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Ain't i a woman too? Challenging myths of sexual dysfunction in circumcised women
Abstract
That the external clitoris is key to women's sexual experience and liberation is as much a symbolic construction as the idea that its removal suppresses women's sexuality. As I hope this chapter has demonstrated, the signifi cance of the exterior clitoris is not so much its neurobiological value in purportedly enabling female sexual enjoyment or orgasm-the latter can be achieved without it as far as the medical as well as anecdotal evidence suggests. Rather, as many writers have noted, what is invested in the clitoris in contemporary Western societies is an all-important symbolic value signifying that women are capable of, have a right to, and can enjoy sexual pleasure with or, importantly, without a man. Thus, some "traditionalist" circumcised African women criticize Western women's rediscovery of the clitoris as a way to deemphasize the sacredness of marriage and promote sexual licentiousness in the guise of women's autonomy. This collection copyright
... Excision has been described as a practice that is personally meaningful in a ritual context as coming of age and the making of womanhood (Ahmadu 2007(Ahmadu , 2000Johnson 2000). However, Penda's father rejected the practice and thus she was cut secretly without his consent. ...
... For Penda, the awareness of the fact that all vulvas are anatomically different was a decisive factor against the operation as was her understanding that the appearance of her vulva may be just as unique before as after the operation, and that her potential lovers most likely would not notice the difference between an 'intact vulva' and a reconstructed clitoris. Ahmadu (2007) describes the sexual encounters of cut women with European men in the Gambia. In her ethnography, the Gambian women's sex partners could not tell the difference between women who had undergone the practice and those who had not. ...
... What is it that leads to this sense of feeling 'abnormal' , inferior and less sexually competent compared to unexcised women? We have argued that in places where FGC is a social norm, the practice is often associated with womanhood and gaining status and maturity within a given community (Ahmadu 2007(Ahmadu , 2000Leonard 2000). In contrast to this, Western discourses on the sexual 'mutilations' of black women commonly depict the 'cultures' of those who perform such practices as 'barbaric' , 'inhumane' , 'backward' and 'in need of ' development. ...
Growing numbers of women are showing interest in clitoral reconstructive surgery after ‘Female Genital Mutilation’. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become ‘whole again’ after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the ‘missing’ clitoris. Such beliefs are nourished by predominant discourses of cut women as ‘sexually mutilated’. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients’ mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy.
... Some studies have explored sexual problems in young women with FGM/C growing up in diaspora settings and in Burkina Faso, who were exposed to negative messages about FGM/C aimed at preventing the practice. These women reported more sexual problems (such as achieving pleasure or orgasm) in comparison with older women who were not exposed to such negative messages [22,[45][46]49]. This could be interpreted in at least two ways (and this is but one example of how sexual experiences and self-understandings may be influenced by the sociocultural context, as we hinted at above). ...
... The independent contribution of FGM/C to those negative outcomes, if any, is therefore not easy to determine. As noticed, many Western studies on sexual function of women affected by FGM/C focused on the genital cutting only [46], rather than looking holistically and considering the full range of potentially relevant factors. ...
... Accordingly, most experts agree that women's needs will often be better met by education to dispel misconceptions about sexual function, and psychosexual therapy to help them build a more positive relationship to their bodies, as well as physical and psychosexual therapy in cases of dyspareunia, than by additional cutting into their intimate anatomy. Thus, even when CR is medically indicated, for example, as a treatment for pain, it should be performed in association with psychosexual therapy [26,46]. ...
Introduction:
Clitoral reconstruction (CR) is a controversial surgical procedure performed for women who have undergone medically unnecessary, often ritualistic genital cutting involving the clitoris. Such cutting is known by several terms; we will use female genital mutilation/cutting (FGM/C). Treatments offered to women affected by complications of FGM/C include defibulation (releasing the scar of infibulation to allow penetrative intercourse, urinary flow, physiological delivery, and menstruation) and CR to decrease pain, improve sexual response, and create a pre-FGM/C genital appearance.
Aim:
In this study, our aim is to summarize the medical literature regarding CR techniques and outcomes, and stimulate ethical discussion surrounding potential adverse impacts on women who undergo the procedure.
Methods:
A broad literature review was carried out to search any previous peer-reviewed publications regarding the techniques and ethical considerations for CR.
Main outcome measure:
The main outcome measure includes benefits, risks, and ethical analysis of CR.
Results:
While we discuss the limited evidence regarding the risks and efficacy of CR, we did not find any peer-reviewed reports focused on ethical implications to date.
Clinical implications:
CR can be indicated as a treatment for pain and potential improvement of associated sexual dysfunction when these have not responded to more conservative measures. Women must be appropriately informed about the risks of CR and the lack of strong evidence regarding potential benefits. They must be educated about their genital anatomy and disabused of any myths surrounding female sexual function as well as assessed and treated in accordance with the current scientific evidence and best clinical practices.
Strength & limitations:
This is the first formal ethical discussion surrounding CR. This is not a systematic review, and the ethical discussion of CR has only just begun.
Conclusion:
We present a preliminary ethical analysis of the procedure and its potential impact on women with FGM/C. Sharif Mohamed F, Wild V, Earp BD, et al. Clitoral Reconstruction After Female Genital Mutilation/Cutting: A Review of Surgical Techniques and Ethical Debate. J Sex Med 2020;17:531-542.
... Adverse outcomes that have been associated with FGM/C of various types include obstetric, gynecologic, sexual, and psychologic harms to health and well-being [2]. Among those who endorse FGM/C, it is widely believed that the practice helps to imbue a sense of belonging, often related to cultural identity (e.g., ethnic, religious, or gender-based), while also increasing one's social status, respectability, and, among other things, perceived sexual virtue or desirability according to local standards (e.g., enhancing sexual power or agency in some groups; tempering "excess" sexual desire or promoting virginity in others) [3][4][5][6]. In any case, where FGM/C is a dominant social norm or seen as a prerequisite for important life goods (e.g., recognition as an adult, eligibility for marriage), a lack of FGM/C is often heavily stigmatized, with negative social consequences for challenging the practice or associated cultural scripts [7][8][9]. ...
... Perceived social support was measured using the Multidimensional Scale of Perceived Social Support [46], which included twelve 5-point Likert questions representing three subscales of support sources including perceived support from [1] a significant other [2], family, and [3] friends. The validity of this scale has been confirmed among other immigrant and refugee populations, including most recently Chin-Burmese refugees [47] and Arab American immigrant women [48]. ...
While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women’s health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, ( n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among ‘No FGM/C’ (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the ‘quadruple jeopardy’ of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination—and not FGM/C status per se—is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.
Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649
... Studies show that the performance of the practice and its meaning changes in the diaspora and many come to completely reject and abandon it [3][4][5][6][7][8][9]. For some, however, the practice is highly cherished or symbolically meaningful, for various reasons including religious belief or perception of women's increased value in marriage [10][11][12][13][14]. In an attempt to deter parents from performing invasive types of FGC, clinicians across different countries, and in 2010 the American Academy of Paediatricians, had suggested that alternative rituals such as pricking, nicking or other symbolic forms of FGC 4 might be considered [15][16][17]. ...
... You have a freedom of choice if you have capacity for consent to do what you wish with your own body". 10 This case makes plain that the consent of a British adult woman of non-migrant background bears more weight in the legal defence in court than the actual formulation of the legislation. ...
Purpose of Review
Based on the discussions of a symposium co-organized by the Université Libre de Bruxelles (ULB) and the University of Lausanne (UNIL) in Brussels in 2019, this paper critically reflects upon the zero-tolerance strategy on “Female Genital Mutilation” (FGM) and its socio-political, legal and moral repercussions. We ask whether the strategy is effective given the empirical challenges highlighted during the symposium, and also whether it is credible.
