Female Genital Cutting

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Female Genital Cutting

• Martin Donohoe

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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 - 2007
• Rare in Asia, Western hemisphere

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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

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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)

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Female Genital Cutting

• Represents cultural control of womens sexual
  pleasure and reproductive capabilities
• surgical chastity belt
• c.f. virginity exams by physicians in Turkey

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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)

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Female Genital Cutting

• Procedures sometimes include
• Incisions/scarification of perineum and vaginal
  walls
• Introduction of corrosives and herbs into vagina

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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

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Female Genital CuttingComplications/Sequelae

• bleeding
• infection
• dyspareunia
• painful neuromas
• keloids
• dysmenorrhea

• infertility
• decreased sexual responsiveness
• shame
• fear
• depression

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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

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Female Genital Cutting

• UN, WHO, and FIGO have condemned
• AAP initially supported ritual clitoral nick,
  then reversed position

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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

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?Cultural Imperialism?

• Other outlawed cultural practices
• Slavery
• Polygamy
• Child labor
• Denial of appropriate, life-saving medical care
  to sick children

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References

• Adams KE. What's Normal Female Genital
  Mutilation, Psychology, and Body Image. JAMWA
  200459(3)168-170. Available at
  http//jamwa.amwa-doc.org/index.cfm?objectid2A3A1
  32A-D567-0B25-5985AC5574B1C538

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References

• Donohoe MT. Individual and societal forms of
  violence against women in the United States and
  the developing world an overview. Curr Womens
  Hlth Reports 20022(5)313-319.
• Donohoe MT. Violence and human rights abuses
  against women in the developing world. Medscape
  Ob/Gyn and Womens Health 20038(2) posted
  11/26/03. http//www.medscape.com/viewarticle/4642
  55

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• Contact Information
• Martin Donohoe, MD, FACP
• martindonohoe_at_phsj.org
• http//www.phsj.org