From AWID: Female genital mutilation and cosmetic genital surgery: Do they have anything in common?

I've re-posted this from AWID. I have written about FGM before here and here and here.
Source: AWID, 11/02/2011 2:17 am

Credit: BlatantWorld

FRIDAY FILE: At first glance, female genital mutilation and genital surgery carried out for cosmetic purposes might seem intrinsically different. On closer examination, however, they may be more similar than they initially appear.

By Kathambi Kinoti

Female Genital Mutilation (FGM) is the centuries-old practice of removing part or all of the external genitalia of women. It is predominantly carried out in parts of Africa and the Middle East as a tool to control women’s sexuality. Genital cosmetic surgery is a modern practice that is undertaken, mainly by women, in order to improve the appearance of their genitalia. Although they are practices that have developed from very different premises, they share some commonalities.

Female Genital Mutilation

The World Health Organization (WHO) classifies the different forms of FGM as follows:

1. “Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
2. Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina).
3. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.
4. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. “

The harmful effects of FGM are numerous: shock, haemorrhage and sepsis are some of the immediate effects. Some girls and women bleed to death after undergoing the practices. In the long term, women can face infertility, obstructed labour during childbirth, obstetric fistula and other conditions.

FGM is recognized in international law as well as in the laws of several countries as a human rights violation, but it remains deeply entrenched in the cultures in which it is practised.

Labioplasty and other modern cosmetic procedures

In recent years there has been a dramatic increase in the number of women electing to undergo cosmetic surgery on their genitals in order to appear younger or more beautiful in modern youth- and beauty-obsessed cultures. Between 2004 and 2007 the number of labiaplasties in private hospitals the United Kingdom tripled, while there was an increase of almost 70 percent in public hospitals in the country between 2006 and 2008.[i]

Procedures include “reduction of the inner labia (labia minora), vaginal tightening, hymen ‘reconstruction,’ clitoral ‘lifts’ and liposuction of the mons veneris (fatty tissue over the pubic bone, these are performed in order to create a sense of proportion when the inner labia have been shortened) clitoral hood reductions and clitoral repositioning.” [ii]

Viv Groskop [iii] wrote of the rise in the numbers of women seeking cosmetic genital surgery: “In the vast majority of cases, labiaplasty is simply a response to the physical appearance of the labia, a desire for more ‘attractive’ genitalia.” Tracey Plowman, a social psychologist who reviewed the ‘The Perfect Vagina,’ a documentary filmed in the United Kingdom, says: “It is common for youth and beauty to be conflated in the world of cosmetic surgery… [and] female genital cosmetic surgery is no different.][iv]

Different but some commonalities

At a basic level, FGM and cosmetic female genital surgery are similar because they both involve modification to female genitalia and neither of them are performed for medically justifiable reasons (although in rare cases there are medical reasons for genital modification such as when girls are born with labia that have not developed properly). Both are performed based on cultural norms and expectations.

Any surgery or excision to the body comes with risks. These risks are on the whole much higher with FGM, since girls or women undergoing cosmetic genital surgery generally have access to top-notch medical facilities. In some contexts, FGM is now carried out by qualified medical doctors in hospitals, but the ‘medicalisation[v]’ of FGM has been strongly advocated against by international entities such as the World Health Organization and United Nations.

The primary difference between the procedures is consent. While cosmetic genital surgery is carried out on women who agree to the procedure, FGM is largely carried out on young girls who do not have the capacity to consent. There are, however, some women who elect to undergo FGM. But for women who consent to either procedure, their decision may not always be from a position of knowledge or power. What constitutes informed consent? Questions about how the practice of cosmetic surgery is regulated have been raised. Are the risks and possible complications of the surgery explained? Is it the knowledge that the procedure is unnecessary, or that they risk losing their lives from excessive bleeding? Or is it about understanding that human vulvas come in a variety of forms, and there is not an “ideal-looking” form?