Recent Findings
The anti-FGM zero-tolerance policy, first launched in 2003, aims to eliminate all types of “female genital mutilation” worldwide. The FGM definition of the World Health Organization condemns all forms of genital cutting (FGC) on the basis that they are harmful and degrading to women and infringe upon their rights to physical integrity. Yet, the zero-tolerance policy only applies to traditional and customary forms of genital cutting and not to cosmetic alterations of the female genitalia. Recent publications have shown that various popular forms of cosmetic genital surgery remove the same tissue as some forms of “FGM”. In response to the zero-tolerance policy, national laws banning traditional forms of FGC are enforced and increasingly scrutinize the performance of FGC as well as non-invasive rituals that are culturally meaningful to migrants. At the same time, cosmetic procedures such as labiaplasty have become more popular than ever before and are increasingly performed on adolescents.
Summary
This review shows that the socio-legal and ethical inconsistencies between “FGM” and cosmetic genital modification pose concrete dilemmas for professionals in the field that need to be addressed and researched.
... We have followed the path of many anthropologists, in that context is considered the main parameter for the construction of sexuality. [18][19][20] The existing literature on FGM/C and sexuality, published from 1965 until today, mostly since the early 1990s, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] is conflicting regarding the effects of FGM/C on sexual feelings. Several socioanthropological studies over the past 20 years have challenged what they call the "western assumption"* that the clitoris is key to female sexual response, and that FGM/C has a negative effect on sexual feelings. ...
... Several socioanthropological studies over the past 20 years have challenged what they call the "western assumption"* that the clitoris is key to female sexual response, and that FGM/C has a negative effect on sexual feelings. [21][22][23][24][25][26][27][28] An extensive literature review, conducted by Obermeyer et al on FGM/C and sexuality, published in 1999, concluded: ...
Female genital mutilation/cutting (FGM/C), officially referred to as female circumcision and at community level as tahara (cleanliness), is still prevalent in Egypt. This study was designed to examine the role of female sexuality in women's and men's continued support for FGM/C, and their perceptions of its sexual consequences. The study was conducted in 2008–09 in two rural communities in Upper Egypt and a large slum area in Cairo. Qualitative data were collected from 102 women and 99 men through focus group discussions and interviews. The clitoris was perceived to be important to, and a source of, sexual desire rather than sexual pleasure. FGM/C was intended to reduce women's sexual appetite and increase women's chastity, but was generally not believed to reduce women's sexual pleasure. Men and women framed sexual pleasure differently, however. While men, especially younger men, considered sexual satisfaction as a cornerstone of marital happiness, women considered themselves sexually satisfied if there was marital harmony and their socio-economic situation was satisfactory. However, sexual problems, including lack of pleasure in sex and sexual dissatisfaction, for whatever reasons, were widespread. We conclude that political commitment is necessary to combat FGM/C and that legal measures must be combined with comprehensive sexuality education, including on misconceptions about FGM/C.
Résumé
La mutilation sexuelle féminine/excision (MSF), appelée aussi circoncision féminine et tahara (purification) au niveau communautaire, est encore très répandue en Égypte. Cette étude avait pour but d'examiner le rôle de la sexualité féminine dans le soutien qu'hommes et femmes continuent d'apporter à cette pratique, et leurs perceptions de ses conséquences sexuelles. L'étude a été réalisée en 2008–09 dans deux communautés rurales de Haute-Égypte et un vaste bidonville du Caire. Des données qualitatives ont été recueillies auprès de 102 femmes et 99 hommes par des entretiens et des discussions en groupes d'intérêt. Le clitoris était jugé important et source de désir sexuel plutôt que de plaisir sexuel. La MSF servait à réduire l'appétit sexuel des femmes et favoriser leur chasteté, mais en général, on ne pensait pas qu'elle réduisait le plaisir sexuel féminin. Néanmoins, les hommes et les femmes concevaient différemment le plaisir sexuel. Alors que les hommes, en particulier les plus jeunes, considéraient la satisfaction sexuelle comme la clé de voûte du bonheur conjugal, les femmes s'estimaient sexuellement satisfaites si l'harmonie régnait dans leur ménage et si leur situation socio-économique était bonne. Les problèmes sexuels, notamment le manque de plaisir pendant les rapports et l'insatisfaction sexuelle, toutes raisons confondues, étaient cependant fréquents. Nous en concluons qu'un engagement politique est nécessaire pour lutter contre la MSF et qu'il faut associer des mesures juridiques à une éducation sexuelle complète, y compris sur les idées fausses relatives à la MSF.
Resumen
La ablación o mutilación genital femenina (MGF), oficialmente conocida como circuncisión femenina y a nivel comunitario como tahara (aseo), aún es frecuente en Egipto. Este estudio fue diseñado para examinar el papel de la sexualidad femenina en el continuo apoyo de la MGF por hombres y mujeres, y sus percepciones de sus consecuencias sexuales. El estudio fue realizado en 2008–09 en dos comunidades rurales en Alto Egipto y en una amplia zona de barrios bajos del Cairo. Se recolectaron datos cualitativos de 102 mujeres y 99 hombres, por medio de discusiones en grupos focales y entrevistas. El clítoris era percibido como algo importante para el deseo sexual y como una fuente de deseo sexual en vez de placer sexual. La MGF tenía como objetivo reducir el apetito sexual de las mujeres y aumentar su castidad, pero generalmente no se consideraba como algo para disminuir el placer sexual de las mujeres. No obstante, la definición de placer sexual ofrecida por los hombres era distinta a la de las mujeres. Mientras que los hombres, especialmente los más jóvenes, consideraban la satisfacción sexual como algo fundamental para la felicidad matrimonial, las mujeres se consideraban sexualmente satisfechas si había armonía conyugal y su situación socioeconómica era satisfactoria. Sin embargo, los problemas sexuales como la falta de placer sexual y la insatisfacción sexual, por las razones que fueran, eran extendidos. Concluimos que el compromiso político es necesario para combatir la MGF y que las medidas jurídicas se deben combinar con una educación sexual integral, que aborde las ideas erróneas respecto a la MGF.
... Psychosexual health problems include symptoms of anxiety, depression, dyspareunia, lack of sexual desire and reduced sexual satisfaction [19,[24][25][26][27][28][29][30]. Nevertheless, there is increasing evidence that the association between FGC and adverse psychosexual health outcomes is context-dependent [12,27,[31][32][33][34][35]. In contexts where FGC is positively regarded, as it is often the case in FGC high prevalent countries, women and girls who underwent FGC are less likely to complain of psychosexual health problems. ...
... In contexts where FGC is positively regarded, as it is often the case in FGC high prevalent countries, women and girls who underwent FGC are less likely to complain of psychosexual health problems. In contrast, women and girls who underwent FGC and then migrated to Western countries, where FGC is negatively regarded, are more likely to report psychosexual problems [27,[31][32][33][34][35]. ...
Background: Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway.
Methods: We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants.
Findings: We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants’ intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms.
Conclusion: The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.
... Quite some scholars have compared this practice to FC (Ahmadu, 2007;Davis, 2002;Johnsdotter & Essén, 2010;Ogunyemi, 2003). ...
... Similarly, other scholars challenge the myth of not being able to enjoy sex after loss of the clitoris through FC (Ahmadu, 2007;Dopico, 2007;Johansen, 2007;Njambi, 2009). ...
Through an analysis on the Western-based discourse on 'African'-assumed Female Circumcision ("FC" hereinafter), this thesis suggests that the controversiality of this issue allows for an uncriticized re-inscription of culture, which falls along the lines of a colonial imperialism. Several sub-narratives of this re-inscription are critically examined and debunked. Simultaneously, stereotypical narratives of the Other in the case of FC are disqualified. Through the disclosure of colonial roots operating in relation to FC, this thesis hopes to do its part in clearing up analytical confusions operative in (some) current scientific work on this topic, which are not addressed because the knowledge they propose is seen as 'self-evident.' Data was acquired through advice from several teachers and careful analysis of footnotes in books and articles on FC. Data was analyzed in a qualitative manner, through thematic analysis.
