoral circumcision are usually grouped together in regard to description, although there exists an obvious difference between them.
  
  
• Clitoridectomy (a.k.a. excision)- In this procedure, the entire clitoris (both prepuce and glans) and adjacent parts or all of the labia minora (or inner lips) are removed (1,4,6).
  

• Intermediate circumcision- Like a clitoridectomy, only part of the labia majora (or outer lips) is also removed.  This is an example of a combination of a clitorodectomy and the most drastic type, infibulation, and is generally not recognized as one of the main types (1).

• Infibulation (a.k.a. Pharaonic circumcision)- This procedure entails the removal of the entire clitoris, adjacent labia (majora and minora), and the closing of the vulva- involving the stitching together (suturing) of the two sides of the vulva across the vagina.  Most often the two remaining sides of the vulva are scraped or cut up so that they heal together to form a cover.  Generally, a small opening is left to allow urine and menstrual fluid to pass (1,4).

          Female circumcision is increasingly being referred to as Female Genital Mutilation (FGM), since most of the literature is from those opposed to the procedure, but also because the word circumcision traditionally meant the removal of only the prepuce of females and the foreskin of males.  When taking into account the different levels of severity of the procedure, it is self-evident why the word circumcision does not encompass the general concept.

          Although many have associated the practice with the religion of Islam, the history of female circumcision is much older.  In fact, it is not practiced in many Islamic countries, such as Algeria, Iran, Iraq, Libya, Syria, Jordan, Morocco and Tunisia.  It is truly more of a socially rooted practice.  Research in the area agrees on female circumcision as originating in tribal Africa, although at present it exists in virtually every corner of the globe, including the United States.  For most females, it happens at the onset of puberty in the context of initiation into the community as a woman, although for various reasons it is occurring earlier in age (1).  It can, however, occur from infancy until a woman is pregnant with her first child.  Even today it is part of a social and political cohesion of community, especially in traditional rural African communities.  It also exists to prevent loss of virginity before the appropriate time in some cultures, and to inhibit promiscuity and extra-marital relations.  Clitoridectomy still exists in cultures that believe the clitoris is "poisonous" or "evil".  (Reference #1 at the bottom of this page is a thorough, credible source for learning more about specific regions and their particular foundations for the practice).

What are the effects of female circumcision?

          There are many short and long-term physiological, sexual and psychological effects associated with female circumcision, many of which vary, or depend altogether, on the level of the procedure and/or who receives it.  In fact, in parts of the West, including the U.S., many women are happy having chosen to have a circumcision for an elongated clitoral prepuce or elongated labia minora (many doctors still will not perform it).  They claim it feels cleaner and that they have more satisfying sexual stimulation from a more exposed clitoris.  However, most of the procedures are more severe than those, with the most profound long-term consequences associated with infibulation.

• A very serious issue surrounding circumcision in lower class, rural areas of Africa where good hygiene may not be practiced is the risk of spreading HIV, which can result in developing the AIDS virus in the women of these communities.  It can happen simply from using the same blade to perform the operation on multiple women (1,3,4,5,6).

• Other health issues that do not involve the actual procedure, per se, but the conditions in which she is treated can be infections due simply to lack of antiseptic.  It is not uncommon for circumcision to lead to death because of this factor (1,4).  

• Another problem in many communities is the lack of knowledgeable and/or qualified practitioners, which can greatly effect the probability of infection and the duration of healing.  This is also frequent in cases where the practice is unlawful, as families will seek to have it done in secret (1,4).

• Many times anesthetics are simply not available to poor communities or those performing the modification in secret; the pain from such a procedure is presumably beyond words.  At the same token, those who do not have access to anesthetics usually do not have access to suitable "tools" to perform the procedure.  Some of the many substitutes researches have made reference to range from dull knives, razor blades and scissors, to tin lids and pieces of glass (1,4).
   
  
• Another problem in many communities is the lack of knowledgeable and/or qualified practitioners, which can greatly effect the probability of infection and the duration of healing.  This is also frequent in cases where the practice is unlawful, as families will seek to have it done in secret.

Procedure-related health issues:

• Clitoridectomy can result in chronic infections, intermittent bleeding, abscesses and small benign tumors of the nerve which cause discomfort and extreme pain, and infections from urine retention (6).
  
  
• Infibulations can result in chronic urinary tract infections, stones in any part of the urinary tract, kidney damage, infections from retained menstrual fluid, pelvic infections, infertility, excessive scar tissue and Dermoid cysts (6).

• When a women who has been infibulated is engaged in sexual intercourse, the formed cover from both sides of the vulva is cut (by her husband, who is probably not a qualified doctor) once again to allow for penile penetration, which can result in infection.  She is usually re-sewn, which recreates the above risks and complications again, only at an enhanced degree because of an increase in scar tissue (6).

• During childbirth, scar tissue on circumcised women often tears.  If she was infibulated, she must be cut to allow the child to pass.  If this is not done, perineal tears or obstruction of the birth may occur.  Women are often reinfibulated after bearing a child (6).

Sex-related effects:

• Although sexual stimulation and orgasm are still not fully understood, most experts find circumcision of the clitoris, partially or wholly, extremely inhibiting to sexual response.

• First intercourse after any circumcision is likely to be extremely painful and uncomfortable, but especially for an infibulated female who has been cut open    (1,6).

Psychological effects:

          Most research in this area is based on self-reports from those who went through the operation long before they came out in the open with it. 

• Reported feelings of victims have included anxiety, terror, humiliation, betrayal and regret, just to name a few (1,4,6)

• Circumcised women may also feel a profound feeling of acceptance into the community, or as a perspective bride, or simply from avoidance of rejection had she not had the procedure.

• http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm
• http://www.theword.org.nz/everyword.html
• http://www.circlist.org/canatomyfemale.html
• http://www.mothersagainstcirc.org/links.htm
• http://www.bhs.berkeley.k12.ca.us/departments/Science/anatomy/anatomy97/female/html/external.html
• http://www.scarleteen.com/body/female_anatomy_2.html
• http://www.e-estrogens.com/
• http://www.gynocologyonline.com/anatomy/anatomy2.htm
• http://www.religioustolerance.org/fem_cirm.htm
• http://hamp.hampshire.edu/~mnbF94/whatis.FGM.html

1. Koso-Thomas, Olayinka (1992) The Circumcision of Women: A Strategy for Eradication.  Zed Books LTD, London.
2. Lutkehaus, Nancy & Roscoe, Paul (1995) Gender Rituals: Female Initiation in Melanesia.  Routledge, New York and London
3. Walker, Alice & Parmar, Pratibha (1993) Warrior Marks: Female Genital Mutilation and the Sexual Blinding of women.  Harcourt Brace and Company, Orlando.
4. Robinson, B. A. (2001).  Female Genital Mutilation: In Africa, the Middle East & Far East.  April 4, 2002, http://www.religioustolerance.org/fem_cirm.htm.
5. Amnesty International (1997).  Female Genital Mutilation.  April 11, 2002, http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm
6. Wheeler, K. N. (2000). Female Anatomy Anatomy and Clitoral Circumcision.  April 11, 2002, http://www.circlist.org/canatomyfemale.html

Nazareth College
Rochester, New York