The Literature on Female Genital Mutilation

Female Genital Mutilation — a Review and Analysis

How prevalent is the practice of female genital mutilation throughout the world? Why is it done, where is it done, and what are the human rights and morality implications? This paper will examine those questions, and provide information that supplements those issues.

The Literature on Female Genital Mutilation

There are four types of female genital mutilation (FGM), according to an article in the British Journal of Midwifery (Momoh 2004, p. 631): 1) Type 1 is called clitoridectomy, in which the “excision of the clitoral prepuce may also involve the excision of all or part of the clitoris”; 2) Type 2 is the cutting away from the body of the clitoris, but may also involved the excision of “all or part of the tabia minora”; 3) Type 3 is called infibulation, and it involves “excision of part or all of the external genitalia and the stitching or narrowing of the vaginal opening”; 4) and Type 4 alludes to all other procedures in which a female’s genitals are cut.

How many females have been subjected to FGM — in any of the four types mentioned above? Momoh writes that it worldwide it affects “more than 120 million women” and in addition, “an estimated two million girls are circumcised each year.” According to another article in the British Journal of Midwifery (Sihwa and Baron, 2004, p. 717), “an estimated 100-130 million girls and women in the world have undergone FGM,” and around 2 million girls are “at risk” annually.

Beyond those initial numbers provided by Sihwa, she writes that “the practice of FGM and its consequences affect an estimated 80 million women in the world” and the places where FGM is most common include Africa, Southeast Asia and the Middle East.

Where is FGM practiced? Meanwhile, FGM is also practiced in regions of western countries where immigrants from Africa, Southeast Asia and the Middle East settle; in London recently, a doctor was banned from practicing after he was videotaped “agreeing to circumcise an eight-year-old girl,” and agreeing to “stitch two older girls.” An English law (the Female Genital Mutilation Act 2005) makes it an offense to “excise, infibulate or otherwise mutilate the whole or any part of the labia majora or labia minora or clitoris” of a female.

“More needs to be done” to educate and train midwives,” Sihwa asserts, pointing out in the article that at a recent conference in London, “less than five” of 50 midwives in attendance were aware of the Prohibition of Female Circumcision 1985 Act, notwithstanding the fact that it had been in place for 20 years.

How is FGM carried out in practice? The country that has the highest incidence of FGM is Somalia, Momoh writes; some 98% of women undergo FGM to one degree or another, due to “entrenched cultural beliefs.” Momoh suggests that the “nomadic existence” of many Somalis reduces the possibility of widespread education regarding the barbaric nature of the practice. What is more troubling — beyond the fact that 98% of females are cut — “the practice is largely conducted by people untrained in surgery (parents, grandparents, and traditional birth attendants, using unsterile utensils).”

The crude, unskilled nature of those procedures inevitably leads to complications and long-term health problems, Momoh continues; following the surgical procedure, the female’s wound is often rubbed with herbs, salt water, sugar, and “camel feces” — and the legs are then “bound together” for several days. Often these procedures are carried out without anesthesia — and quite frequently the procedures are performed on girls “too young to give consent.”

What are the complications associated with procedures that cut or mutilate or remove a female’s genitals? Sihwa’s article explains that a female may experience “hemorrhage, infections” and even death, in the short-term. In the long-term, complications include genital malformations, chronic pelvic complications, “recurrent urinary retention and obstructed labour.”

What are the justifications for FGM? Sihwa writes that some cultures believe “that the clitoris is poisonous and dangerous and will cause a man to sicken or die” if the clitoris comes into contact with the penis; another belief is that an “unmodified clitoris” leads to lesbianism; still another belief is that FGM “makes a woman’s face more beautiful and prevents vaginal cancer,” Sihwa explains.

Momoh writes that in Somalia, there are several justifications for FGM: “maintaining cultural, traditional and religious norms”; making sure that females “remain pure until they get married”; and increasing the “marriage eligibility of daughters” (including a higher dowry for a virgin). There are also parents who have FGM procedures performed on their daughters because they wish to protect the young girls from “being raped by men” or from participating in “illegal sex” prior to marriage.

