Female circumcision (including excision) loosely refers to a number of procedures performed on the female genitalia and which are generally of a cultural, rather than medical, nature. Although occasionally practiced by some doctors in the United States until the 1970's, in recent years it is only common in parts of Africa and by minority groups in some counties of the Middle East. Less frequently it occurs among some immigrant communities in parts of Asia and the Pacific, North and Latin America and Europe. Opponents of these practices use the term female genital mutilation (FGM) when they are performed on a minor.
The practice is rejected by nearly all proponents of universal human rights, both in Western civilization, in sub-Saharan Africa (where many governments are now leading actions against it), and in Asia. In those areas, it is regarded as an unacceptable and illegal form of body modification and mutilation of those that are too young or unaware to make an informed choice.
Some confusion occurs in discussing this topic as there are several distinct practices that are all generally referred to by this name. In particular, while female circumcision is generally thought of in the West as involving the complete destruction of the female sexual organs in an effort to eliminate the female's sexual pleasure, in some forms female circumcision is claimed to be analogous to male circumcision, in that both procedures can involve the removal of the prepuce and the frenulum.
In other cases, the procedure has no tissue removal at all, but is simulated with a knife as part of a ceremony, or with a symbolic drop of blood released with a needle. Those that actually involve plastic surgery are usually divided into three major types.
Type I, "clitoridotomy" (also called "hoodectomy" as a slang term), or sunna circumcision, after one of the Islamic traditions, involves the removal or splitting of the clitoral hood. This type of female circumcision is claimed to be comparable to male circumcision, although the physical functions of both genders have been reported as impacted one way or another. In addition, female circumcision of Type I is applied on much later age than male circumcision in the U.S., but at similar ages as males in affected parts of Africa.
When practiced for medical reasons, it is said to be an elective surgery intended to enhance the sexual sensitivity of the clitoris, and considered only in cases where the prepuce is overgrown or cannot be retracted. There are a number of internet groups where clitoridotomy for sexual reasons is discussed.
From the late 19th century until the 1950s, it was practiced, not to enhance, but to control female sexuality, and was advocated in the United States together with more invasive procedures such as the removal of the clitoris and infibulation by groups like the Orificial Surgery Society until 1925. Specifically, doctors performing or advocating the procedure were concerned that girls of all ages would otherwise engage in more masturbation and be "polluted" by the activity, which was referred to as "self-abuse"  (http://www.noharmm.org/paige.htm).
Through the 1950s, some doctors continued to advocate clitoridotomy for hygienic reasons or to reduce masturbation, even as other procedures were increasingly believed to be a violation of genital integrity, and as such, a form of genital mutilation. For example, C.F. McDonald wrote in a 1958 paper titled Circumcision of the Female  (http://www.noharmm.org/circumfemale.htm), (http://www.courtchallenge.com/refs/fgm2.gif), "If the male needs circumcision for cleanliness and hygiene, why not the female? I have operated on perhaps 40 patients who needed this attention." The author goes on to describe how a two-year old was no longer practicing frequent masturbation after the procedure.
Such views regarding masturbation became widely discredited by the 1960s as a result of the so-called "sexual revolution". A small minority of doctors has since advocated clitoridotomy of adults to increase sexual sensitivity, so as to increase sexual pleasure, rather than to decrease masturbation frequency, e.g., where the clitoral hood is so large as to make stimulation of the clitoris difficult.
In the U.S., the last documented clitoridotomy for sexual purity occurred in 1958. The procedure was performed on a 5-year-old girl to reportedly stop her from masturbating. Since this time the procedure has only generally been offered to adult females to enhance sexual pleasure. The clitoral hood removal web page ( (http://www.geocities.com/hoodectomy/hoodectomy.html)), as well as a number of other websites offer enthusiastic testimony for the alleged sexual benefits of the practice.
Type II or clitoridectomy is more extensive and implies the partial or total removal of the external part of the clitoris, and sometimes also the labia minora. It has only rarely been performed in Western nations.  (http://www.fgmnetwork.org/articles/duffy.htm). It is, however, quite common in many countries of sub-Sahara Africa, east-Africa and the Arabian Peninsula.
