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Female Genital Mutilation

It’s gone by other names, primarily female circumscision, as if it was nothing more than the male equivalent of removing the foreskin. It’s supposedly another one of those awful things that “can’t happen here.” Read the CNN report about the British, who may finally get serious about stopping the practice, and you’d never guess that tens of thousands of children suffer through the mutilation and its lifelong consequences right here in the good old U. S. of A.

Why the bizarre silence? Because it’s a “cultural issue,” you know. The approved term is now female genital cutting. Some people felt that the term “mutilation” was culturally insensitive.

For those occasions when somebody starts suggesting that this is a “cultural” matter, consider the facts.

First, an anatomy lesson, developmental anatomy, to be precise. The tissues in males and females come from the same embryonic structures. They just follow a different path of development. The biologists’ term for that is homologous structures. The types of nerves and arousal present in the different male and female structures are much the same, with some differences I’ll note below.

Testes and ovaries are obviously homologous. The skin of the scrotum comes from the same embryonic tissue as the outer labia in women. It’s quite sensitive in both sexes. The inner labia is homologous to the skin on the urethral side of the penis. That’s very, very, very sensitive. The shaft of the penis continues well back into the body, as does the equivalent structure in women. In women the two strands of tissue pass around and on either side of the vagina. They’re “erect” on arousal, but the erection consists of lots of blood flow without stiffness. (Probably needless to say, that not only enhances sensation for the woman but also for her male partner.) The head of the penis is homologous to the clitoris and both are covered in a foreskin. The obvious part of the “clitoris” is that covering skin, and the actual bulb of the clitoris, about the size of a large-headed pin, is within that.

This is where the biggest difference in sensations occurs. The number of nerve endings in the clitoris are about the same as the number spread throughout the head of the penis (the glans). Numbers of nerve endings per square millimeter matters a great deal. It’s like the difference in sensitivity between the surface of your eye and the inside of your mouth, except that nature’s idea for the clitoris and glans is an overload of pleasure rather than anything else. (For those interested in more information, any developmental anatomy text recaps the information. A table of homologies (Loyola Univ. Chicago), and a simple intro (U. Miami-Coral Gables) to the development of sexual organs.)

With that as background, everyone, regardless of gender, can get a fair idea of what the different kinds of genital mutilation mean.

There are different degrees of the practice. (See Wikipedia for a “culturally sensitive” but generally accurate summary.) In the least invasive, the homologue of the male foreskin is removed. The result, however, is anything but homologous. It’s like removing a person’s eyelids, not just, for instance, exposing the inside of the lip. This type can only really be done by doctors since others are generally ignorant of female anatomy. Most mutilations aren’t performed by doctors.

In the least invasive common form, the whole external structure of the clitoris is removed. This is equivalent to having the whole glans cut off. The next variety is removal of the whole clitoris and the inner labia. The fourth type involves removal of clitoris and inner and outer labia. The remnant tissue is then stitched together, leaving a small hole for urination and menstruation. If you think back to the list of homologies, this is the equivalent of cutting off the whole penis and most of the scrotum, and then stitching what’s left of the scrotum back together. This type of mutilation, as I understand it, is the commonest form. You can see why I find “cutting” an inadequate term.

There is a final level of destruction that goes beyond even this, and basically tries to make sure there’s nothing left, but I gather that is uncommon these days.

The practice tends to be associated with Muslims in the Western mind, but one of the epicenters is Ethiopia, a majority Christian nation. Andrew Heavens, who reported from Addis Ababa for years, and is now in Khartoum, Sudan, gives some glimpses of the results.

An Ethiopian friend described finding a hut in a village near the regional capital Jijiga a few months ago. Inside there was a row of little girls sitting close to each other with their legs stretched out and their ankles tied together. They had undergone the procedure earlier in the week and were having to sit dead still for days on end for the wounds to heal.

The other image was from my own visit to the town of Gode, not so far from the border with Somalia. A group of boys were playing outside their school, watched by a line of girls. I asked why the girls weren’t playing with them. The teacher next to me shrugged and said “We’re afraid that if they fall they may break their stitches.”

It is not hard to imagine what genital mutilation does to the ability to enjoy sex. (The hard part is not to imagine it.) Assuming no infections and perfect healing, any subsequent enjoyment of sex is limited to the undamaged vaginal lining and the erectile tissues that surround the vagina. It would be like trying to get off with nothing but the stub of a penis, and most of that scarred to the point where sex hurt. The biology of it makes me extremely dubious of claims by some people that sex after mutilation is just fine, thank you. It makes no biological sense, although it does make some psychological sense. It’s always easier, at first, to be in denial than to acknowledge the harm that’s been done.

Robbing women of sex is considered a non-issue, I guess because women don’t have sex (they have babies), and they don’t need pleasure. (Well, they don’t die for lack of it, do they?)

The medical consequences are getting some attention. Most of the mutilations are not done by doctors and are not under sterile conditions. Death can occur from shock (in the clinical medical sense that the body shuts down) and from bleeding. Infection is the biggest post-operative danger. Infection increases the already considerable tissue damage and the scarring. Diseases such as HIV can also be introduced by the cutting tools. The tissue damage alone is often enough to lead to serious urinary tract infections and diseases, reproductive tract infections, and infertility.

Planned sex, i. e. with a husband, requires the stitches to be taken away by some means. One method is for the husband to use a knife. Since he’s probably not a surgeon, this leads to yet further complications. After childbirth, the woman is stitched back up if the husband is absent for long enough periods of time.

There is also a lot of torture that uses sex going on in places like Darfur. Consider that the sexual torture we hear about is being done on a population of women almost all of whom have been subjected to mutilation.

FGM is not limited to subsaharan Africa and parts of the Middle East. Ethnic groups that use the practice continue to do so when they emigrate. In the US, for instance, the African Women’s Health Center [link moved to here] points out that 228,000 women and girls have been or are at risk for mutilation, and of those over 61,000 are younger than 18. (The African Women’s Health Center was founded by Dr. Nawal Nour, initially because immigrant patients had nobody who knew much about the medical problems faced by this population of women. They provide whatever medical assistance the woman wants, including reconstructive surgery.) These numbers of women at risk have increased in recent years. The problem is getting worse, not better.

This crime against humanity is starting to get some attention in Europe and the UK. (E. g. this BBC report.) Its criminality is starting to be recognized in the countries where it primarily occurs (e g. Egypt), although enforcement is so spotty as to be in the quantum dot range. In the US, there isn’t the concerted action you’d like to see against something so barbarian. (Of course, this is far from the only crime where we’ve slipped from civilized standards.) However, at least one heartnumbingly outrageous case was prosecuted. Other than that, I’m not sure where the outrage is.

Interesting, how human rights are only ever a “cultural” issue when women are involved. Was apartheid excused as the “culture” of the white Afrikaners? Does anyone pretend Chinese culture excuses the practice of selling the organs of executed prisoners for transplant?

It’s one more symptom of the inarticulate assumption that women aren’t really human. They just produce humans now and again. Sure, some of them are adorable, some of them are wives, mothers, daughters, and sisters. But, when you get right down to it, they’re weird. You can’t understand them. Who knows what they want. I remember hearing a rancher say once that branding cattle doesn’t hurt them. Much, anyway. No doubt it’s the same with those strange flaps of skin those creatures known as “women” have.