According to the Web site Religious, FGM is a “social custom, not a religious practice.” That said, in Muslim countries where FGM (alluded to as “sunna”) is practiced, and has been practiced (originally in the time period “al-gahilyyah,” which means “the era of ignorance”) for perhaps as long as 2,000 years, there are two passages from the Prophet Mohammed — which are considered questionable at best and inaccurate at worst in scholarly communities — that appear to promote FGM.

And although the Qur’an, the Old Testament, and the New Testament offer no insights on the subject of FGM, the “Sunnah” — reportedly the words and deeds of the Prophet Mohammed — does offer several references to FGM. In a Sunnah story about a woman performing infibulation on slaves, she is said to have commented to Mohammed that she would continue the procedure unless it is “forbidden and you order me to stop doing it.” Mohammed replied, “Yes it is allowed. Come closer so I can teach you: if you cut, do not overdo it, because it brings more radiance to the face and it is more pleasant for the husband.” On another occasion, Mohammed is alleged to have said (to the Ansars’ wives), “Cut slightly without exaggeration, because it is more pleasant for your husbands.”

Meanwhile, the Muslim Women’s League quotes renowned scholar Sayyid Sabiq as saying all such quotations are “non-authentic.” Indeed, many Muslims, according to the Web site, believe the Qur’an “promotes the concept of a husband and wife giving each other pleasure during sexual intercourse. In 2:187 of the Qur’an: “It is lawful for you to go in unto your wives during the night preceding the (day’s) fast: they are as a garment for you and you are as a garment for them.”

From the perspective of international human rights issues, the World Health Organization (Dorkenoo and Mohammed 1998, pp. 4-6) takes the position that FGM is “the single most extreme, violent and painful practice causing physical, psychological and emotional problems and even the death of girls and women in some societies.” Also, the WHO representative goes on, “FGM comprises all procedures involving partial or total removal of the external genitalia or other injury to the female genital organs.” Beside the health problems alluded to earlier in this paper, which may result from FGM, the WHO’s experts say that women and girls may also suffer from tetanus, HIV, infertility and depression.

The practice of FGM is “no longer confined to the 26 sub-Saharan African countries where it has been prevalent for centuries,” the authors explain. It now has moved into most western nations, albeit, there are laws against FGM in Canada, the U.S., Sweden, Switzerland, Britain and France, among other nations.

And there is a “technical difference” between male and female genital mutilation, the article continues. In a female, the simple removal of the clitoral prepuce (known as female circumcision) is indeed “equivalent to male circumcision,” albeit that procedure constitutes “less than 1% of all female genital mutilations.” In over 95% of the cases of female genital mutilation, the WHO article explains, “the clitoris, the labia minora, and (often) the labia majora are excised and the vulva is sewn up.”

The biological equivalent for a male would be to “be partial to almost two-thirds removal of the male sexual organ, including in some cases removal of tissue from the scrotum, followed by stitching up the remaining tissue.”

The position of the WHO has consistently been to “recommend that governments adopt clear national policies to abolish FGM,” and to strengthen educational programs so that the public knows that FGM is a “serious health hazard” and also know that FGM “reinforces the inequality suffered by women in their communities.”

An article in WHO (Nybro 1998, p. 6-7) reflects what it is like to be a midwife in Denmark, working with Somali women living in Denmark; Ms. Nybro needs to show great care and sensitivity to pregnant Somali women, so the Somali women develop a trust with the Danish midwife. That trust, the article continues, could lead to the expectant mother turning away from the “savage custom” of FGM, and deciding not to have her new daughter cut into.

An empirical study of 522 FGM cases in South-Western Nigeria. A research article in the Journal of Obstetrics and Gynaecology (Dare, et al. 2004, pp. 281-283) reports on a study conducted at three teaching hospitals in Nigeria shows that of 522 women examined and interviewed who had FGM procedures performed on them, 89% of those procedures were done by “untrained personnel.” And of those 522 women, up to 67% of them “reported complications following the procedure.” The most common complaints? “Severe pain and bleeding” were reported by 69% of those who had complications.

Why did the Nigerian women go through with the FGM procedures? About 63% said they did it for cultural and/or traditional reasons, and just less then 20% of them said they wanted their future female children to undergo FGM. The researchers note that although about 100,000 teenagers — most living in Sub-Saharan Africa — die from complications following FGM procedures annually, and the practice of FGM is considered “to be a violation of human, women’s and children’s rights,” the dark issues surrounding FGM “are shrouded in secrecy, and systematic research into the magnitude” of the issue is “scarce.”

