1. Female Genital Cutting Martin Donohoe

2. Female Genital Cutting 135 million women affected worldwide (2 million girls/year) 135 million women affected worldwide (2 million girls/year) Most in Africa (e.g. 98% of women in Somalia, 80% in Egypt, 50% in Kenya) Most in Africa (e.g. 98% of women in Somalia, 80% in Egypt, 50% in Kenya) Outlawed in Egypt - 2007 Outlawed in Egypt - 2007 Rare in Asia, Western hemisphere Rare in Asia, Western hemisphere

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

4. Female Genital Cutting Has been called female genital mutilation Has been called female genital mutilation Not female circumcision Not female circumcision i.e., male equivalent would be penectomy i.e., male equivalent would be penectomy 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) 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)

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

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

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

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

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

12. Management of Female Genital Cutting Sensitivity/understand cultural identity issues Sensitivity/understand cultural identity issues Deinfibulation Deinfibulation Immigration Issues Immigration Issues

13. Female Genital Cutting UN, WHO, and FIGO have condemned UN, WHO, and FIGO have condemned Illegal to perform in U.S. under child abuse statutes Illegal to perform in U.S. under child abuse statutes ?“cultural imperialism”? ?“cultural imperialism”?

14. ?Cultural Imperialism? Other outlawed “cultural practices”: Other outlawed “cultural practices”: Slavery Slavery Polygamy Polygamy Child labor Child labor Denial of appropriate, life-saving medical care to sick children Denial of appropriate, life-saving medical care to sick children

15. References Adams KE. What's Normal: Female Genital Mutilation, Psychology, and Body Image. JAMWA 2004;59(3):168-170. Available at http://jamwa.amwa- doc.org/index.cfm?objectid=2A3A132A-D567- 0B25-5985AC5574B1C538 Adams KE. What's Normal: Female Genital Mutilation, Psychology, and Body Image. JAMWA 2004;59(3):168-170. Available at http://jamwa.amwa- doc.org/index.cfm?objectid=2A3A132A-D567- 0B25-5985AC5574B1C538 http://jamwa.amwa- doc.org/index.cfm?objectid=2A3A132A-D567- 0B25-5985AC5574B1C538 http://jamwa.amwa- doc.org/index.cfm?objectid=2A3A132A-D567- 0B25-5985AC5574B1C538

16. References 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. 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 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 http://www.medscape.com/viewarticle/464255

17. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org