The form of female circumcision regarded as the most severe is Type III, which is also referred to as infibulation or pharaonic circumcision. It consists of a clitoridectomy, the removal of the labia minora, the cutting of the labia majora and then suturing of labia majora to cover the vagina, leaving an opening to allow urine and menstrual blood to pass through. The sewn-together labia majora are opened by the woman's husband before sexual intercourse. The labia that are sewn together are not like a mocassin sewn with leather thread which can be opened when the thread is cut. Since the skin is abraded and raw after being cut, it will heal together and form a smooth surface with a scar if joined together with thread and the woman is prevented from moving the wound for some time. Sometimes the legs are bound together to prevent movement. This healed surface must be cut or ripped open for intercourse or childbirth. The husband or wife may insist on the vagina being closed afterwards with subsequent rehealing of the tissue. This procedure may be repeated for subsequent intercourse or childbirth.
This practice is often reported as causing disappearance of sexual pleasure for the women affected, as well as major medical complications, although advocates of the practice deny this, and continue to carry it out.
Other types of female circumcision
Other forms are collectively referred to as Type IV. This includes a diverse range of practices, including pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina. Type IV is found primarily among aboriginal tribes and isolated ethnic groups as well as in combination with other types. An example, was practiced as an initiation rite among some groups of Australian Aborigines. It involved cutting or tearing the vagina of a pubescent girl to enlarge it, after which the girl engaged in coitus with several male tribal members.
Areas of practice
Prevalence of female circumcision in Africa
Female circumcision is today mainly practiced in African countries. It is common in a band that stretches from Senegal in West Africa to Somalia on the East coast, as well as from Egypt in the north to Tanzania in the south. In these regions, it is estimated that more than 95% of all women have undergone this procedure. It is also practiced by some groups in the Arabian peninsula  (http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm), especially among a minority (20%) in Yemen.
In Oman a few communities still practice female circumcision; however, experts believed that the number of such cases was small and declining annually. In Saudi Arabia and the United Arab Emirates, it's practiced among some foreign workers from East Africa and the Nile Valley. The practice can also be found among a few ethnic groups in South America, India and Malaysia. In Indonesia the practice is almost universal among the country's Muslim women; however, in contrast to Africa, almost all are Type I or Type IV (involving a symbolic prick to release blood) procedures.
The practice is particularly common in Somalia, followed by Egypt, Sudan, Ethiopia and Mali. Among ethnic Somali women, infibulation is traditionally almost universal. In the Arab peninsula, sunna circumcision is usually performed, especially among Arabs (ethnic groups of African descent are more likely to prefer infibulation).
Amnesty International estimates that over 130 million women worldwide have been affected by these procedures, with over 2 million female circumcisions being performed every year.
In modern times, the practice has spread to Europe and the U.S. due to immigration. Some tradition-minded families have the procedure performed while on vacation in their home countries.
Female circumcision is primarily a social practice, not a religious one. It is today a mainly African cultural practice. It crosses the lines of various religious groups. It is found among Christians, Muslims, and Animists alike.  (http://www.state.gov/g/wi/rls/rep/crfgm/10106.htm)
A number of reasons are put forward for the practice of female circumcision. These include the belief that it annuls or moderates sexual desires in women. It is also believed that it is more hygienic. Frequently the practice is associated with traditional initiation rites. Some believe religion justifies the practice.
In some cultures there exists the belief that a newborn child has elements of both sexes. In the male body the foreskin of the penis is considered to be the female element. In the female body the clitoris is considered to be the male element. Hence when the adolescent is reaching puberty, these elements are removed to make the indication of sex clear.
The operation is most often carried out by female practitioners. Thus it has been attributed by some authors to a deep-rooted fear of elder women that the more attractive younger women might seduce away their husbands and thus leave them without support.
Many African Muslims believe that female circumcision is required by Islam. In fact, no form of genital modification and mutilation is mentioned in the Qur'an, but only in disputed hadiths. Clerics supporting female circumcision rely on a single disputed hadith and another hadith which was discredited by the consensus of scholars as forged. In Saudi Arabia (Hijaz), where Islam originated, female circumcision has never been practiced by the locals before or after Muhammad. Muhammad, the prophet of Islam, never allowed the procedure to be performed on any of his daughters. Most scholars believe it is practiced more as a result of ignorance and misconceived religious fervor, than for reasons of true religious doctrine. Many Arab Muslims interpret different passages as being in opposition to female circumcision, and believe the practice to be un-Islamic.
