Seven things to have in mind when meeting women having undergone female genital surgeries in Africa

This is a summary of the article Seven Things to Know about Female Genital Surgeries in Africa published in 2012. Experts in the field of female genital cutting (FGC) came together to debunk myths surrounding FGC. Their main aim was to “express [their] concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little‐known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates”. They identified seven take home messages, seven things to know about female genital surgeries in Africa, as follows:

  1. Research by gynecologists and others has demonstrated that a high percentage of women who have had genital surgery have rich sexual lives, including desire, arousal, orgasm, and satisfaction, and their frequency of sexual activity is not reduced. This is true of the 10 percent (type III) as well as the 90 percent (types I and II). One probable explanation for this fact is that most female erectile tissue and its structure is located beneath the surface of a woman's vulva. Surgical reductions of external tissues per se do not prevent sexual responsiveness or orgasm.

  1. The widely publicized and sensationalized reproductive health and medical complications associated with female genital surgeries in Africa are infrequent events and represent the exception rather than the rule. Reviews of the medical and demographic literature and direct comparisons of matched samples of “uncut” and “cut” (primarily type II) African women suggest that, from a public health point of view, the vast majority of genital surgeries in Africa are safe, even with current procedures and under current conditions. In countries in Africa where morbidities (infertility, stillbirths, menstrual problems, damage to the perineum) are relatively high compared to North American or European standards, those morbidity levels are just as high for “uncut” women.

  1. Female genital surgeries in Africa are viewed by many insiders as aesthetic enhancements of the body and are not judged to be “mutilations”. The globalization of images of women's bodies has increasingly popularized the ideal of a smooth and clean genital look that is reminiscent of the aesthetic standards associated with genital surgeries in East and West Africa. As an index of this recent trend, although the number of operations performed each year is quite small, type I and type II genital surgeries (described as clitoroplexy, clitoral reduction, and labiaplasty by cosmetic surgeons) are gaining in popularity in North America and Europe.

  1. Customary genital surgeries are not restricted to females. In almost all societies where there are customary female genital surgeries, there are also customary male genital surgeries, at similar ages and for parallel reasons. In other words, there are few societies in the world, if any, in which female but not male genital surgeries are customary.

  1. The empirical association between patriarchy and genital surgeries is not well established. The vast majority of the world's societies can be described as patriarchal, and most either do not modify the genitals of either sex or modify the genitals of males only. Also, female genital surgeries are not customary in the vast majority of the world's most sexually restrictive societies.

  1. Female genital surgery in Africa is typically controlled and managed by women. Similarly, male genital surgery is usually controlled and managed by men. Although both men and women play roles in perpetuating and supporting the genital modification customs of their cultures, female genital surgery should not be blamed on men or on patriarchy. Demographic and health survey data reveal that when compared with men, an equal or higher proportion of women favor the continuation of female genital surgeries.

  1. The findings of the WHO Study Group on Female Genital Mutilation and Obstetric Outcome is the subject of criticism that has not been adequately publicized. The reported evidence does not support sensational media claims about female genital surgery as a cause of perinatal and maternal mortality during birth. A careful reading of the WHO study reveals that the results are very complex. There were no statistically significant differences in reproductive health between those who had a type I genital surgery and those who had no surgery. The perinatal death rate for the women in the sample who had a type III surgery was, in fact, lower (193 infant deaths out of 6,595 births) than for those who had no surgery at all (296 infant deaths out of 7,171 births) and became statistically significant only through nontransparent statistical adjustment of the data.

Reference:

Public Policy Advisory Network on Female Genital Surgeries in Africa, Policy Advisory Network on Female Genital Surgeries in Africa, Public Policy Advisory Network on Female Genital Surgeries in Africa, By The Public Policy Advisory Network on Female Genital Surgeries in Africa, Medicinska fakulteten, Medicinska och farmaceutiska vetenskapsområdet, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH) & Uppsala universitet 2012, "Seven Things to Know about Female Genital Surgeries in Africa", The Hastings Center Report, vol. 42, no. 6, pp. 19-27.

