Let’s talk about female circumcision

Isatou Jallow during the Islamic festival of Eid held at the Convention Center for Seattle's large Muslim population. After arriving in Seattle two years ago, she had reversal surgery for her circumcision, through Harborview's International Medicine Clinic. (Photo courtesy Isatou Jallow)
After arriving in Seattle two years ago, Isatou Jallow had reversal surgery for her circumcision through Harborview’s International Medicine Clinic. (Photo courtesy Isatou Jallow)

Hearing people toss around the acronym ‘FGM’ in conversation, it sounds like it could be a strain of bacteria, or maybe an obscure indie band. 

Once you discover that it stands for “Female Genital Mutilation” it’s no surprise that people — from doctors to bloggers, are more comfortable with the short version.

FGC (the preferred term for many because it references the more neutral word “cutting) is the process of removing female genitalia — some combination of the clitoris, labia minora, and labia majora, and often sewing the vaginal opening shut all but for a small hole to urinate from.

The procedure is done without anesthesia, on girls from infancy to 15-years-old, according to the World Health Organization.

The process is enough to make you wince, no matter which parts you have between your legs.

Also called female circumcision, FGC bears little resemblance to the religious or health-related circumcisions performed on boys around the world. And it’s a rising issue in the U.S., as more and more immigrants from places where it’s a common practice are turning up in hospitals and doctor’s offices here.

FGC mostly occurs in parts of Africa, where it is either allowed by law or just taking place against it. But it also happens in the Middle East and parts of India.

FGC sparks a lot of questions for those unfamiliar with the practice. But the first is usually “why?”

According to Isatou Jallow, a Gambian woman living in Seattle, it is a deeply rooted cultural practice. Jallow, who is a Muslim, points to the absence of any mention of female circumcision in the Koran or the Bible. 

But it’s so normalized, she says, in certain places where the practice has been taking place for thousands of years, that women make good careers out of circumcising young girls.

In many cases, circumcision is seen as improving virginity and marriage prospects, and therefore a necessary rite of passage. 

Jallow had the procedure done to her when she was eight years old. Her parents were from two different tribes, one of which had a practice of circumcision, while the other did not. Family members who considered her unclean for not being circumcised upon birth, took her and her sister, then five, to a public ceremony where women gathered in special clothing to mark the event. She was in recovery for two months.

When Jallow hit puberty, she knew something was wrong. Her abdomen swelled with pain from the blood unable to pass through her sewn shut opening. Jallow began searching the internet for anything she could find on FGC, and began to ask her own questions.

(Image courtesy UNICEF)
(Image courtesy UNICEF)sn

Jallow was later awarded a scholarship to study international law and political science in Morocco where she earned her B.A., and eventually received a work visa to come to the United States. Since coming to the U.S. in 2012, she’s been treated for some of the many complications resulting from having the procedure done to her all those years ago.

Beyond the initial shock factor for the uninformed, FGC raises larger, more complex questions: Is it a religious issue or a cultural one? Human rights issue or medical quandary? Should we denounce the practice, and if so, how?

Americans have a hard enough time saying ‘vagina’ in public, so approaching the sensitive topic has been a struggle for doctors, activists, and caseworkers alike. In 2010, The American Academy of Pediatrics suggested that American doctors be given permission to perform a ceremonial ‘pinprick’ on girls from families attached to the practice, to keep them from returning to their home countries for the full procedure.

After a strong backlash, the policy was reversed a month later. Many believed that despite the benign procedure, a ritual nicking would play into a deeply-rooted fear of female sexuality, and wouldn’t necessarily prevent families from pursuing the full procedure.

In the United States, there is a tangible sense of otherness associated with FGC. It is banned here, as well as under international law, and inconceivable to many. Something that seems so unequivocally wrong by western standards can be grounds for tension between Americans and these ethnic groups living here, captured disturbingly in the infamous cake-cutting by the Sweden’s Minister of Culture in 2012.

A woman with an understanding of these complexities is Dr. Alexandra Molnar, a physician at the International Medical Clinic at Harborview Medical Center. When she first started there seven years ago, she was the only female physician available to take on increasing cases of Somali women requesting female doctors, 98% of whom, she says, have undergone some form of genital cutting.

“It’s a women’s issue,” she asserts, making the case for a global feminism despite the discrepancy in cultural norms. Though many would also argue it’s an education issue — there is a high correlation between lack of formal education and incidences of FGC, according to several self-report and observational studies across Africa and the Middle East. 

