Changes

Female circumcision, also known as "female genital cutting" ([[FGC]]) or "female genital mutilation" ([[FGM]]) is a blanket term that can refer to a wide array of genital cutting performed in girls and women, performed for social, cultural and/or religious reasons.

Female genital cutting ([[FGC]]) shares a strikingly similar history to [[circumcision|male circumcision]] in Western medicine, being offered as a way to curb sexual activity, which was thought to cause disease.<ref>[[John Harvey Kellogg|Kellogg, John Harvey]]</ref><ref> {{REFjournal |last=Morris |first=Robert Tuttle Morris, M.D. |init=RT |title=Is evolution trying to do away with the clitoris? |journal=American Association of OB/GYNs Vol. |volume=5, |year=1892, pp. |pages=288-302.}}</ref><ref> {{REFjournal |last=McFarland |first=T. Scott McFarland, M.D. |init=TS |title=Circumcision of Girls. |journal=Journal of Orificial Surgery. Vol. |volume=7,July |date=1898,pp.-07 |pages=31-33.}}</ref><ref> Benjamin E. Dawson, A.M., M.D. Circumcision in the Female: Its Necessity and How to Perform it. American Journal of Clinical Medicine. Vol.22, No. 6, June 1915, pp.520-525. {{Dawson1915}}</ref><ref> Belle C. Eskridge M.D. Why not circumcise the girl as well as the boy? Texas State Journal of Medicine Vol. 14, May 1918.{{Eskridge1918}}</ref><ref> Mc Donald, C.F., M.D. Circumcision of the female. General Practitioner Vol. 18 No3, Sept 1958, pp.98-99.{{McDonald1958}}</ref><ref> W.G. Rathmann M.D. Female Circumcision: Indications and a new Technique. General practitioner Vol. 20, No.3, Sept 1959, pp.115-120.{{Rathmann1959}}</ref> In the US, female genital cutting was covered by Blue Shield until 1977. Today all forms of FGM are considered female genital mutilation (FGM), which are banned in all western countries.

On April 26, 2010, the AAP changed its long-held stance of female genital cutting.<refname="Luscombe">{{REFnews | last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher=Time | work= | quote=On April 26, the organization changed its long-held stance on female genital cutting... | date=2010-05-11 | accessdate=2011-09-27}}</ref> In their report, chiefly authored by Dena Davis, a professor at Cleveland-Marshall College of Law at Cleveland State University,<ref>{{REFnews | last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher=Time | work= UNI| quote=...the report's lead author, Dena Davis, a professor at Cleveland-Marshall College of Law at Cleveland State University... | date=2010-05-11 | accessdate=CSUOhio}},<ref name="Luscombe"/ref> the AAP advised doctors to inform families that the procedure is medically unnecessary and even dangerous.<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http:/"/www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher=Time | work= | quote=In its new report, the AAP advises doctors to inform families... | date=2010-05-11 | accessdate=}}</ref> The AAP raised the idea of legalizing a less-severe ritual cutting, which they compared to an ear piercing,<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher=Time | work= | quote=...the AAP raises the idea of legalizing a less-severe ritual cutting... | date=2010-05-11 | accessdate=2011-09-27}}<"/ref><refname="MacReady">{{REFjournal | last=MacReady | first=Norra | coauthorsinit=N | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The authors suggested that a “ritual nick,” in which the clitoral skin is pricked or incised, might satisfy these symbolic requirements, and “is no more of an alteration than ear piercing”. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref> the reasoning being that female circumcision had symbolic or ceremonial aspects for many parents,<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http:"//www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...female circumcision had symbolic or ceremonial aspects. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref> and offering a "ritual nick" might dissuade parents that were resolute, from sending their daughters to their home countries,<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article"/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher= | work= | quote=...to dissuade parents from sending their daughters to be circumcised in their home country... | date=2010-05-11 | accessdate=2011-09-27}}</ref> thereby avoiding greater harm.<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article"/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher= | work= | quote=...a ritual nick as a possible compromise to avoid greater harm... | date=2010-05-11 | accessdate=2011-09-27}}</ref> The AAP had deviated from a much more forceful statement published in 1998, which unequivocally condemned [[FGC ]] in any form.<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2"/fulltext | quote=...the AAP revised a much more forceful statement published in 1998, which unequivocally condemned FGC in any form. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref>

The Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress on the same day the AAP published its new recommendation.<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher= | work= | quote=On the same day the AAP published its new recommendation... | date=2010-05-11 | accessdate=2011-09-27}}<"/ref> New York Representative Joseph Crowley, one of the bill's sponsors, condemned the AAP's move as "the wrong step forward on how best to protect young women and girls" by creating confusion about the acceptability of FGM in any form.<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher= | work= | quote=I am sure the academy had only good intentions... | date=2010-05-11 | accessdate=2011-09-27}}<"/ref> Davis of the AAP countered that such a law would be difficult to enforce.<ref>{{REFnews | lastname="Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article"/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | publisher= | work= | quote=Davis counters that such a law would be extremely difficult to enforce. | date=2010-05-11 | accessdate=2011-09-27}}</ref>

