Dr. Abeer Barakat, assistant lecturer of public health, Cairo University, researched this subject in 1997, and with her study and some of our own research we will try to elucidate the public on this much discussed topic.
What is female circumcision?
Female circumcision is the partial or complete removal of the external genitalia, varying from removal of the prepuce (hood) of the clitoris only, to full excision of the clitoris, labia minora and labia majora.
Several classifications of female circumcision exist; one of which (for simplicity) is the following:
- Clitoridectomy (1st degree circumcision) is the removal of the prepuce of the clitoris.
- Excision (2nd degree circumcision) consists of removal of the prepuce and glands of the clitoris and often the removal of the whole of it.
- Sunnah circumcision (3rd degree circumcision) includes excision and paring of the adjacent parts of the labia minora above the plane of the labia majora, or the removal of the whole of it.
- Infibulation (4th degree circumcision) -or Pharaonic circumcision- consists of removal of all the external genitalia, the whole of the clitoris and the entire labia minora.
In the WHO classification one additional type called Type 4 exists which includes all other unclassified practices involving female genitalia. This includes: pricking, piercing or incising the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning the clitoris and surrounding tissues; introcision; scraping (angura cuts) or cutting (gishiri cuts) of the vagina or surrounding tissues; introduction of corrosive substances or herbs into the vagina; and any other procedure that falls under the definition of female genital mutilation (FGM).
Where did Female Circumcision originate?
It is difficult to ascertain whether it was originally an old African puberty rite that reached Egypt by diffusion or a Pharaonic survival plan that fits within the Egyptian cultural patterns and has subsequently spread to other parts of Africa.
In a Greek papyrus in the British Museum dated 163 BC, reference is made to the circumcision of girls in Memphis at the age when they received their dowries.
However, Elliot Smith, the Egyptologist, stated that there is no evidence of infibulation in pre-dynastic or later Egyptian mummies.
Among the various tribes inhabiting the West Coast of the Red Sea, the Kreophagoi were said to mutilate their sexual organs and excise the genitals of their women in the Jewish manner.
Jesuit missionaries and others have referred to the prevalence of excision in Ethiopia from the earliest Christian times.
The early Roman technique of slipping rings through the labia majora of their female slaves to prevent them from becoming pregnant, and similarly the chastity belt, introduced in Europe in the 12th century by the Crusaders, were intended as a barrier against unlawful sex. (The chastity belt was a chain belt that was locked and held a metal plate in the genital region with only an opening for urination.)
In the USA, a female circumcision and excision were forwarded by the Orificial Society, which was formed in 1890.
Anthropologists for some of the original inhabitants of Australia have reported Introcision, or cutting into the perineum to enlarge the vagina as a puberty rite, in the past.
How Prevalent is Female Circumcision?
The practice of female circumcision is widespread in Egypt. According to the Egyptian Demographic and Health Survey (EDHS) done in 1995, 97% of the ever-married females questioned had been circumcised. The prevalence was only 90%, however, with those with secondary or higher education as well as in the frontier provinces. According to other studies, two thirds of circumcised females showed a partial or total excision of the clitoris and labia minora, while partial or total excision of the clitoris was less common and of the labia minora only was least common. Labia majora excision occurred in one in eleven cases only.
In the Middle East:
Female circumcision is not practiced in the Middle East, or in the countries of the Arab Peninsula, with the exception of Yemen, the United Arab Emirates, Bahrain and Oman.
In Bahrain, genital operations are rapidly decreasing, and consist of a cut made over the clitoris.
It is not practiced in the cradle and of Islam, namely Saudi Arabia. Neither is it practiced in Algeria, Iran, Iraq, Libya, Morocco and Tunisia.
Documentation on the prevalence of different types of FGM began in the early twentieth century with reports by European travelers and missionaries.
Muslims, Christians, some animists and one Jewish sect practice FGM in Africa. But it is not a requirement of any of these religions. The distribution of the practice does not follow the distribution of these religious groups in the African continent. Infibulation is overwhelmingly the most common type of circumcision performed in Africa.
Through out the world:
FGM is reportedly practiced among a few groups in Asia and among some in Australia.
What are the reported reasons behind performance of female circumcision?