Dr. Molnar’s extensive career working with international communities has allowed her to shed light on the practice within the medical community, addressing how those affected want to be treated in the U.S. She recently co-authored a paper on the subject, contextualizing the issue for doctors and discussing health implications.

She is keen to raise the issues, but is wary of how discussions around FGC take place.

“There are doctors who totally ignore it, or don’t bring it up,” says Molnar. Others, she says, especially incoming residents, get too fascinated with FGC because it’s so different, and neglect their patients’ other heath issues.

Dr. Molnar stressed the importance of talking about FGC in an informative, respectful way, without exoticizing it.

Most of her patients prefer the more informal term ‘circumcision’, and range from carrying extensive trauma around FGC, to being completely unaware that the procedure ever took place.  Depending on the type of procedure, complications can include infertility and difficulty during childbirth, urinary problems, abnormal scarring, vaginal pain and infection. For many of her patients who are refugees, FGC is also a source of emotional trauma, in addition to many associated with the horrors of forced migration.

Doctors like Molnar are able to perform ‘reversal’ surgery, where the wound is re-opened, allowing more comfortable menstruation, urination and sex. Still, once it’s gone, there’s no getting back the clitoris, the only human organ designed purely for female sexual pleasure.

“I feel like something was taken from me,” says Jallow, reflecting on her experience with FGC. “I feel like less of a woman.”

Dr. Molnar hopes that increased education on the issue can address both medical needs, and a deeper cultural awareness.

Two interpreters at the International Medicine Clinic at Harborview Medical Center. Many interpreters employed there also work as cultural mediators, working with doctors and patients to contextualize medical conditions like FGC. (Photo courtesy Dr. Carey Jackson)
Two interpreters at the International Medicine Clinic at Harborview Medical Center. Many interpreters employed there also work as cultural mediators, working with doctors and patients to contextualize medical conditions like FGC. (Photo courtesy Dr. Carey Jackson)

“I’ve had a lot of women say ‘this is a part of what makes us who we are. Our country has been destroyed in so many ways, and this is part of how we see ourselves as people,” Dr. Molnar says.

Jallow says that despite the pain she’s suffered, she does not want to separate from her home, or her culture.

“It’s not about detaching,” she says. “It’s about educating”.

For her, this means connecting with other family members and friends in the Gambian community, and openly talking about circumcision. She hopes to have her own NGO one day.

“There’s nothing wrong with changing culture if it is harmful,” she says. “I don’t want any girl to go through that.”

4 Comments

  1. This makes my blood boil. To my knowledge only France has prosecuted anyone for this. I talked to a young man recently who is here from Egypt. He is “educated” and seemed very ordinary, but when I mentioned about FGM he casually said, “It’s cleaner.”
    I’m not sure education is the answer. The world needs to bring to bear as much power and sanction over the violation of a persons body as they do over political ideas, and more. If a person violates the very personal nature of the body of a woman (or man), how can they respect or honor anything else.
    I think all persons known or to have acknowledged to have taken part in FGM should be banned from travel to any countries where FGM is outlawed, and politicians and leaders should stop talking bull and do something. In Egypt FGM is illegal yet the rate of it being done is 90+ percent!
    There’s simply no room for talk about this.
    It’s time for the international community to back up what they say or declare they are as much a part of it as the mutilators themselves.

  2. The map fails to display South Asia. Malaysia, Indonesia and Singapore have high rates of female genital cutting, usually performed in hospitals and clinics, in conditions of sterility and less invasive than the often touted Pharaonic Circumcision (infibullation and ablation).

    I disagree with the assertion that it’s a women’s issue. Genital Cutting (without gender qualifier) is a children’s issue. When adults hold a knife or a razor or a scalpel to a child’s genitals, there’s no amount of screaming or kicking that will save the child. Whether this happens in a bush or a hospital bed, with or without anesthesia, at 2 days or 16 years, doesn’t change that this is an intentional injury inflicted upon a minor who cannot provide informed consent. I am obviously implying that male circumcision on a minor is also a violation of the child’s physical integrity.

    Let’s remember that Western doctors perform partial clitoris excision on girls deemed to have a too large clitoris. In conditions of sterility. Under anesthesia. Excising the corpus spongosium from the clitoris and “reducing” the glans, a procedure not medically needed and which adult women who have been subjected to it during childhood often denounce and wish had not been forced upon their bodies.

    Point is, nobody should raise a blade to a child’s genitals unless it is a life or death situation. No doctor, no priests, no matron, no one.

  3. I have a special interest in getting involved in advocacy work for FGM. Does anyone have any guidance as to who who / where / how to go about this? Any and all guidance helps!

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