The AAP's endorsement of a "ritual nick" sparked a backlash<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http:/"/www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The American Academy of Pediatrics (AAP) sparked a backlash... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref> which was swift and universally negative. The AAP's recommendation had been perceived by many as a tacit endorsement of the "ritual nick," and an effort to appease parents who threatened to subject their daughters to worse procedures.<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2"/fulltext | quote=...was interpreted by many as a tacit endorsement of the ritual nick... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref> In short, the AAP was forced to retract its endorsement, and on May 1, Judith Palfrey, President of the AAP, released a statement that read in part, “the AAP does not endorse the practice of offering a ‘clitoral nick’. This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members”members.”<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals"/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=On May 1, Judith Palfrey, President of the AAP, released a statement... | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref> Palfrey reiterated this stance in an interview with ''The Lancet'', saying “we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick.” <ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}<"/ref> The AAP has since withdrawn the committee's report and has rewritten it completely.<ref>{{REFjournal | lastname="MacReady | first=Norra | coauthors= | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com"/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The AAP has since withdrawn the committee's report and has rewritten it completely. | pubmedID= | pubmedCID= | DOI=10.1016/S0140-6736(10)61042-2 | date=2010-07-03 | accessdate=2011-09-27}}</ref>

[[FGC ]] consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away. The WHO—which [[WHO]] — which uses the term Female Genital Mutilation ([[FGM]])—divides — divides the procedure into four major types<ref name = "WHO - Terminology"/> (see Diagram 1), although there is some debate as to whether all common forms of FGM fit into these four categories, as well as issues with the reliability of reported data.<ref name="Elmusharaf_2006">{{REFjournal | last=Elmusharaf | firstinit=S | coauthorslast2=Elhadi |init2=N Elhadi, |last3=Almroth |init3=L Almroth | title=Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study | journal=BMJ | volume=333 | issue=7559 | pages=124 | url= | quote= | pubmedID=16803943 | pubmedCID=1502195 | DOI=10.1136/bmj.38873.649074.55 | date=2006-07-15 | accessdate=

[[Image:FGC-Types.png|thumb|Diagram 1:This image shows the different types of FGM and how they differ to the uncircumcised intact female anatomy. '''Note:''' The graphic comes from an external source and incorrectly refers to the [[clitoral glans]] as just the [[clitoris]].]]

The WHO defines Type I FGM as the partial or total removal of the clitoris [[clitoral glans]] ([[clitoridectomy]]) and/or the prepuce ([[clitoral hood]]); see ''Diagram 1B''. When it is important to distinguish between the variations of Type I cutting, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris [[clitoral glans]] with the prepuce.<ref name = "WHO - Terminology">{{REFdocument |url=http://www.who.int/reproductive-health/publications/fgm/fgm_statement_2008.pdf |title=Eliminating Female Genital Mutilation – An interagency statement OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO |publisher=Department of Reproductive Health and Research (RHR), World Health Organization |format=PDF |date=2008 |accessdate=}}</ref>

The WHO's definition of Type II FGM is "partial or total removal of the clitoris [[clitoral glans]] and the [[labia minora]], with or without [[excision ]] of the [[labia majora]]. When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the [[labia minora ]] only; Type IIb, partial or total removal of the clitoris [[clitoral glans]] and the [[labia minora]]; Type IIc, partial or total removal of the clitoris[[clitoral glans]], the [[labia minora ]] and the [[labia majora]].<ref name="WHO - Terminology">{{REFdocument | url=http://www.who.int/reproductive-health/publications/fgm/fgm_statement_2008.pdf | format=PDF | title=Eliminating Female Genital Mutilation – An interagency statement OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO | publisher=Department of Reproductive Health and Research (RHR), World Health Organization | postscript= | date=2008 | accessdate=}}</ref>

=== Type III: [[Infibulation ]] with [[excision ]] ===

The WHO defines Type III FGM as narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the [[labia minora ]] and/or the [[labia majora]], with or without [[excision ]] of the clitoris [[clitoral glans]] ([[infibulation]])."<ref>WHO, 2006-10-02</ref> It is the most extensive form of FGM, and accounts for about 10% of all FGM procedures described from Africa.<ref>{{REFweb | quote= | url=http://www.who.int/mediacentre/factsheets/fs241/en/index.html | title=Female genital mutilation | last= | first= | publisher=World Health Organization | work= | date=June 2000 | accessdate=2008-01-23}}</ref> [[Infibulation ]] is also known as "pharaonic circumcision".<ref>[http://www.worldvision.org/about_us.nsf/child/eNews_fgmfaq_030706?OpenDocument&lpos=main&lid=fgm_faq Frequently Asked Questions on Female Genital Mutilation (FGM)]</ref>

There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. The WHO defines Type IV FGM as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization."<ref name="WHO - Terminology"/> This includes a diverse range of practices, such as pricking the clitoris [[clitoral glans]] with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.<ref name="WHO - Terminology"/> {{LINKS}}* {{REFjournal |last=Karaman |first=M. Ihsan |init=MI |title=Female circumcision debate: A muslim surgeon’s perspective |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260090/ |journal=Turk J Urol |date=2021-05-01 |volume=47 |issue=3 |pages=193–8 |DOI=10.5152/tud.2021.20546 |accessdate=2022-04-30}}

[[Category:Genital Surgerysurgery]][[Category:FGM in the United States]]