... Other men had not had sexual experience with uncut women or reported that they had not noticed a difference and said it was impossible for a man to tell if his partner was cut or not. This finding is in line with Ahmadu (2007) whose ethnographic research in the Gambia showed that men often cannot tell the difference between cut and uncut women during sex (Ahmadu 2007). As we have no information regarding the type of FGM the women who these men had sex with had undergone, it is not possible to draw further conclusions on this. ...
... Other men had not had sexual experience with uncut women or reported that they had not noticed a difference and said it was impossible for a man to tell if his partner was cut or not. This finding is in line with Ahmadu (2007) whose ethnographic research in the Gambia showed that men often cannot tell the difference between cut and uncut women during sex (Ahmadu 2007). As we have no information regarding the type of FGM the women who these men had sex with had undergone, it is not possible to draw further conclusions on this. ...
A mixed methods study exploring men’s involvement in Female Genital Mutilation in Belgium, the Netherlands and the United Kingdom
... In Southwestern Nigeria, the cutting coincides with the naming ceremony of the baby girl, while in the Southeast, a girl who has just undergone the procedure is provided with special food, is allowed to rest for a whole week, and is surrounded by girls who have had FGM/C dressed in colourful clothes (Anuforo et al., 2004). In Sierra Leone, the cutting is part of an initiation process into secret societies, in which the girls are taken into the forest for several weeks (Ahmadu, 2000(Ahmadu, , 2007Kallon & Dundes, 2010). Leaders of the society emphasize that the essence of the process is to give the girls a sense of belonging. ...
... Leaders of the society emphasize that the essence of the process is to give the girls a sense of belonging. Ahmadu (2000Ahmadu ( , 2007 provides further insights into FGM/C, to which she refers as ''circumcision'' in her writing as an insider from an ethnic group where FGM/C is entrenched and as an intellectual and anthropologist who has experienced FGM/C personally. She emphasizes that the female secret society promotes peace through marriages, sexual conduct, fertility, and reproduction. ...
Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions.
... How this relates to FGC is complex. In addition to differences in type of FGC performed across cultures (Table 1), the root causes, symbolic meanings, social or religious connotations, and parental motivations for genital cutting of children or adolescents may also differ substantially (Earp & Steinfeld, 2018; see also Abdulcadir et al., 2012;Ahmadu, 2000Ahmadu, , 2007Dellenborg, 2007;Earp, 2016a;Earp & Steinfeld, 2017;Leonard, 2000aLeonard, , 2000bManderson, 2004;Shell-Duncan & Hernlund, 2000;Shweder, 2000Shweder, , 2013Walley, 1997). Contrary to the oftensimplistic Western stereotypes about African, Southeast Asian, and Middle Eastern forms of FGC, these causes, meanings, connotations, and parental motivations are not necessarily tied to patriarchal dominance of women by men (Abdulcadir et al., 2012;Baumeister & Twenge, 2002;Shell-Duncan, Moreau, Smith, & Shakya, 2018), nor to an urge to limit specifically female sexual desire or pleasure (Ahmadu, 2007;Ahmadu & Shweder, 2009;Earp, 2015b;Leonard, 2000aLeonard, , 2000bWade, 2012). ...
... In addition to differences in type of FGC performed across cultures (Table 1), the root causes, symbolic meanings, social or religious connotations, and parental motivations for genital cutting of children or adolescents may also differ substantially (Earp & Steinfeld, 2018; see also Abdulcadir et al., 2012;Ahmadu, 2000Ahmadu, , 2007Dellenborg, 2007;Earp, 2016a;Earp & Steinfeld, 2017;Leonard, 2000aLeonard, , 2000bManderson, 2004;Shell-Duncan & Hernlund, 2000;Shweder, 2000Shweder, , 2013Walley, 1997). Contrary to the oftensimplistic Western stereotypes about African, Southeast Asian, and Middle Eastern forms of FGC, these causes, meanings, connotations, and parental motivations are not necessarily tied to patriarchal dominance of women by men (Abdulcadir et al., 2012;Baumeister & Twenge, 2002;Shell-Duncan, Moreau, Smith, & Shakya, 2018), nor to an urge to limit specifically female sexual desire or pleasure (Ahmadu, 2007;Ahmadu & Shweder, 2009;Earp, 2015b;Leonard, 2000aLeonard, , 2000bWade, 2012). Instead, genital cutting practices affecting children of all sexes are undertaken for a wide variety of reasons across societies, with many, if not most, of these reasons construed as positive or affirming in the local social ontologies (Androus, 2013;Shweder, 2013;Svoboda, 2013;Vissandjée, Denetto, Migliardi, & Proctor, 2014). ...
I elaborate on one of the key psychosocial considerations raised by Connor et al. (2019), namely the potentially stigmatizing nature of much current activist, academic, and social-policy discourse surrounding non-Western forms of FGC. I explore how this discourse may, at least along certain dimensions, inadvertently harm the very people it is intended to help, focusing on possible implications for sexual experience. Mindful of this concern, I conclude with some suggestions for how ethical opposition to FGC can be grounded in a principled way that does not further stigmatize individuals who have already been affected by non-consensual, medically unnecessary genital cutting.
... Studies have shown that being confronted with stigmatising attitudes towards one's body may impair body image in women and girls with FGC. 1,4 Increased attention is being placed on how professionals can provide empirically grounded, sensitive, and holistic care and support for girls and women with FGC without contributing to stigmatisation and impaired selfesteem. 5,6 Sexual health counselling is an arena in which norms and values about sexuality, body, and health are communicated and negotiated, and where both the provider and the recipient enter the conversation with their own specific set of ideas, experiences, and assumptions. ...
... Instead, genital modifications are typically associated with values such as enhanced femininity, adherence to aesthetic ideals, and improved status as a woman. 1,3,18,23,24 Research shows that psychological expectations play a determinant role for sexual wellbeing: anxiety over one's body or the outcome of sexual activity are major influences on sexual inhibition. 25,26 This has important implications for professionals' encounters, especially with sexually inexperienced women, as they are in a state of developing their own sexual self-image; young women with FGC who are resident in Western countries live in a society that is openly opposed to the practice and tells them that they are "mutilated" and deprived of their ability to ever enjoy sex. ...
Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called "the FGM standard tale". The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia's role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual's body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.
... Some research documents that FGC decreases women's sexual satisfaction, orgasm frequency, and sexual desire (Alsibiani & Rouzi, 2010;Andersson, Rymer, Joyce, Momoh, & Gayle, 2012;Anis et al., 2012;Berg & Denison, 2012). In contrast, other research documents no association between women who underwent FGC and the occurrence of premarital sex or sexual satisfaction (Ahmadu, 2007;Catania et al., 2007;Makhlouf Obermeyer, 2005;Van Rossem & Gage, 2009). These measures (e.g., premarital sex, sexual satisfaction, and orgasm frequency) do not fully capture many important aspects of sociosexuality-defined by Simpson and Gangestad (1991) as individual differences in willingness to engage in uncommitted sexual relations. ...
... One of the major motivations for FGC is to ensure that a woman will be uninterested in sexual relationships outside marriage (Skaine, 2005;WHO, 2014), although most Igbo women seem to be unaware of this (Adinma & Agbai, 1999). Studies demonstrating that women who have undergone FGC have lower sexual satisfaction provide some indirect evidence for this idea (Alsibiani & Rouzi, 2010;Andersson et al., 2012;Anis et al., 2012;Berg & Denison, 2012; but see Ahmadu, 2007;Catania et al., 2007;Makhlouf Obermeyer, 2005), but no direct test of this question has been made. ...