The power of social pressure

FGM is a measure to curb women’s sexual desire, even though it is acknowledged that it does not always eliminate this desire. FGM is also a community affair. In many cultures there is a regular circumcision season during which girls who have attained a certain age collectively undergo rituals that “transform them into women.” These rituals involve the physical removal of parts of the genitalia, as well as the impartation of social and cultural mores that prepare them for womanhood in that community. Some societies that practice FGM do not require girls and women to undergo any particular ritual, but their state of being circumcised or uncircumcised is still considered the business of their communities. Not having undergone the cut isolates them and precludes them from marriage. FGM confers social status on many parties: parents, extended families, husbands, circumcisers and of course, women and girls themselves.

On the other hand cosmetic genital surgery is a measure that is regarded as improving women’s desirability. Although the choice to undergo the surgery may be an individual one, the suggestion that it is necessary originates in evolving societal values that define what desirable genitalia look like. The beauty industry, mainstream media and profit-making health care sector all collaborate to exert immense pressure on women to be youthful and beautiful according to rigid standards. Groskop quotes a gynaecologist, Dr Sarah Creighton who says that “women are aiming for a certain genital appearance that used to be an obligation only for some glamour models.” While it can be argued that women have the right to make decisions about their own bodies, the combination of actors influencing any woman’s decision to undergo this surgery makes it difficult to ascertain to what extent her choice is completely informed.

Sara Johnsdotter and Brigitta Essén [vi] argue that “procedures involving genital modifications are intertwined with political considerations; they are never purely about anatomy and physiology but are intrinsically entangled with cultural norms and ideology.” In the context of women’s bodies, these cultural norms and ideology give rise to notions about how women are expected to look. So a woman who elects to undergo cosmetic genital surgery may be unduly influenced to think that she needs to modify her body. In the case of FGM these cultural norms and ideology restrict women’s sexuality.

The harmfulness and pervasiveness of FGM should never be downplayed. Indeed, there is extensive work being done to eliminate FGM, and there has been some success even though the practice persists. It is also important to challenge modern ideologies that influence women to seek to modify their genitalia. Although the two practices may stem from different beliefs and have different effects, they both have roots in societal impositions on women’s bodies.

[i] “A cut too far: the rise in cosmetic surgery on female genitalia.” The Guardian, November 20, 2009. http://www.guardian.co.uk/lifeandstyle/2009/nov/20/cosmetic-vulva-surgery. Site accessed on February 7, 2011.

[ii] Johnsdotter, S and Essén, B. 2010: “Genitals and ethnicity: the politics of genital modifications.”Reproductive Health Matters 2010; 18 (35) 29-37.

[iii] See note ii.

[iv] Plowman, T. “The Perfect Vagina.”Reproductive Health Matters 2010; 18(35) 111-114.

[v] FGM provided by medical practitioners in order to make it safe – advocates cite the performance of this needless procedure on children as a violation of medical ethics. (Broken bodies broken dreams, 2005:52)

[vi] See note ii

Genital cutting in the news this month

Genitals have been on my mind a lot these past few months. Below are two stunning articles that emphasize the unfortunate misalignment in the discourse around genital cutting of boys versus genital cutting of girls. In an article from Friday, 18 June 2010, the headline reads "Circumcisions kill 20 boys in South Africa." This cutting has killed and disfigured boys, but we approach it with benign language. Why don't we speak out for these boys the way we speak out for girls who have been subjected to genital cutting? It's all mutilation in my book, and while a gendered approach permits important insights into social issues, we must avoid becoming blinded by gender bias.

Meanwhile, I want to draw your attention to the on-going gender mutilation that is occurring in the US. This article draws attention to the grisly, homophobic practices of Dr. Dix Poppas. Hilarious, unfortunate names aside, these baby girls' genitals are subject to the capricious, aesthetic bias of certain medical practitioners hacking away willy nilly at newborns' vulvae like some kind of postmodern Michelangelo. Abominable.

I've previously written about genital cutting here and here.