Many reasons exist for people of different cultures to perform this operation and they vary as much as the cultures themselves.
|Mystical and ritualistic factors: the circumcision ceremony (in many countries) includes many superstitious performances depending on the country of origin ranging from the time of day in which it is performed to wearing protective necklaces.|
- Chastity and preservation of virginity are the most common motivations for the performance of female circumcision. It is believed that by performing the operation in its mild form the sexual desire of the girl is decreased thus hindering the chances of sexual promiscuity. In its more severe forms, as in stitching the vaginal orifice, which occurs in some African communities, the girl is physically prevented from being approached sexually. The importance of maintaining virginity is utmost as the girl is meant to be approached only by her future husband and some think that female circumcision is one of the ways to ensure her virginity for that moment.
- Tradition: the acceptable image of a woman with a place in society is that of one who is circumcised among other various characteristics. The fear of losing the psychological, moral, and material benefits of "belonging" is one of the greatest motivators of conformity. The notion of sexual victimization through performance of the operation is not felt while women and girls remain firmly within their own culture. However, unmarried girls who move into European circles are beginning to be conscious of it. It is difficult to assess the psychological damage of a tradition that is so universally accepted.
- Hygienic motivations: It is believed that the secretions produced by the glands in the labia minora and majora are foul smelling, unhygienic and so make the female body unclean. However, in noncircumcised women, it is very easy to clean the external genitalia. It is only in the rare cases where there is a stricture of the prepuce of the clitoris (phimosis) or elongation of the prepuce (foreskin) that is difficult to clean; in such cases a properly done surgical circumcision without encroaching on the clitoris may be required.
- Male approval: the argument that circumcision enhances male sexual performance is only valid where males have been conditioned to believe that sexual pleasure and prowess can only be achieved with circumcised women who are subdued and passive during the act itself.
- Mystical and ritualistic factors: the circumcision ceremony (in many countries) includes many superstitious performances depending on the country of origin ranging from the time of day in which it is performed to wearing protective necklaces.
- Education versus ignorance: statistics have proven that a strong relationship exists between the type circumcision chosen and the parents' education. Daughters of highly educated parents are commonly either not circumcised at all, or if circumcised, the 3rd degree or the intermediate type is chosen in preference to the 4th degree.
- Financial motivation: the cost of the operation is beneficial to certain people who perform the operation such as traditional birth attendants and some qualified doctors who perform the operation.
- Other reasons: some believe that female circumcision is one of the rites that allow passage of a girl from childhood to femininity. External genitalia are considered ugly and become more beautiful after circumcision.
The operation is performed in different communities by different people and with various tools. In more educated communities, a trained doctor performs the operation with sterilized equipment. In the more ignorant societies, a traditional birth attendant performs the operation using a variety of tools ranging from unsterilized knives and razors to sharp stones taken straight from the ground.
Complications of the operation
de range of complications exists in relation to female circumcision ranging from short-term to long-term. The short-term complications include bleeding, infection, pain, urinary retention, stress, shock, and damage to the urethra and anus. In the case of minor operations, most wounds heal with few long-term problems. Cases have been reported where girls have suffered repeated infections, soreness and intermittent bleeding for many years. The stitch used to tie the clitoral artery may not be absorbed totally, becoming the focus for an abscess. The tough scar over the clitoris may split open during childbirth.
Infibulation, on the other hand, is accompanied by an expansive list of long-term complications that needs further discussion out with this article. However, besides the greater risk of infections and general damage to the area, some complications include: hematocolpos, dysmenorrhea, pelvic infections and infertility, more frequent indication for Cesarean section delivery, difficulty in penetration during the wedding night due to tight scarring of the vaginal opening, dyspareunia and vesico-vaginal and recto-vaginal fistulae.
The issue of sexual desire and satisfaction
The psychological aspect of human sexual arousal is a complex phenomenon that is not fully understood by experts. It involves emotions, concepts of morality, past experience, acceptance of eroticism, fear of disease or pregnancy, dreams, and fantasies. The combination of physical messages from sensory organs and the emotional images culminate in a psycho-physiological state during which a person is able to experience orgasm. The erection of the clitoris is only secondary to the higher center stimulation in which its function is to lead the stimulation to its destination and orgasm during a sexual act. So whether the clitoris is present or absent it makes no difference as regards chastity, as it has a secondary role.