Female genital cutting (FGC) involves partial or total removal of the external female genitalia and causes detrimental effects on woman’s physical and psychological health. Estimates suggest that 130 million women and girls have experienced FGC worldwide. A frequently cited reason for performing this procedure is to restrict female sexuality. To test this idea, we examined women’s willingness to engage in uncommitted sexual relations (sociosexuality) among the traditional Igbo community in Southeastern Nigeria, a region in which FGC is prevalent. Women with FGC reported more restricted sociosexuality in all three domains (attitude, behavior, and desire) compared to women without FGC. Our results suggest that FGC significantly restricts female extra-pair behavior. We provide evidence that this practice is partially attributable to sexual conflict over reproduction by decreasing paternity uncertainty and increasing the reproductive costs to women.
... For example, those subjected to the most extensive form often require surgical intervention (deinfibulation) to facilitate sexual intercourse and childbirth [16,17]. Moreover, recent evidence indicates that girls and women subjected to FGC, who live in a context where the majority condemn FGC, such as Western countries, are more likely to report psychosexual problems than those in countries of origin [10,[18][19][20][21][22]. Consequently, many Western countries have established FGC specialized clinics to meet their affected immigrant population's potential healthcare needs [23]. ...
Background
Female genital cutting (FGC) may cause a series of health problems that require specialized healthcare. General practitioners (GPs) are gatekeepers to specialized healthcare services in Norway. To refer girls and women subjected to FGC to appropriate services, GPs need to assess whether the health problems reported by these patients are related to FGC. However, we do not know to what degree GPs assess FGC as a potential cause of the patients' health problems. We also know little about the GPs' patterns of training and knowledge of FGC and their effect on the GPs' assessment of FGC as a potential cause of health problems.
Method
We employed a cross-sectional online survey among GPs in Norway to examine: 1) patterns of received training on FGC, self-assessed knowledge, and experiences with patients with FGC-related problems and 2) the association between these three factors and the GPs' assessment of FGC as a potential cause of patients' health problems. A total of 222 GPs completed the survey. Data were analysed using binary logistic regression, where we also adjusted for sociodemographic characteristics.
Results
Two-third of the participants had received training on FGC, but only over half received training on FGC-related health problems. Over 75% of the participants stated a need for more knowledge of FGC typology and Norwegian legislation. While the majority of the participants assessed their knowledge of FGC medical codes as inadequate, this was not the case for knowledge of the cultural aspects of FGC. Female GPs were more likely to have experience with patients with FGC-related health problems than male GPs. Among GPs with experience, 46% linked health problems to FGC in patients unaware of the connection between FGC and such health problems. GPs were more likely to assess FGC as a potential cause of health problems when they had experience with patients having FGC-related problems and when they assessed their knowledge of FGC typology and FGC-related medical codes as adequate.
Conclusion
To improve their assessment of FGC as a potential cause of patients' health problems, GPs should receive comprehensive training on FGC, with particular emphasis on typology, health problems, and medical codes.
... At the same time, Somali women and men generally perceive types of FGC that remove all or parts of the external clitoris, commonly referred to as Sunna circumcision, as having few negative consequences for women's health and sexuality, at least compared to infibulation (Johansen, 2022). A disregard of the possible harm of clitorectomy on sexual function has also been demonstrated among researchers and healthcare workers (Dellenborg, 2004;Ahmadu, 2007;Ahmadu and Shweder, 2009;Jordal et al., 2020). Swedish gynecologists refuting the negative effect of the clitorectomy on women's sexual function (Jordal et al., 2020) highlight the internal structures of the clitoris, and thus perceive it impossible to "cut" the clitoris in any substantial way, as most of the clitoral organ will remain under the surface and be accessible to stimulation through the vagina (O'Connell et al., 1998). ...
Female genital cutting (FGC) is a traditional practice, commonly underpinned by cultural values regarding female sexuality, that involves the cutting of women's external genitalia, often entailing the removal of clitoral tissue and/or closing the vaginal orifice. As control of female sexual libido is a common rationale for FGC, international concern has been raised regarding its potential negative effect on female sexuality. Most studies attempting to measure the impact of FGC on women's sexual function are quantitative and employ predefined questionnaires such as the Female Sexual Function Index (FSFI). However, these have not been validated for cut women, or for all FGC-practicing countries or communities; nor do they capture cut women's perceptions and experiences of their sexuality. We propose that the subjective nature of sexuality calls for a qualitative approach in which cut women's own voices and reflections are investigated. In this paper, we seek to unravel how FGC-affected women themselves reflect upon and perceive the possible connection between FGC and their sexual function and intimate relationships. The study has a qualitative design and is based on 44 individual interviews with 25 women seeking clitoral reconstruction in Sweden. Its findings demonstrate that the women largely perceived the physical aspects of FGC, including the removal of clitoral tissue, to affect women's (including their own) sexual function negatively. They also recognized the psychological aspects of FGC as further challenging their sex lives and intimate relationships. The women desired acknowledgment of the physical consequences of FGC and of their sexual difficulties as “real” and not merely “psychological blocks”.
... Numerous scholars have argued that this selective focus reflects moral double standards rooted in racism and cultural imperialism (Gunning, 1991;Obiora, 1996;Tangwa, 1999;Ahmadu, 2000Ahmadu, , 2007Ahmadu, , 2016bMason, 2001;Shweder, 2002Shweder, , 2013Njambi, 2004;Ehrenreich and Barr, 2005;Oba, 2008;Dustin, 2010;Smith, 2011;Kelly and Foster, 2012;Boddy, 2016Boddy, , 2020Onsongo, 2017;Shahvisi, 2017Shahvisi, , 2021Shahvisi and Earp, 2019). Some have therefore called on the WHO to revise its policy: either by including Western-associated 5 so-called "cosmetic" female genital surgeries in the campaign against "FGM" (Esho, 2022), or by establishing an age limit or consent criterion for FGC to be applied without discrimination or favor (Dustin,3 For the purposes of this paper, an intervention to alter a bodily state is medically necessary "when (1) the bodily state poses a serious, time-sensitive threat to the person's well-being, typically due to a functional impairment in an associated somatic process, and (2) the intervention, as performed without delay, is the least harmful feasible means of changing the bodily state to one that alleviates the threat" (BCBI, 2019) (p. ...
The World Health Organization (WHO) condemns all medically unnecessary female genital cutting (FGC) that is primarily associated with people of color and the Global South, claiming that such FGC violates the human right to bodily integrity regardless of harm-level, degree of medicalization, or consent. However, the WHO does not condemn medically unnecessary FGC that is primarily associated with Western culture, such as elective labiaplasty or genital piercing, even when performed by non-medical practitioners (e.g., body artists) or on adolescent girls. Nor does it campaign against any form of medically unnecessary intersex genital cutting (IGC) or male genital cutting (MGC), including forms that are non-consensual or comparably harmful to some types of FGC. These and other apparent inconsistencies risk undermining the perceived authority of the WHO to pronounce on human rights. This paper considers whether the WHO could justify its selective condemnation of non-Western-associated FGC by appealing to the distinctive role of such practices in upholding patriarchal gender systems and furthering sex-based discrimination against women and girls. The paper argues that such a justification would not succeed. To the contrary, dismantling patriarchal power structures and reducing sex-based discrimination in FGC-practicing societies requires principled opposition to medically unnecessary, non-consensual genital cutting of all vulnerable persons, including insufficiently autonomous children, irrespective of their sex traits or socially assigned gender. This conclusion is based, in part, on an assessment of the overlapping and often mutually reinforcing roles of different types of child genital cutting—FGC, MGC, and IGC—in reproducing oppressive gender systems. These systems, in turn, tend to subordinate women and girls as well as non-dominant males and sexual and gender minorities. The selective efforts of the WHO to eliminate only non-Western-associated FGC exposes the organization to credible accusations of racism and cultural imperialism and paradoxically undermines its own stated goals: namely, securing the long-term interests and equal rights of women and girls in FGC-practicing societies.