My father's insightful commentary on genital cutting

In response to my blog post Maternity, abuse, and genital mutilation, my father wrote the following (posted with permission):

My awesome dad had the following to say on this post:

Why is [circumcision] a celebration?

I agree and disagree with your blog. I don’t think women's genitalia should be cut ever!!! Not because of culture or religious reasons but I also don’t understand why they do it. If it has a legitimate medical benefit then maybe and only maybe, but absolutely not for some ritual that is outdated because they did it hundreds of years ago out of shear "cave man logic" ignorance. I guess there is a smegma issue with women and extra skin but I cant comment on that since I have no vagina to base an opinion on. [As a man, I am] not in a position to have an opinion on the female issue really.


As far as men go though, I am a man and have been around many other men who are and are not circumcised. I'm no expert and don’t claim to be, but I just cant imagine what benefit or why someone would want to leave the foreskin on a man's penis and I have no religious or other agenda behind my belief. The foreskin hangs and lays over the end of the penis, so much so on some men that it totally engulfs the end of the penis so you can't even see it. All that foreskin hanging over the end and closing shut for the better part of the day is nothing more than a smegma collection center, allowing germs to build up. When a man pees he merely shakes it and that is it, leaving the end the large majority of the time wet with pee. It's not shaken dry right after peeing. So, the [head of the penis] retracts wet and all that piss collects in the foreskin cave festering till shower time. Not too mention the men who probably take a shower and don’t bother to go out of their way to pull the foreskin back to wash it. I was never traumatized as a child because I simply had no mental clue what was going on when the circumcision was complete and I am so thankful not to have to deal with a foreskin all my life. One can also pee by the way and not even pull the foreskin back to do so and men do it, I've seen it done. I think some men go through childhood not being reinforced and taught the importance of foreskin management also. Anyhow, overall, it just makes decent common sense to remove it right at the time of birth and it's over forever. Waiting, I am definitely not a proponent of, at all.

I believe there are a gazillion men like me who have absolutely zero religious agenda and support no foreskin if given an option at birth. Don’t cut it later, do it before [the baby] comes home from the hospital for the very first time. Waiting would create a more stressful situation and then we have a whole new set of circumstances to deal with.

Of course, opinions are like butt holes, everyone has their own. With regards to men, I don't think there is a right and a wrong choice but I do firmly believe that eliminating foreskin at time of birth is a very good idea.

Again, not having a vagina and that whole experience eliminates me from being able to make a common sense judgment or opinion on what women should or shouldn’t do.

--end--

Oh that everyone without a vagina would leave vaginal decision-making to the vagina bearers. Thanks for sharing dad!

Maternity, abuse, and genital mutilation

In preparation for an upcoming event in Fes next month (Forum on Marginalised Women and Social Integration 11-13 March), I was exploring Prof. Fatima Sadiqi's website and her published work. That in turn led me to the maelstrom of fascination that is EBSCOhost and all of the wonders that it possesses. There I landed on an article by Drs Mustafa Afifi and Margareta von Bothmer called "Egyptian women’s attitudes and beliefs about female genital cutting and its association with childhood maltreatment" from the journal Nursing and Health Sciences (2007). I am the sort of person who sets aside articles on female genital cutting to read as a reward for getting work done…


My first encounter with an earnest activist against genital mutilation occurred during my final year at UMBC. A friend and fellow linguistics major espoused (and continues to espouse) an outspoken objection to male circumcision as genital mutilation. While I disagree with him that it is comparable to the most extreme form of female genital cutting or mutilation (which includes the partial or total removal of the labia and/or clitoris often along with the partial closing of the vaginal opening), I do agree that the decision to remove the foreskin of the penis is one that should not simply be standard protocol, as it currently is in the US and other countries. I furthermore disagree with the practice even as a religious tradition, but that point is beyond the scope of this entry.

