1. Female Genital Cutting
Martin Donohoe

2. Female Genital Cutting
125 million girls and women affected worldwide (3 million girls/year)
29 countries
Most in Africa (e.g. 98% of women in Somalia, 89% in Sudan, 80% in Egypt, 50% in Kenya)
Outlawed in Egypt
Rare in Asia, Western hemisphere

3. 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

4. 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)

5. 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

6. 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)

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

10. 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

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

12. Management of Female Genital Cutting
400,000 women and girls in US affected
Sensitivity/understand cultural identity issues
Deinfibulation
Clitoral reconstructive surgery (breaking scar, pulling the remaining clitoris, the majority of which lies below the surface, back out)
Immigration Issues

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

14. Female Genital Cutting
Illegal to perform in U.S. under child abuse statutes before 1996 and by federal ban since then
?“cultural imperialism”?
Girls Protection Act of 2011 would criminalize taking a minor girl living in the US outside the country for purpose of FGC
Stuck in house and senate committees
Fear of FGC can be the basis for an asylum claim

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

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

17. 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.

18. Contact Information:
Martin Donohoe, MD, FACP