... This is because there are in a position to communicate directly with affected community members. (Ahmadu, 2007). ...
This study examined Southeast State residents’ perception of broadcast media coverage of “unknown” gun men activities in Southeast Nigeria. The objectives were to: Determine the root cause of “unknown” Gun men activities in the Southeast Nigeria; ascertain the impact of the “unknown” Gun men activities on the Southeast Nigeria residents; find how effectively broadcast media has covered their activities; and ascertain whether broadcast stations have displayed high level of accuracy, truth and fairness in reporting the unknown gun men activities. The study was anchored on the Perception theory. Survey method was adopted. A sample size of 385 was drawn from a population of 1, 403,972 using the Australian Calculator. Multi-stage sampling technique was used. Findings revealed that bad governance is the root cause of the unknown gun men activities in Southeast of Nigeria; unknown gun men negatively impacted on the residence; broadcast media have not adequately reported the activities of “unknown” gun men attacks in Southeast Nigeria, and that the broadcast media have not displayed high level of accuracy, truth and fairness in reporting the unknown gun men activities. It recommended that good governance is important to ensure national security; that since there can be no economic growth in Nigeria amidst insecurity challenges, there is need for the public to cooperate with government and security agencies to apprehend those behind the insecurity; the Nigerian broadcast media must imperatively recognize the surveillance function of the media; the broadcast media stations in Nigeria should embrace objectivity in their reportage of events.
Keywords: Assessment, Residents, Perception, Media Coverage, “Unknown” Gun Men.
... The complex reasons for which the practice is performed and its meaning within the social context have also been largely discussed (Boddy, 1989;Gruenbaum, 2001;Shell-Duncan & Hernlund, 2000;Shell-Duncan et al., 2011). Commonly mentioned reasons for practising are linked to various forms of control of female sexuality-such as to prevent debauchery and promiscuity, and to ensure virginity before marriage and marital fidelity (Boddy, 1989;Fahmy et al., 2010;Hosken, 1993;O'Neill, 2018;Shell-Duncan & Hernlund, 2000); due to conceptions of purity and aesthetics (Boddy, 1989;Fahmy et al., 2010;O'Neill, 2018); as a way to mark coming of age and status change within the community (Ahmadu, 2000(Ahmadu, , 2007Leonard, 2000); and for religious reasons due to the belief that the practice is a religious recommendation (Abu-Salieh, 2001;Isa et al., 1999;Johnson, 2000;Merli, 2010) even though FGM is not formally prescribed by any religion. ...
he health consequences of female genital mutilation (FGM) have been described previously; however, evidence of the social consequences is more intangible. To date, few systematic reviews have addressed the impact of the practice on psycho-social well-being, and there is limited understanding of what these consequences might consist. To complement knowledge on the known health consequences, this article systematically reviewed qualitative evidence of the psycho-social impact of FGM in countries where it is originally practiced (Africa, the Middle East, and Asia) and in countries of the diaspora. Twenty-three qualitative studies describing the psycho-social impact of FGM on women’s lives were selected after screening. This review provides a framework for understanding the less visible ways in which women and girls with FGM experience adverse effects that may affect their sense of identity, their self-esteem, and well-being as well as their participation in society.
... In many places where FGM is performed it is a social norm and endorsed as a traditional, ritual or religious practice, although FGM is not formally prescribed by any religion. Commonly mentioned reasons for practising are control of female sexuality-such as to ensure virginity before marriage and marital fidelity [2][3][4][5]; conceptions of purity and aesthetics [2,5,6]; or as a way to mark coming of age and status change within the community [7][8][9]. Guinea has a high prevalence of FGM, as 95% of women have undergone this practice, with 65% occuring between the ages of five to fourteen years with a peak between the ages of five to nine years (37%) [10]. According to the Demographic Health Survery 2018, 58% of women have undergone Type I or II FGM, 10% reported infibulation (type III) and 11% Type IV [10]. ...
Background
Guinea has a high prevalence of female genital mutilation (FGM) (95%) and it is a major concern affecting the health and the welfare of women and girls. Population-based surveys suggest that health care providers are implicated in carrying out the practice (medicalization). To understand the attitudes of health care providers related to FGM and its medicalization as well as the potential role of the health sector in addressing this practice, a study was conducted in Guinea to inform the development of an intervention for the health sector to prevent and respond to this harmful practice.
Methodology
Formative research was conducted using a mixed-methods approach, including qualitative in-depth interviews with health care providers and other key informants as well as questionnaires with 150 health care providers. Data collection was carried out in the provinces of Faranah and Labé and in the capital, Conakry.
Results
The majority of health care providers participating in this study were opposed to FGM and its medicalization. Survey data showed that 94% believed that it was a serious problem; 89% felt that it violated the rights of girls and women and 81% supported criminalization. However, within the health sector, there is no enforcement or accountability to the national law banning the practice. Despite opposition to the practice, many (38%) felt that FGM limited promiscuity and 7% believed that it was a good practice.
Conclusion
Health care providers could have an important role in communicating with patients and passing on prevention messages that can contribute to the abandonment of the practice. Understanding their beliefs is a key step in developing these approaches.
... Mi percepción, tras escuchar y leer a F. Ahmadu, es que las reacciones de rechazo extremo de muchos occidentales a la idea de la remoción ritualista de cualquier tejido genital femenino parten de comprensiones parroquiales y prejuicios y valores perfectamente cuestionables sobre el cuerpo, el género, el sexo, y el dolor. Su arbitrariedad se hace manifiesta a la luz de la investigación clínica y del punto de F. Ahmadu (2007) y R. A. Shweder (2002 de que hay muy pocas protestas en occidente contra lo que podría llamarse la Mutilación Genital Masculina -la circuncisión de los hombres. A muchos occidentales les resulta fácil aceptar el "hecho" de que esta sea una práctica sa ludable, higiénica e incluso estéticamente agradable de nuestras sociedades o, por lo menos, que no sea una práctica éticamente cuestionable. ...
Este ensayo es una respuesta positiva del autor, un antropólogo con experiencia en otros temas, a una ponencia y varios escritos de la antropóloga sierraleonesa y estadinense del Dr. Fuambai Ahmadu sobre el tema de la circuncisión femenina en África. Persuadido por los argumentos de Ahmadu, el autor arguye que parte de las percepciones y de la retórica de los movimientos anti MGF (anti mutilación genital femenina) son parroquiales y no liberales y hace un llamado para que antropólogos, y otros, acepten la prescripción metodológica de nuestra disciplina de prestar atención cuidadosa y a lo largo de un buen período de tiempo, a lo que la gente sobre quien escribimos dice y hace. Además, de ser críticos con nuestras propias premisas y creencias, antes de adoptar cualquier causa supuestamente liberal que busque erradicar o establecer esta o aquella práctica social.
... Their lack of prejudice even makes them suggest that the diversity of genital appearance should be framed as healthy and beautiful. This is a crucial message in a time when global anti-FGM activism, ubiquitous in Western host countries, sends messages telling migrated girls and women with FGC that they are "mutilated," disfigured, and not fully feminine (for critical discussions of this state of affairs, see, e.g., Ahmadu, 2007;Catania, Abdulcadir, Puppo, Verde, Abdulcadir, & Abdulcadir, 2007;Johnsdotter, 2020;Johnsdotter & Essén, 2015;Johnson-Agbakwu & Warren, 2017;Malmström, 2013;Villani, 2009). ...
... On the other hand, some studies have revealed divergent views on the role of the clitoris in sexual pleasure, women's ambivalence toward sexual pleasure as a procreative value of sexuality, as well as women who privilege their husband's sexual satisfaction over their own (Ahmadu, 2007;Dopico, 2007). A study of the association between genital cutting and sexual morbidity in Nigeria, for example, revealed that the practice did not appear to affect sexual functioning and enjoyment (Okonofua, Larsen, Oronsaye, Snow, & Slanger, 2002). ...