Links to the text:

https://onlinelibrary.wiley.com/doi/full/10.1002/hast.81#hast81-bib-0009

https://www.sfog.se/media/295486/omskarelse_rapport.pdf

References:

1. See F. Ahmadu, “Disputing the Myth of Sexual Dysfunction of Circumcised Women: Interview with Richard Shweder,”Anthropology Today 45, no. 6 (2009): 14– 17

L. Catania, “ Pleasure and Orgasm in Women with Female Genital Mutilation/Cutting (FGM/C),” Journal of Sexual Medicine 4 (2007): 1666– 78

T. Esho et al., “Female Genital Cutting and Sexual Function: In Search of an Alternate Theoretical Model,”African Identities 8, no. 3 (2010): 221– 35

Gruenbaum, The Female Circumcision Controversy strange ref

H. Lightfoot‐Klein, “The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in the Sudan,” Journal of Sex Research 26, no. 3 (1989): 375– 92;

C. Obermeyer, “Female Genital Surgeries: The Known, the Unknown, and the Unknowable,”Medical Anthropology Quarterly 13 (1999): 79– 106

H. Stewart, L. Morison, and R. White, “Determinants of Coital Frequency among Married Women in Central African Republic: The Role of Female Genital Cutting,” Journal Biosocial Science 34 (2002): 525– 39

D. Veale and J. Daniels, “Cosmetic Clitoridectomy in a 33‐Year‐Old Woman,” Archives of Sexual Behavior, published online August 12, 2011, DOI: 10.1007/s10508‐011‐9831‐4.

2. See B. Essén et al., “Is There an Association between Female Circumcision and Perinatal Death?” Bulletin of the World Health Organization 80 (2002): 629– 32

B. Essén et al., “No Association between Female Circumcision and Prolonged Labor: A Case Control Study of Immigrant Women Giving Birth in Sweden,” European Journal of Obstetrics and Gynecology and Reproductive Biology 121, no. 2 (2005): 182– 85

U. Larsen and S. Yan, “Does Female Circumcision Affect Infertility and Fertility? A Study of the Central African Republic, Cote d'Ivoire, and Tanzania,” Demography 37 (2000): 313– 21;

L. Morison et al., “The Long‐Term Reproductive Health Consequences of Female Genital Cutting in Rural Gambia: A Community‐Based Survey,” Tropical Medicine and International Health 6, no. 8 (2001): 643– 53; Obermeyer, “Female Genital Surgeries.”

3. Morison et al., “The Long‐Term Reproductive Health Consequences of Female Genital Cutting in Rural Gambia.”

4. See S.D. Lane and R.A. Rubinstein, “Judging the Other: Responding to Traditional Female Genital Surgeries,” Hastings Center Report 26, no. 3 (1996): 31– 41;

C. Smith, “Unpacking Female Body ‘Mutilation’ in Senegal and the U.S.,” Global Gender Current, December 13, 2011, http://globalgendercurrent.com/2011/12/unpacking‐female‐body‐%E2%80%9Cmutilation%E2%80%9D‐in‐senegal‐and‐the‐u‐s/;

R. Conroy, “Female Genital Mutilation: Whose Problem, Whose Solution? Tackle ‘Cosmetic’ Genital Surgery in Rich Countries before Criticizing Traditional Practices Elsewhere,” British Medical Journal 333, no. 7559 (2006): 106; and

A. Kennedy, “Mutilation and Beautification,” Australian Feminist Studies 24, no. 60 (2009): 211– 31, on contrasting discourses of mutilation and beautification.

5. M. Navarro, “The Most Private of Makeovers,” New York Times, November 20, 2004; for a recent online pop culture and celebrity magazine discussion of the topic of cosmetic genital surgery as a rapid growth industry in the United States, see “Rapid Growth of Female Genital Cosmetic Surgery,” Zimbio, August 30, 2012, http://www.zimbio.com/Plastic+Surgery/articles/QiJ5‐n1gcBq/Rapid+Growth+Female+Genital+Cosmetic+Surgery; Conroy, “Female Genital Mutilation”;

C. Nurka, “Female Genital Cosmetic Surgery: A Labial Obsession,” The Conversation, August 28, 2012, http://theconversation.edu.au/female‐genital‐cosmetic‐surgery‐a‐labial‐obsession‐9119.

6. WHO Study Group on Female Genital Mutilation and Obstetric Outcome, “Female Genital Mutilation and Obstetric Outcome: WHO Collaborative Prospective Study in Six African Countries,” Lancet 367 (2006): 1835– 41.

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