1. Female Genital Cutting
Martin Donohoe

2. Female Genital Cutting
200 million girls and women affected worldwide (3 million girls/year)
30 countries
½ in Egypt, Ethiopia, and Indonesia
Many in Africa (e.g. 98% of women in Somalia, 90% in Sudan, 27% in Kenya)
Outlawed in Egypt – 2007 (was 80%, still 70%)
2016: 27 sub-Saharan countries have banned
Rare in Asia, Western hemisphere

4. 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

5. 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)

6. 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

7. 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)

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

11. 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

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

13. Female Genital Cutting
500,000 women and girls in US affected/at-risk
Some women choose, for beauty’s sake, the “Barbie” (surgery to fuse the outer and inner labia, to create a clamshell-type effect)
Sensitivity/understand cultural identity issues
Immigration Issues

14. Management of Female Genital Cutting
Deinfibulation
Clitoral reconstructive surgery (breaking scar, pulling the remaining clitoris, the majority of which lies below the surface, back out) – associated with complications without conclusive evidence of benefit

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

16. Female Genital Cutting
Illegal to perform in U.S. under child abuse statutes before 1996 and by federal ban since then
?“cultural imperialism”?
2017: First federal charges brought against 2 doctors in MI
2013: U.S. criminalizes transport of underage girls out of country for FGC (“vacation cutting”)
Fear of FGC can be the basis for an asylum claim

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

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

19. 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.

20. Contact Information:
Martin Donohoe, MD, FACP