Female orgasm has both clitoral and vaginal components. Evidence suggests that orgasms require clitoral stimulation while vaginal stimulation, though pleasurable, is a minor triggering mechanism: also direct clitoral stimulation is a greater stimulus than coitus, which causes pelvic pressure and traction on the clitoral hood.
With infibulation, there is destruction of practically all the nerve endings in the outer sex organs that convey the pleasurable sensations to the brain. She is left with the sensations from the vestibule at the vaginal orifice and the vagina itself whose nerve endings respond more to pressure than touch. If she has an orgasm then it is what is called "vaginal orgasm" in contrast to the more effective "clitoral orgasm." Studies performed found that 29.8% of infibulated women found sexual satisfaction or had orgasms compared to 48% of 1st degree circumcised women.
With clitoridectomy, some of the sensitive tissue at the base of the clitoris, along the inner lips and around the floor of vulva, are still intact and will give sensory sexual messages if properly stimulated. In addition, other sexually sensitive parts of the body, such as the breasts, nipples, lips, neck and ears may become hypersensitized to compensate for lack of clitoral stimulation and thus enhance sexual arousal.
In normal noncircumcised females, orgasm does not always occur. In excision, some local sensitive areas still exist in what is left of the clitoris, labia minora and vestibule, besides the pressure response of the vagina. This explains why, in spite of excision, about one third of those excised still get satisfaction and a pleasurable sensation and another 42% reach orgasm, compared to the 1st degree circumcision where 27% have satisfaction and 48% reach orgasm.
|Sebaceous glands around the clitoris attempt to prevent adhesions of the prepuce to it. This sometimes fails and the clitoris is adheres tightly to the prepuce. This defect may range from 25% of the normal surface adherent to complete coverage.|
No satisfaction at all was present in 39% of infibulated women, 25% of those of 1st degree circumcision, and much less in the uncircumcised category.
In Dr. Barakat's study, in which 97.6% of those interviewed had excision of the clitoris with partial or total excision of the labia minora, 72.8% of the women experienced orgasms.
Are there documented medical indications for female circumcision?
Indications for female circumcision were documented in 1959 by an American physician, WG Rathmann MD, who performed many female circumcisions in the United States during his long years of practice. These indications in general terms are of functional need: lack of ability to have a climax or ability to have one only with considerable difficulty; and an anatomic or mechanical factor that needs correction.
According to Dr. Rathmann, the two common problems that make the highly sensitive area of the clitoris unable to be stimulated are phimosis and redundancy. Sebaceous glands around the clitoris attempt to prevent adhesions of the prepuce to it. This sometimes fails and the clitoris is adheres tightly to the prepuce. This defect may range from 25% of the normal surface adherent to complete coverage. A prepuce for the protection of the clitoris is normal and useful, but if it is excessive and extends past the eminence of the clitoris it can prevent contact and is harmful. In general, the greater the degree of phimosis or redundancy, the greater the probability of satisfactory results by its correction.
Religious aspects of the practice
Whatever the origin of female circumcision, it did not originate in the Islamic tradition, contrary to popular belief. Both Muslims and Christians have circumcised their daughters since early times, and there is considerable evidence that the practice existed long before Christianity and Islam. There is no question that female circumcision preceded Islam in Africa.
In relation to Islam there are some sayings of the Prophet Muhammad (peace be upon him) which are interpreted differently by Islamic scholars. In one of these sayings the Prophet (PBUH) says to Umm Atteya, "If you circumcise do not go deep (i.e. do not encroach on the clitoris) because it would be useful to the wife and desirable to the husband ".
The majority of Islamic scholars doubt the authenticity of these hadiths. This view was supported by the recent declaration of the present Sheikh (head) of Al-Azhar, Sheikh Tantawi, basing his declaration on many references, old and new, and among them some eminent Islamic scholars such as Sheikh Shaltout, a previous head of Al-Azhar.
Another previous Sheikh of Al-Azhar, Sheikh Gad El-Haqq, was in favor of the authenticity of these hadiths and thus, favored circumcision, but on the condition that "it should not cut the clitoris or any part of it." "Only a part of the skin of the hood should be removed." "The operator should pay compensation if he removes or injures the clitoris".
The Health page of Islam-online does not address this subject to promote a certain opinion on the issue, whether for or against. However, we do feel that the public should know the different aspects on this issue.
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