Of the 522 women in the Nigerian study, 63% underwent genital mutilation “before the age of 13”; up to 31% of the procedures were performed “before the age of 5 years”; and around 4% of the women had the procedure performed during their pregnancy.

Four-hundred and sixteen of the 522 women “could remember the circumstances surrounding the operation”; and of these, 89% had their genitals mutilated by “medically untrained personnel” (59% of the untrained personnel were “traditional birth attendants,” 41% were “an elder in the family” and the remaining 11% were doctors or midwives).

One hundred twenty-seven of the 522 women want their female child to have the operation, while 207 (40%) reportedly are “indifferent.” Of the 522 women in the study, a scant 8% were aware that the procedure is currently illegal in Nigeria. The study concludes that the agencies presently working on preventing female genital mutilation “are reaching only a small percentage of people for whom FGM is a tradition practice.”

“Psycho-sexual Effect of Female Genital Mutilation on Sudanese Men.” In an article in The Ahfad Journal (Magied and Musa 2004, pp. 18-28), the authors point out that while FGM is “well-known” for its “infliction of … hazards” on girls and women in general, very little is known about the “psychosexual effect of FGM on Sudanese women, and “hardly any literature” exists on Sudanese men with reference to FGM.

The article reported data resulting from the research of 200 males, surveyed through questionnaires and interviews; four groups of 50 married men each were selected from each of these four categories: workers, nurses, clerical staff and “advocates.”

Clearly, the authors of this research use English as a second language, but their findings are pertinent and germane. The main points of the article are that a) “Sudanese men experience feelings of fear” from the “expected difficulty of penetrating a tight vaginal orifice,” and they become “furtherly aggravated when effecting coitus” takes up to several weeks, even months; b) in order to facilitate coitus, some Sudanese men “resort” to lubricants, while others “seek surgical interventions by professions” (presumably doctors, who “undo” stitches), and still others “suspect impotence after repeated unsuccessful trials to effect coitus”; c) a “contradiction” was found in the men: while they preferred an “uncircumcised wife” they also choose to have their daughters circumcises; this situation is called a “Cultural Inhibition Syndrome” (CIS).

Some of the data this survey reported is quite interesting, and revealing. For example, 46% of “workers,” but only 26% of clerical staff and 28% of advocates expressed feelings of “fear” before the first wedding night with a circumcised wife. Meanwhile 74% of clerical staff and 68% of advocates expressed “pleasure” in anticipating the first night of marriage with a circumcised wife.

The reasons given for fear perhaps tell something about male attitudes in the Sudan towards women: Some 87% of male workers, 83% of nurses, 85% of clerical staff and 93% of advocates feared the possible failure to “penetrate a tight vagina”; but a distinct minority (13% of workers, 17% of nurses, 15% of clerical staff and 7% of advocates) experienced any fear that they might inflict “pain” on their circumcised wives.

As to length of time prior to initial coitus, close to a majority, or a scant majority (48% of workers, 54% of nurses, 56% of clerical staff and 36% of advocates) were able to achieve coitus with their circumcised spouses within a time frame of one to six days.

As a result of this published study, the authors recommended that “the health hazards of FGM should be incorporated into the curricula of schools … [and] all health providers should make an oath” to not practice FGM.” Moreover, the Sudan Medical Council “should suspend” any health provider practicing FGM, and those who get circumcised (and those who are responsible for having children circumcised) “should be penalized.”

In an article in the British Journal of Midwifery (“Gender and Daily Life in Ethiopia” pp. 99-100), the un-identified author notes that the practice of FGM is “perpetuated by women, but justified in gendered terms. It is commonly held that without having been circumcised, a woman will find it difficult to marry or will be difficult for her husband to control.” It is also used in the sense of reducing “sexual urges, to keep women docile.”

But the author’s report that it is not hard to believe FGM is widespread in Ethiopia, given the fact that Ethiopian girls are also vulnerable to “culturally sanctioned violence, including abduction, particularly when fetching water or fuel wood.” Why are girls abducted in Ethiopia? They are snatched by older men “in order to be forced to marry, often by being raped so that her family will be pressured to let her remain with her new husband rather than returning in disgrace.”

