In response to a Post Comment

"The thing that I find interesting is how incensed people are about female genital cutting---yet male genital cutting is viewed by many as totally ok since it doesn't technically interfere with sexual relations, etc. Regardless, I think society holds a double-standard."

Male circumcisions do have cosmetic benefits but they also have health benefits too:

1. Some boys will suffer from a condition called Phimosis, in which the foreskin can not be pushed backward far enough to permit urination, proper cleaning of the penis, and can also become a problem called Paraphimosis in which, during sexual intercourse, the tight foreskin makes it back past the head of the penis (glans penis) and gets stuck there, unable to go back forward, thus cutting off circulation to the penis and to the skin itself- a very painful experience that requires immediate circumcision

2. Boys who are not properly educated by their parents as to how to properly clean around the head of the penis, under the foreskin, accumulate a cheesy foul smelling substance called Smegma. This strongly predisposes the man to penile cancer. Also, if they have phimosis, then there is definitely no way that they can clean the smegma even if they wanted to.

3. Sexually transmitted diseases are easier transmitted and carried in an uncircumcised man due to more vascular surface area and more "nooks and crannies" for things to be harbored.

I do not care whether a man in circumcised or uncircumcised, as long as they are not suffering from any issues and have good hygiene.

I personally think that it is my patients' choice as to whether or not they want to circ their sons. I do advise them however of the pros and cons. If there is an adequate opening i.e. enough foreskin, then it is mostly personal preference that governs the decision to remove the foreskin or not. There are cultural, religious and social factors that come into play. If they choose not to, then its fine with me, but I do encourage the parents to teach proper hygiene techniques to their son from a young age, to prevent some of the above mentioned issues.

If there is Phimosis, usually even if the moms decide not to circ their son, sooner rather than later they end up coming back to us because of issues with urinating etc. In that case, it would be much better to have the procedure done as a baby and not as a 5 yr old who would be more cognizant of and traumatized by the experience.

Female Genital Cutting, serves no health benefit. As a matter of fact, it puts the women in a constant uphill battle with their health for the rest of their lives. I do not believe that circumcisions on men and FGC are analogous.

My two cents on the subject

Female Genital Cutting has always incensed me, as do any women's rights violations. These women do not feel pleasure during intercourse not only because they no longer have a clitoris, but because depending on the degree of the procedure, the vaginal opening can be barely large enough to fit the tip of a pinky through, and so intercourse is often very painful and results in tearing and bleeding and therefore very frequent infections. Other issues arise during childbirth. Some women will allow their vaginas to be cut open so that they can deliver the baby easily, and other women refuse such interventions, which as you can only imagine, results in very bloody and greusome childbirths.

In the recent years, when men of the societies involved have been asked about how they feel having a wife who has undergone FGC, it has become more and more common to hear them say that they are not fond of it either, for the same reasons as above. Many of the men want to know that they are pleasing their wives. This is a tradition that although has some patriarchal roots, is definitely reinforced and upheld by the women in the society.

I can put some pictures up if you would like to see them.

Female Genital Cutting throughout Sub-Saharan Africa

Female Genital Cutting (FGC) is a traditional form of body mutilation practiced throughout western, north central, and northeastern Africa. Also known as female circumcision, it can be defined as a wide range of practices involving the partial or total alteration or removal of the external genitalia for non medical reasons.

There are four recognized types of FGC. Type I is a “clitoridectomy” that is an excision of the prepuce* and Type II is an “excision” that includes removal of the prepuce, clitoris, and potentially the labia minora. More severe, Type III is called “infibulation” and it is the removal of all outer genitalia and stitching of the vaginal opening. The most drastic form is Type IV is considered “unclassified” as it includes all of the above, plus burning, piercing, pricking, or stretching of the genitalia.

The health problems that arrive from the procedure are too numerous to count, but they include uncontrolled bleeding, infection of the cuts, fistulae, and life-threatening complications during childbirth.

Although there has been a plethora of technical information on the practice since it was brought to the fore of international human rights discourse, it is actually little understood for its cultural entrenchment. We do know that the operation is performed generally

before or around puberty. There is intense social stigma for those adult girls who have not undergone genital cutting, which interferes with their abilities to have their own families. Therefore, many parents insist on FGC because they believe it will make the girls less

promiscuous and therefore better wives to potential husbands. On a continent where a daughter is often viewed as an economic burden, FGC is mainly practiced in impoverished rural areas to ensure that the daughter does not remain at home unmarried.

Although the practice spans all religions in Africa, it is commonly associated with Islam

and the most severe form of FGC is practiced in countries with a Muslim majority, such as Somalia and Sudan.

Public awareness campaigns were first prevalent internationally, and those campaigns only later became localized. The most well-known film about FGC is Alice Walker and Pratibha Parmar’s 1993 British film Warrior Marks. It internationally convinced large numbers of people that a highly damaging, oppressive ‘ritual’ was being inflicted without reflection, based on patriarchy and lack of education. The goal of the filmmaker was to galvanize a global movement against the practice. A year earlier, the Inter-American Committee had produced a film on Nigeria called Female Circumcision: Beliefs and Misbeliefs. It depicts how FGC can be done even on a three-year old through decorative scarification and tattooing by a male barber. This film weakened the cultural argument that the ritual is solely helping young women make the transition into womanhood. Contrary to Warrior marks, Beliefs and Misbeliefs was actually intended for African audiences as an education tool. It includes spoken language and subtitles in various indigenous languages and includes culturally-pertinent images related to FGC. Interestingly, when this film was screened by a health worker to groups of women, the health worker had the chance to clarify certain misconceptions of audience members about health. For example, she debunked the myth that if the clitoris touches the baby’s head during labor, the baby will die. The screening led to a great discussion about other violations of women, such as early marriage.

Perhaps the spread of technical health education coupled with culturally-relevant media is the key to mitigating the harm caused by female genital mutilation.

written by Laine Strutton

*prepuce is a retractable piece of skin which covers part of the genitals of primates and other mammals.

On a male, this covers the head of the penis (glans penis).

On a female, it surrounds and protects the head of the clitoris (glans clitoridis).

Sources:

Gruenbaum, E. (2001). The female circumcision controversy: An

anthropological perspective. Philadelphia: Philadelphia: University of

Pennsylvania Press.

Shell-Duncan, B., & Hernlund, Y. (2000). In Shell-Duncan B., Hernlund

Y. (Eds.), Female "circumcision" in Africa : Culture, controversy, and

change. Boulder: Lynne Rienner Publishers.

Rahman, A., & Toubia, N. (2000). In Center for Reproductive Law &

Policy, RAINBO (Organization) (Eds.), Female genital mutilation: A

guide to laws and policies worldwide. London ; New York: Zed Books in

association with Center for Reproductive Law and Policy and Research,

Action and Information Network for the Bodily Integrity of Women.

The World Health Organization's website,

<http://www.who.int/gender/other_health/en/index.html>.

Sorry for the long hiatus from this blog. If you've read my regular blog, you would know that this last month has been one of hectic transition for me. I hope to put the Female Genital Cutting post up this weekend and then hopefully add to the blog at least every 2-3 weeks. This first year of residency training will either prove to power my Women's Health Corner or overshadow it. I hope and pray that I am able to do both and give each of my posts the time and effort that they deserve. Thanks for your patience.