Purpose
The purpose of this study was to perform a scoping review to identify validated instruments used to measure sexual health and wellbeing among women who have undergone FGM/C and assess their strengths and limitations.
Method
A systematic search of several databases and search engines retrieved studies that described measures of sexual health and wellbeing among women who have undergone FGM/C and their validation studies retrieved. Measurement properties were evaluated and entered into evidence tables.
Results
The search retrieved 20 studies that met the inclusion criteria with a total of 13 measurement instruments identified for evaluation. Important thematic deficiencies were identified such as a lack of: input from the target population during instrument development, consideration of literacy levels required for the target population to adequately respond to the items, description on handling of missing responses, and limited use of multiple subscales that assess different aspects of sexual health and wellbeing.
Conclusions
Results underscore the need to develop and (re)validate instruments that can be used to evaluate the sexual health and wellbeing of women who have undergone FGM/C evaluating broader aspects of sexuality such as intrapersonal, interpersonal and socio-cultural factors.
... Sexual function rules the day, as it did in the Magennis and Vaziri case [24], unsurprisingly in a contemporary western world so focused on sexuality and sexual pleasure as the lightning rod of agency [25]. The reduction of sexual pleasure, however, is clearly debatable for many cultures (and indeed for many women) [5,[26][27][28][29]. The weight of this function, as well as its presumptive tie-at least in many cultural constructions, to the natural function of the woman to engage in heterosexual intercourse (which may or may not produce children)means that woman cannot be functional as woman 2 if she is thus mutilated. ...
Purpose of Review
In 2019, the highest court in Australia is deliberating on the question of what constitutes mutilation. This paper examines the arguments in the first case prosecuted using Female Genital Mutilation law in Australia and considers how the arguments have drawn on ideas of function and desire of women’s genitals as well as of women themselves. The brief writings on this case and on FGM law in Australia are discussed, particularly the work of Kennedy, Sullivan, Seuffert and Iribanes, and Gans.
Recent Findings
The paper finds that the ideas of genital function in the deliberations and judgments of this case rely on a problematic idea of the natural function of a woman and a presumption of the harm of female genital mutilation irrespective of alternative research, and rely on a singular document published in Australia in 1994 that did not include any engagement or opinions of people from the communities who practice circumcision or genital cutting in Australia.
Summary
The partial information relied on in Australian law about the practices of female genital cutting and the immediate presumption of harm in respect to any form of the practices means that future research and indeed legal opinion already presume that the practices are a mutilation.
... When a woman asserts that FGC has decreased her sexual desire and pleasure, unless she underwent the ritual after she started having sexual relations, this is the internalization of someone else's discourse, because by definition, she cannot know. Mobilizing a comparison between a "before and after," FGC is beyond the bounds of possibility [15,16]. That is not to say that FGC has no bearing on sexual pleasure, but rather that we need to be prudent in our assertions and fully cognizant of their consequences on women's embodied experiences, including their sexual experiences and how they can be modulated by our discourse. ...
Purpose of Review
This paper stems from a presentation given at the “Second International Expert Meeting on Female Genital Mutilation/Cutting (FGM/C): Sharing data and experiences, improving collaboration,” which took place at Centre Hospitalier Universitaire Ste. Justine, Montreal, Canada, in May 2018. It aims to shed light on the psychosexual health of women with female genital cutting (FGC), drawing from both scientific research and clinical work. This paper also addresses the inherent challenges to healthcare delivery for “cut” women and seeks to illuminate the social and historical realities that form the backdrop to the clinical encounter.
Recent Findings
While there is a vast body of literature on the psychological determinants of sexual health, studies on “cut” women’s sexual health have yet to delve into its psychological correlates. In addition, healthcare delivery for women with FGC poses a number of challenges, which impinge upon patient experience and health-seeking behavior.
Summary
Ethical considerations in care delivery for women with FGC must delve into the hegemonic nature of the patient-practitioner interactions and politics of Otherness. Interdisciplinary research and praxis on FGC will prevent biological reductionism and the pathologization of these women. It will afford more integrated, comprehensive, and ethical care for women with FGC.
... On the other hand, some studies have revealed divergent views on the role of the clitoris in sexual pleasure, women's ambivalence toward sexual pleasure as a procreative value of sexuality, as well as women who privilege their husband's sexual satisfaction over their own (Ahmadu, 2007;Dopico, 2007). A study of the association between genital cutting and sexual morbidity in Nigeria, for example, revealed that the practice did not appear to affect sexual functioning and enjoyment (Okonofua, Larsen, Oronsaye, Snow, & Slanger, 2002). ...
Objective: We conducted a scoping review to identify and assess instruments used to measure sexual health and wellbeing in women who have undergone female genital mutilation/cutting (FGM/C). Method: We retrieved and assessed 10 validated instruments using an 18-item checklist derived from the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Results: All instruments were developed and initially validated among literate, predominantly Caucasian participants in North America and Europe. Only 1 validation study was conducted among women living with FGM/C. Conclusion: Most instruments only measured sexual functioning. Findings underscore the need to validate instruments appropriate for use among FGM/C survivors.
... FGC activism and efforts to abolish FGC have also been criticised for being based on a western, ethnocentric, and discriminatory viewpoint (Ahmadu 2007;Gruenbaum 2001;Longman and Bradley 2015;Njambi 2007;Shweder 2000). Critics have argued that western attempts to abolish FGC reveal a double standard in which similar practices are regarded as being fundamentally different, depending on whether they are practised in the West or in other cultures (e.g., cosmetic genital surgery, male circumcision, and intersex surgery) (Earp 2016a;Johnsdotter and Essén 2010;Oba 2008;Onsongo 2017). ...
Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semistructured interviews and focus group discussions were conducted. Data were collected in 2015. The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.
... In many countries that practice FGC, while removing the external portion of the clitoris is viewed as dampening sexual drive and giving women control over their sexuality ( Abusharaf, 2001b ), the external portion of the clitoris is often not seen as an important component to sex with one's husband ( Gruenbaum, 1996 ;Abusharaf, 2001b ;Ahmadu, 2007 ). It is also possible that FGC shifts the sites of sexual pleasure ( Einstein, 2008 ); women with FGC are less likely to choose their clitoris as the most sensitive part of their body, with the majority choosing their breasts ( Okonofua et al., 2002 ). ...
... Other common reasons are "purity"-according to local conceptions-and esthetics [8]. Despite the sexual and psychological violence that women are subject to through FGM, having gone through the practice grants women special status within their community [9,10]. Those who refuse to go through the practice are often subject to abuse, social exclusion, and stigmatization [11,12]. ...
Purpose of Review
To describe the multidisciplinary approach of the Brussels-based referral center, one of the two centers for women living with female genital mutilation (FGM) in Belgium. This approach is contextualized and compared to the latest literature on the subject.
Recent Findings
According to the World Health Organization, women who have undergone FGM should be able to benefit from multidisciplinary care. Clitoral reconstructive surgery appears to be a crucial but controversial element of this holistic treatment; its long-term benefits and role in sexual satisfaction are still the focus of many questions.
Summary
Clitoral reconstructive surgery has been reimbursed by Belgian social security since 2014 only in conjunction with multidisciplinary care. In our referral center, the care is provided by a gynecologist, a midwife, a psychotherapist, and a sexologist. Five preoperative consultations are mandatory to obtain the refund. CeMaVie’s first line of treatments is non-surgical therapies.
... Thus, while it is true that adult women who elect cosmetic labiaplasty and other such surgeries for themselves generally report being satisfied with the outcome, sexually and otherwise [121,122], the findings from these studies cannot be simply mapped on to women whose genitals were altered when they were children [4,123]. Instead, many women who were raised in cultures that practice nontherapeutic FGC-but who eventually came to question the prevailing norms of their societies and later adopted a dissenting perspective-express anger and resentment about having been subjected to a medically unnecessary genital surgery when they were too young to understand what was as stake or effectively resist [92,124,125]. Such negative emotions, in turn, can impair sexual well-being over and above any "purely" physical risks, even where the latter may be perceived as minimal [126,127]. ...
