2. FGC, Sexual Pleasure, and the Risks of Cosmetic Surgery Wednesday, October 25

3. Listen one more time to Luanita “I can tell you this: I enjoy being with my husband -- my body responds to him! My love life with my husband is not over because of being cut.”

4. Important, powerful anti-FGC argument Excision and infibulation eliminate a woman’s ability to experience erotic/physical pleasure They therefore deprive her of capacity to realize her full potential as a human being They must therefore be eradicated

5. Growing evidence that situation may be a bit more complicated Most studies focus on excision and infibulation (mildest forms of sunna not associated with reduction in ability to have orgasm)

6. Yoruba study Sunna -- not total excision, performed in about 50% of population, tended to be performed in infancy 900 women interviewed, 1995-1997 (Orubuloye et al, 2000) Asked: “How do you think cutting has affected your capacity to enjoy sexual activity?”

7. Yoruba study, 2 Respondents say they know they had no real way of knowing what sex would be like without cutting What many DO know: they still enjoy sex, and they report “finishing” (having orgasms) Some say they BELIEVE that they enjoy sex more than uncut women (matter of cultural belief, education)

8. Yoruba study, 3 Of 290 rural Yoruba women, 3% said they could not answer the question 4% said they believed that cutting had reduced their sexual pleasure 40% said they believed cutting had no effect on sexual pleasure 53% said they believed cutting increased their capacity to enjoy sexual activity

9. Yoruba study, 4 Of 676 urban Yoruba women, 16% said cutting had reduced their capacity for sexual pleasure 63% said it had had no effect 16% said that it had increased their capacity for sexual pleasure

10. The Somali study Marcia Inhorn (late 1980s) Sample of 150 Somali women (infibulated) –50% reported enjoying sex –30% reported “finishing” Sample of uncut women in Egypt and Saudi Arabia –50% reported feeling pleasure during sex –30% reported “finishing”

11. The Kenyan Rendille study Questionnaire administered by interviewers to 2000 women in 1994-1996 (Shell- Duncan et al, 2000) These women cut at marriage: have erotic experiences before cutting roughly “two thirds” reported decline in sexual responsiveness roughly “a third” said it had no significant effect about 5% reported improvement of erotic response

12. How can this be? Whole clitoris is never removed: significant sensitive tissue always remains In infibulation, weight and friction upon external tissue stimulates sensitive organ beneath Much of erotic response is not directly connected to clitoral stimulation

13. Eroticism of barriers In Sudan –Sex NOT enhanced by woman;s pain –Sudanese men reputed to be very loving and gentle (gentle childraising?); rape very rare -- far less rare than in US –Penetration is slow, gentle, less frequent –Opening created slowly over time, to “fit” husband; no tearing

14. Sudanese woman 1 “Mmmm. When you are stitched, that is when the touching is the best. Because he must go slow, he must pay attention to every part of your body. He cannot simply run to your organ, and enter there, and be finished. No. My body remains closed to him, and he must pay close attention to it. He will linger, caress every part.”

15. Sudanese woman, 2 “I am sorry for the woman without the barrier, because then the man can simply possess her and not be tender. He thinks: she is just good for sex, and takes her, and it is over. But with my scar, he must remember that I am far more than a sex ‘machine’ – he cannot use me, he must be patient and gentle.”

16. Women’s oral poetry in Sudan Reported by Karen Kenyon, in Women of Omdurman “Climb my mountain/climb it again/Can you make it? Can you make it? I keep you out/I let you in/Come to me, and I will let you in.” “He comes to me in the night/Ablaze with heat/Only my organ can quench his fire/Only my coolness can quench his fire/Ah my love/Until the next time/ Until the next time.” “Let him come/He tries to enter/And tries again/ but I keep him back, I keep him back [laughter]/ He comes when I am ready.”

17. Control over timing and pace Infibulated women must co-operate more, give greater consent Alexandri Bout’s interviews with Sudanese women on sex –women, not men, initiate

18. Yet, many do recognize a reduction in “capacity” How do those who say they enjoy sex interpret this reduction? “Cutting does not take away women’s pleasure. In no way. What it does is make her less crazy about men...She is able to be calm, not allow herself to be manipulated by men’s wiles. She knows who she is! The woman who wants sex too much is a slave to men. Cutting frees her! It definitely frees her! With excision, women become much more in control, more masters of their destinies. I enjoy sex, but I am not dependent on it…”

19. The risks of liposuction, breast augmentation, and FGC Need to think comparatively Social pressures to cut, to “not stand out”, to “be normal”, to be lie others (far more common cause of cosmetic surgery than to be “perfect’)

20. Risks of liposuction 1999: 230,000 liposuctions, 350% rise since 1992. 90% performed on women. 1999 study: 20% of all liposuctions involved some important complication (blood clots, pain, numbness, bruising, discoloration) 1998 study: between 1994-1998, one in 5000 liposuctions resulted in death (2-3 times higher than normal pregnancy) 1996-1998: 100 deaths due to liposuction

21. Risks of sterile sunna Unsterile sunna: 10-15% involve significant complications No reliable data on deaths Recent study in Kenya: women who undergo sunna in sterile medical environemnt have 70% lower risk of complication, or about 5%.

22. Risks of saline implants (legal today) 1997 study in New England Journal of Medicine: 25% of women with saline implants experience adverse effects in first 5 years In 10% of saline implants: infections, tearing, need for corrective suregry In 35% of all saline implants, high level of capsular contracture: tightening of scar tissue around implant. Pain and hardening.

23. So, a question: If it is OK for “Western” women to take these calculated risks under social pressure to “not stand out”, should it also be OK for African women to take calculated risk of sterile sunna?