After visiting Egypt the first time this summer, and staying 11 weeks in Cairo, I learned how widespread the practice of female genital cutting is in that country. Despite government action to make the practice illegal, as well as declarations from both Christian and Muslim religious authorities that the practice is not a part of religious protocol, it nonetheless continues. What is more, increasing attention to the issue has resulted in increased ‘medicalizing’ of the practice. Formerly, female genital cutting was carried out by traditionally trained female practitioners. Today the overwhelming majority of female cutting is carried out by formally trained medical professionals, often in hospitals.

The purpose of the article is to draw attention to the connection between abuse and female genital cutting. The conclusion is that women who are abused are more likely to abuse their children and to have their daughters’ genitals cut. The authors refer to previous research that has isolated another connection, between women who have had abortions and the likelihood that they will abuse their children.

***extrapolateextrapolateextrapolate***

Therefore the authors make the leap that these abortionists will also be more likely to have their daughters’ genitals cut. This notion rests on the assumption that abortions are traumatic events. The subtext is that women who have abortions experience guilt and shame because abortion is type of ‘trauma.’ The authors continue with the sentiment that “the woman ‘knows’ [emphasis by authors] subconsciously that her traumatic event (the abortion—clarified by me) must be exposed and understood to be conquered.” This statement is totally inscrutable to me. Why on earth must the so-called event be exposed and understood? Exposed to whom? Understood by whom? Even more absurdly the authors make the leap that if the psyches of women who have had abortions demand them to reenact the so-called trauma in the form of abusing their children, then likewise will women who have had their genitals cut be compelled to continue that practice, as well as other intentional abuses of their children.

Firstly, since abortion is illegal in Egypt, I can only assume that women who undergo abortions in Egypt have done so illegally. While I cannot account for the reasons behind the abortions, I might reasonably assume that they occur either to avoid the social stigma of pregnancy outside of marriage or to prevent the growth of households by eliminating potential members. In the latter case, the abortion, though illegal and thus carrying definite risk (medical and legal), is a manifestation of empowerment. It represents a woman’s control (in the face of legal, religious, and social constraints) over her own fertility, and may not actually accompany any sense of shame or trauma or guilt—why would it? It is disappointing that the researchers have chosen to reinforce the norm of abortion as a universally shameful act resulting in (what is assumed to be or ought to be) requisite guilt.

What IS this previous research? One of the articles in the bibliography that is provided as ‘previous research’ that proves the link between abortionists and child abuse is not academic scholarship but religious activism. Hosted by Heritage House 76, a Christian, anti-abortion organization is the sponsor of the the Elliot Institute, which hosts the article “Abortion Trauma and Child Abuse.” Together these sources present the damning reality of religious dogma and non-science appearing as legitimate academic material. Shocking.

Another citation of ‘proof’ is the result of a study whose sample was from Baltimore, a far cry from Egypt. The population consisted of women receiving public assistance who had had abortions in addition to carrying children to term. While this article is not a religious piece, it still does not account for the contextual peculiarities that govern the case of Egypt—where abortion is illegal and where women’s agency is far different than women’s agency in Baltimore (being a poor woman in Baltimore is worlds away from being any type of woman in Egypt). Thus the extrapolation of the conclusion is beyond weak.

I began reading this article out of curiosity, but before I had reached the halfway point, outrage and annoyance compelled me to continue avoiding my work once again and spell out my frustration. Integrity is everything in research. Cheating, plagiarizing, fudging data, and any number of other offenses severely degrade the quality of academic research. Writing that pretends to be research but is really activism disguised as scholarship is outrageous and offensive to critical thinking people. Activism posing as scientific data has no place in scholarly research. Admittedly the social sciences must avoid relativism in order to shed light on abhorrent phenomena that interfere with human dignity. Nonetheless, normative assessments must be tempered by frameworks that guarantee that we are not replacing dangerous relativism with equally dangerous religious or other philosophical bias.

In sum, we must allow social scientists to condemn abhorrent practices like female genital cutting without allowing items off of a religious agenda (like anti-abortion ideology) to sneak into the analysis.