Purpose of Review
The purpose of this study is to survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices.
Recent Findings
Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework is needed.
Summary
All children have an interest in genital autonomy, regardless of their sex or gender.
... Other men had not had sexual experience with uncut women or reported that they had not noticed a difference and said it was impossible for a man to tell if his partner was cut or not. This finding is in line with Ahmadu (2007) whose ethnographic research in the Gambia showed that men often cannot tell the difference between cut and uncut women during sex (Ahmadu 2007). As we have no information regarding the type of FGM the women who these men had sex with had undergone, it is not possible to draw further conclusions on this. ...
... FGM/C is also associated with higher rates of sexual problems [16]. In countries of migration, experiences of stigma and/or being different can increase women's concerns over their own sexuality [89][90][91]. The WHO recommends sexual counselling for preventing or treating female sexual dysfunction among women living with FGM/C, but not clitoral reconstruction [18]. ...
Background:
For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector.
Method:
A mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data.
Results:
A total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors' involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration.
Conclusion:
Substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluation.
... For det første er seksuell kontroll en viktig begrunnelse for kjønnslemlestelse, noe som kan gjøre at negative seksuelle konsekvenser for kvinnen ikke nødvendigvis oppfattes som et tungtveiende argument mot praksisen. For det andre har en sett at et slikt budskap kan føre til stigmatisering og vonde følelser hos jenter og kvinner som allerede er kjønnslemlestet (Ahmadu, 2007;Johnsdotter & Essén, 2015). ...
The report investigates whether the systems that has been established to ensure that refugees and asylum seekers in Norway receive the necessary information about female genital mutilation functions according to its intention. The aims of this program for the dissemination of knowledge about female genital mutilation is to prevent girls living in Norway from female genital mutilation and to provide health care services for girls and women who have been exposed to this procedure. We found that only 2/3 of health education institutions provided training on female genital mutilation and in those that did, there were large variations in the extent and content of teaching. This implies that there are major variations in healthcare provider's competence to carry out their respective tasks in this area. Furthermore, we identified some shortcomings in the routines for the dissemination of information: Some immigrants groups were frequently targeted with repetitive information, whereas other groups never received any information. We also found that the form and content of existing information was limited and therefore in need of strengthening. One area that could strengthen the work is to increase the use of long-term discussion groups, include more resource persons from affected groups in the work and expand the messages provided. The latter refers to a need to openly discuss the factors motivating female genital mutilation in the first place. Furthermore, we found that service providers in smaller places with few residents from affected groups often experienced major challenges in their work: Many had less access to resources, less opportunities for professional updates and fewer discussion partners. Many felt that alone with challenging tasks, and often experienced confidentiality as a serious restriction for professional exchange and good decisions. The study also revealed that there may be a need to strengthen and better coordinate the provision of health care to provide a more equal offer, make the offer more acceptable to the user groups.
The connection between human rights, peace and security highlights the stakes attached to the respect and enforcement of the principle of universality. Yet the 1948 Universal Declaration of Human Rights and all subsequent international conventions have been questioned by States and communities: they are believed to be reflective of euro-centric values. This is why cultural relativism has emerged as an alternative to the principle of universality of human rights. This raises security questions: if a state questions universality of human rights, does it undermine the whole UN peace and security system? Is cultural relativism a threat to universality, leading to fragmentation and insecurity? The book chapter seeks to address such issues while looking at transcending the dichotomy between universalism and relativism. Scholars’ views and strategies to overcome the tensions and ensure the respect of human rights while promoting peace and security are consequently examined.KeywordsUniversalityHuman RightsSecurityRelativism
Policy statements on penile circumcision have focused primarily on disease, dysfunction, or sensation, with relatively little consideration of psychological and psychosocial implications of the procedure. There has also been minimal consideration of potential qualitative changes in the subjective experience of sexual activity following changes in penile anatomy (foreskin removal) or associated sexual biomechanics. We present a critical overview of literature on the psychological, psychosocial, and psychosexual implications of penile circumcision. We give consideration to differences among circumcisions performed in infancy, childhood, or adulthood. We also discuss potential psychosocial effects on parents electing, or failing to elect, circumcision for their children. We propose a framework for policy considerations and future research, recognizing that cultural context is particularly salient for the narratives individuals construct around penile circumcision, including both affected individuals and medical professionals who perform the surgeries. We argue that additional attention should be paid to the potential for long-term effects of the procedure that may not be properly considered when the patient is an infant or child.
‘[The] average third world woman leads an essentially truncated life based on her feminine gender (read: sexually constrained) and being “third world” (read: ignorant, poor, uneducated, traditionbound, domestic, family-oriented, victimized, etc.). This, I suggest, is in contrast to the (implicit) self-representation of Western women as educated, modern, as having control over their own bodies and sexualities, and the freedom to make their own decisions’ (Mohanty, 2003: 337). Not much has changed regarding Western views of the ‘third world woman’ in the 37 years since Chandra Mohanty made these remarks – this is especially so when it comes to the heated topic of female circumcision, female genital cutting or what opponents refer to as female genital mutilation among African and Muslim women. In Richard Shweder’s (2022) conclusion of the target article, he outlines four key considerations that justify male circumcision and argues that these factors ought to also determine the acceptability of female circumcision in liberal democracies: (1) the practice is broadly supported by the communities that uphold them; (2) the practice is motivated by the fundamental principle of gender equality; (3) the practice is not more physically invasive than what is legally allowed for male circumcision; and (4) there is scant evidence of harm. Shweder (2022) points out that all four conditions are consistent with the practice of khatna – a mild, barely visible form of female circumcision among the Dawoodi Bohra. In this response article, we consider these four standards in our discussion of Kenya’s High Court ruling this year to uphold the Prohibition of Female Genital Mutilation Act 2011. It first describes the legal context for challenging the constitutionality of the Act and outlines the key provisions within the Kenyan Constitution and its Bill of Rights that the plaintiff identified in her petition, focusing especially on the rights of Kenyan women to bodily autonomy and cultural expression. It then delves into the complex symbolic, cultural and socio-religious nuances of gender-inclusive circumcision rituals, citing various case studies in our reflection on the four points Shweder proposes for legitimising female circumcision.
This article examines the absence of discussion about male circumcision in the first legal case against female circumcision in Australia, the Vaziri and Magennis case of 2015, 2018 and 2019, where the High Court of Australia prosecuted three people for practising female circumcision. It engages with the work of Rick Shweder on this case, arguing that what powerfully informs legal cases on this topic in Australia is less anthropological or medical evidence, than antifemale genital mutilation advocacy in the forms of literature and activism. These forms of anti-female genital mutilation discourse, the article argues, obscure the obvious comparison between male circumcision – as a ritual or ceremony that results in the production of a man as a man of God or of the nation – and female circumcision, which is understood as a mutilation. In lieu of the missed comparison, the result of this representation in legal and fictional texts is a rendering of the woman as unable to authorise her own agency, that is, as a remnant of mutilation, a rendering that is far from accurate.
Key messages
Legal deliberations on female circumcision would benefit from comparison with the significance of male circumcision.
Legal deliberations on female circumcision need to be informed by evidence from circumcised women and less by anti-female genital mutilation activism, which is curated for popular consumption.
