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Female Genital Cutting

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Presentation on theme: "Female Genital Cutting"— Presentation transcript:

1 Female Genital Cutting
Martin Donohoe

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

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4 Female Genital Cutting
All socioeconomic strata and all major religions 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

5 Female Genital Cutting
Has been called female genital mutilation Not female circumcision 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)

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

7 Female Genital Cutting
Type I - removal of clitoris 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 IV - total infibulation – labia majora cut, rough edges sewn together (15% of procedures)

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

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

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

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

14 Management of Female Genital Cutting
Deinfibulation 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

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

16 Female Genital Cutting
Illegal to perform in U.S. under child abuse statutes before 1996 and by federal ban since then ?“cultural imperialism”? 2017: First federal charges brought against 2 doctors in MI 2013: U.S. criminalizes transport of underage girls out of country for FGC (“vacation cutting”) Fear of FGC can be the basis for an asylum claim

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

18 References Adams KE. What's Normal: Female Genital Mutilation, Psychology, and Body Image. JAMWA 2004;59(3): Available at

19 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): 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.

20 Contact Information: Martin Donohoe, MD, FACP


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