Using baptism ceremonies of newborns as an opportunity to excise females is being reported as commonplace in the African nation of Burkina Faso (Contemporary Sexuality 2004, pp. 7-8). The good news for those opposed to FGM’s widespread acceptance in Africa is that only 1 to 2% of women in Burkina Faso’s “high urban populations” now are being subjected to FGM. That is well down from the “two out of three girls” being subjected to FGM in 1996. Still, though, in the rural “resistant-to-change” provinces of Burkina Faso, the percentages remain fairly high — “36 to 55% in 14 provinces — of girls who have genital mutilation procedures performed on them.

The sad reality though, is that in those rural provinces, the “clandestine activities of circumcisers” include the insidious strategy of using “baptism ceremonies of newborns as an opportunity to excise,” according to Antoine Sanons of the “National Committee Against the Practice of Circumcision (CNLPE).”

A joint survey by the WHO and CNLPE revealed that “70% of instances of female genital mutilation are to girls age 7 and younger.” In order to avoid the law — it is against the law in Burkina Faso as well as 12 other African nations, though the law is not fully enforced in most cases — “the circumcisers have been smart enough to substitute adolescents with little girls,” Hortense Palm of the CNLPE was quoted as saying.

Meanwhile, the Economist (September 2004 p. 75) reports that a quarter of women in Nigeria are presently circumcised, and 90% in Mali have had FGM procedures performed on them. In Egypt, the article continues, a massive campaign against FGM was launched 10 years ago during the International Conference on Population and Development; the campaign was created to try to reduce the percentage of women (97% at that time) being mutilated, most often by a midwife. Unfortunately, the 97% figure has been reduced “only slightly,” the Economist reports, but the good news is that there has been a shift from the use of midwives to primarily doctors who perform the mutilation.

In conclusion, a research article in the Journal of Medicine and Philosophy (Bishop 2004 pp. 473-497), using a rather lofty intellectual theme, states that “nothing challenges” the tolerance of Western liberalism “like the practice of sunna … ” And the Western critique of sunna “often maps onto the bodies of African women Western symbolic notions of sexual and political freedom, as symbolized in the clitoris.”


Bishop, Jeffrey P. (2004). “Modern Liberalism, Female Circumcision, and the Rationality of Traditions,” Journal of Medicine and Philosophy, vol. 29, no. 4, pp. 473-497.

British Journal of Midwifery (2004). “Gender and Daily Life in Ethiopia,” pp. 98-99, October.

Contemporary Sexuality (2004). “Mixed News on Female Genital Mutilation,” vol. 38, no. 8, pp. 7-8. August.

Dare, F.O., Oboro, V.O., Fadiora, S.O., Orji, E.O., Sule-Odu, A.O., and Olabode, T.O. (2004), “Female Genital Mutilation: An Analysis of 522 Cases in South-Western Nigeria,” Journal of Obstetrics and Gynaecology, vol. 24, no. 3, pp. 281-283.

Dorkenoo, Efua, and Mohammed, Rahmat (1998), “Female Genital Mutilation (FGM),” in “Health Issues of Minority Women Living in Western Europe,” World Health Organization Report on a WHO Meeting, Copenhagen, Denmark.

Economist (2004). “The unkindest cut for a woman,” vol. 372, issue 8391, p. 75.

Magied, Ahmed Abdel, and Musa, Suad (2004). “Psycho-sexual Effect of Female Genital Mutilation on Sudanese Men,” The Ahfad Journal, vol. 21, no. 1, pp. 18-28.

Momoh, Comfort (2004). “Attitudes to Female genital Mutilation,” British Journal of Midwifery, vol. 12, no. 10, p. 631.

Nybro, Lisbet. (1998). “Pregnancy and Birth in Minority Groups in Denmark: Focus on Somali Women,” in “Health Issues of Minority Women Living in Western Europe,” World Health Organization Report on a WHO Meeting, Copenhagen, Denmark.

Religious (2004). “Female Genital Mutilation (FGM) in Africa, the Middle East & Far East: Debates about FGM,” Available from Accessed 15 February 2005.

Sihwa, Joyce, and Baron, Maurina. (2004). “Female Genital Mutilation: Cause for Concern in the UK,” British Journal of Midwifery, vol. 12, no. 11, p. 717.

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