Positioning circumcised women as mutilated women denies the significant and informed voices of circumcised women who do not experience the practices as mutilation. </ul
Legal regulations of the body produce and seek to protect specific imaginations of the body in an idealized form—that is, not only what a body is but also what it ought to be. In this article, we apply a queer criminological approach to interrogate the regulation of the body-that-ought-to-be that has animated two legal interventions regarding body modification: the criminalization of female genital cutting (FGC), often described in law as female genital mutilation (FGM), and the regulation of gender-affirming manual hormone use. By analyzing discourses that have circulated in Australian law regarding both practices, we show how the legitimacy of a given body modification has been tied to that modification’s potential to either threaten or affirm a body’s capacity to produce intelligible gender. We contend, on this basis, that the body that the law has sought to protect in these instances is a body that is not queer.
Introduction
Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldès in France. The technique was then modified by different authors.
Aim
This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris.
Methods
We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris.
Main Outcomes
A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting
Results
We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldès, We included the technical modifications and contributions described in articles published subsequently.
Conclusion
Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM.
Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;XX:XXX–XXX.
“It is the task of scholars working on the topic of female genital cutting not only to provide perspectives to reduce ethnocentrism, but also to offer ideas for generating acceptable changes for immigrants and their new countries, informed by reasonable approaches that do not rely on inflamed rhetoric or distorted science. The work of scholars, such as those writing in this volume, is essential to engaging in a more just and thoughtful future, where human cultural behaviors can change in positive directions that ameliorate the conditions of the lives of women and girls without unjust condemnations of different ways of living.”
These words are from the keynote lecture at the 9th FOKO conference in Sweden, Female Genital Cutting: The Global North & South, which appears as a chapter in this anthology. This keynote was delivered by Professor Ellen Gruenbaum, an American anthropologist who has done research on this subject for more than four decades. The other chapters build on research papers presented at the conference, covering studies done in countries where circumcision of girls is widely practiced as well as those from European countries which host migrant communities that are affected by these practices. The collection covers a wide range of the issues that currently demand attention among Nordic researchers in the field of female genital cutting.
This article analyses discourses on so-called female genital mutilation or cutting (FGM/C) in Northern Ireland. We identify a tension between affected communities' need for improved supports and resources on the one hand, and the absence of resources and support, or inappropriate and sometimes harmful interventions, on the other hand. We conclude that this mismatch between requirements and actual provisions is one effect of the isolated politicization of FGM/C, in ways that reinforce global North gender norms. We argue that non-hypocritical transcultural engagements require critical assessment of how the (historically and culturally specific) gender binary organises global North perspectives on all forms of non-therapeutic genital cutting. Two significant barriers are identified. First, there is a lack of awareness in Northern Ireland of the origins of current double standards in the regulation of genital cutting. Second, the ‘two communities’ model of Northern Irish politics impedes the development of interlinked and contestatory publics.
This book explores the phenomenon of anti-femail genital mutilation (FGM) social media activism. Against a backdrop of over 200 million girls and women worldwide affected by FGM, this volume examines key global online campaigns to end the practice, involving leading virtual platforms such as Twitter, Facebook and YouTube. Drawing from twenty-one fieldwork interviews with anti-FGM activists, frontline practitioners and survivors, the volume investigates opportunities and challenges inherent to cyberspace. These include online FGM bans as well as practices such as 'cyber-misogyny' and 'clicktivism'. Global campaigns featured include the UN's International Day of Zero Tolerance for FGM, the WHO's Sexual and Reproductive Health Programme, The Girl Generation, The Guardian's End FGM Global Media Campaign and the Massai Cricket Warriors. Furthermore, ten case-studies document prominent anti-FGM campaigners. Firstly, five African-led narratives from celebrated activists: Efua Dorkenoo OBE, Waris Dirie, Ayaan Hirsi Ali, Jaha Mapenzi Dukureh and Leyla Hussein. Second, five accounts from FGM survivors interviewed for the book: Mama Sylla, Masooma Ranalvi, Farzana Doctor, Fatou Baldeh and Mariya Taher. By exploring anti-FGM online activism, this book fills a gap in the literature which has largely overlooked FGM's presence in cyberspace as a virtual social movement. Female Genital Mutilation and Social Media will be of interest to activists, survivors, frontline professionals, students, academics and the wider public.
Critics of non-therapeutic male and female childhood genital cutting claim that such cutting is harmful. It is therefore puzzling that ‘circumcised’ women and men do not typically regard themselves as having been harmed by the cutting, notwithstanding the loss of sensitive, prima facie valuable tissue. For female genital cutting (FGC), a commonly proposed solution to this puzzle is that women who had part(s) of their vulvae removed before sexual debut ‘do not know what they are missing’ and may ‘justify’ their genitally altered state by adopting false beliefs about the benefits of FGC, while simultaneously stigmatising unmodified genitalia as unattractive or unclean. Might a similar phenomenon apply to neonatally circumcised men? In this survey of 999 US American men, we find that greater endorsement of false beliefs concerning circumcision and penile anatomy predicts greater satisfaction with being circumcised, while among genitally intact men, a trend in the opposite direction occurs: greater endorsement of false beliefs predicts less satisfaction with being genitally intact. These findings provide tentative support for the hypothesis that the lack of harm reported by many circumcised men, like the lack of harm reported by their female counterparts in societies that practice FGC, may be related to holding inaccurate beliefs concerning unaltered genitalia and the consequences of childhood genital modification.
A constantly evolving swirl of competing discourses, stories, images and scripts shape both our sense of the world we inhabit and who we are in this world. Jerome Bruner has referred to this assemblage of shifting narratives as a ‘communal tool kit’, a fund of knowledge that keeps us updated about ways in which our culture changes and how we should behave in order to get on in the world (Bruner, 2003). Not surprisingly, the idea of the nation and of national belonging or national identity continues to provide a tidy and compelling frame for how we think about culture — despite numerous attempts to reveal the constructed, indeed invented, nature of the nation and of nationhood. And speaking from within this frame, one obvious way to delineate national belonging has always been via stories about those who do not belong, namely a nation’s immigrants.
Female genital cutting (FGC) is a persistent social norm in the Liben district of southern Ethiopia. This study explores whether the sexual experiences of married men and women differ by women's FGC status. Qualitative in-depth interviews were conducted with 28 women with different types of FGC (or no FGC) and 21 husbands. Compared to others, women with more severe FGC reported traumatic sexual experiences and decreased sexual desire. Nonetheless, participants largely endorsed FGC for daughters, revealing pressure to maintain the practice. Opportunities for change exist, as women and men recognized the sexual pleasure and healthy birth experiences of uncut women.
Résumée
Cet article examine les constructions de sens (frames) autour de l’excision et de la chirurgie esthétique génitale, par l’exemple de la nymphoplastie. L’analyse porte sur des entretiens menés auprès d’experts ayant une connaissance approfondie des pratiques de modification génitale en Suisse. Les résultats montrent que l’excision et la nymphoplastie sont placées dans un rapport de « miroir inversé », où la nymphoplastie est décrite par des caractéristiques positives alors que l’excision représente son miroir négatif. Par conséquent, cet article argumente que le débat sur les « mutilations génitales féminines » en Suisse reproduit l’allégorie du « Nous versus les Autres », conformément à la rhétorique du nationalisme sexuel.
Female genital cutting/circumcision, the partial or total removal of the external female genitalia, is a common practice in many parts of Africa. To those who perceive female circumcision as a legitimate rite of passage, the practice is culturally approved and steeped in tradition. The negative reactions and harsh judgments of Westerners who then seek to eradicate the practice are seen as ethnocentric. On the other hand, opponents of female genital cutting emphasize that the practice is a ritualized form of violence and a detriment to women’s health. The practice deprives girls and women of the basic rights to physical wellbeing and bodily integrity. This thesis will provide a cross-cultural overview of the ethical debate on this controversial subject, including both the justifications for the continuation of the practice and those advocating its cessation. I will discuss the different factors that support the persistence of the practice and then formulate a culturally sensitive plan of action for the eradication of female genital cutting/circumcision. Ultimately, I assert that female circumcision is really genital mutilation and a violation of basic human rights with severe physical and emotional consequences.
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