A few others, like the Egyptian Mufti Sheikh Jad Al-Hâqq 'Ali Jad Al-Hâqq allegedly issued, in 1994, a fatwa stating: "Circumcision is mandatory for men and for women. If the people of any village decide to abandon it, the [village] imam must fight against them as if they had abandoned the call to prayer."  (http://www.memri.org/bin/articles.cgi?Area=reform&ID=SP72104)
It is also common among African Christians in some countries, and believed to be justified on religious grounds. For example, in Ethiopia some "Coptic Christian priests refuse to baptize girls who have not undergone one of the FGM procedure."  (http://www.state.gov/g/wi/rls/rep/crfgm/10098.htm)
Among practicing cultures, female circumcision is most commonly performed between the ages of four and eight. Although, as with most plastic surgery, advocates of it believe it should be performed under hygienic conditions and with the application of an appropriate anaesthetic. This technology has only been available for a relatively short time, and even today the procedure is usually carried out without anesthesia and under unsanitary conditions. As with any procedure, female circumcision can be extremely painful and dangerous to health when not performed hygienically. Some argue that making the process illegal drives it underground and thus puts the recipients at greater risk. Some opponents of the practice argue that the deterrent effect of prohibition outweighs such risks.
Practices such as infibulation, when carried out with shards of glass and other unsanitary tools, can commonly cause infections, sometimes resulting in death or serious long term health effects. These include urinary and reproductive tract infections (caused by obstructed flow of urine and menstrual blood), various forms of scarring and infertility. First sexual intercourse can always be extremely painful, and infibulated women also need to open the labia majora carefully. Sexual pleasure through stimulation of the external part of the clitoris, almost universally regarded outside of practicing cultures as an important part of typical female sexuality, is of course eliminated.
Prohibition has led to female circumcision being undertaken without any anaesthetic or sterilization, and by persons with no medical training. The procedure, when performed without any anaesthetic, can lead to death through shock or excessive bleeding. The failure to use sterile medical instruments can lead to infections and the spread of disease, such as AIDS, especially when the same instruments are used to perform procedures on multiple women.
Female circumcision is prohibited in several Western countries. Not all countries ban all types of procedure. For instance Type I circumcisions (for medical reasons only), and any form on adult women, are openly available in the USA, whereas, in the UK there is an outright ban even on this elective surgery taken by mature adults. In Canada, just running the risk of female genital mutilation is already sufficient reason to obtain the political asylum status. In France, in recent years several women excising minor girls have been handed prison sentences up to five years;  (http://www.droitsenfant.com/excision.htm) courts have also handed sentences between 6 and 15 months for parents.  (http://www.humanite.presse.fr/journal/1999-02-17/1999-02-17-443296)
Some countries in the area of practice have also prohibited female circumcision but the practice goes on in secret. In many cases, the enforcement of this prohibition is a low priority for governments. Some countries have tried to medicalize the procedure while in other countries there is no prohibition.
There is a growing movement in the West to see the practice on minors prohibited throughout the world. Advocates of the procedures argue that this is an example of Western cultural imperialism, while opponents of the procedures argue that human rights are universal and not subject to cultural exceptions, and that such involuntary practices are a severe violation of human rights.
Laws/Enforcement in Countries where FGC is Commonly Practiced, according the US State Department:
- Burkina Faso: A law prohibiting FGC was enacted in 1996 and went into effect in February 1997. Even before this law, however, a presidential decree had set up the National Committee against excision and imposed fines on people guilty of excising girls and women. The new law includes stricter punishment. Several women excising girls have been handed prison sentences.  (http://www.monde-diplomatique.fr/1998/09/STOLZ/10970)
- Central African Republic: In 1996, the President issued an Ordinance prohibiting FGC throughout the country. It has the force of national law. Any violation of the Ordinance is punishable by imprisonment of from one month and one day to two years and a fine of 5,100 to 100,000 francs (approximately US$8-160). We are unaware of any arrests made under the law.
- Cote d’Ivoire: A December 18, 1998 law provides that harm to the integrity of the genital organ of a woman by complete or partial removal, excision, desensitization or by any other procedure will, if harmful to a women's health, be punishable by imprisonment of one to five years and a fine of 360,000 to two million francs (approximately US$576-3,200). The penalty is five to twenty years incarceration if the victim dies and up to five years' prohibition of medical practice, if this procedure is carried out by a doctor.
- Djibouti: FGC was outlawed in the country’s revised Penal Code that went into effect in April 1995. Article 333 of the Penal Code provides that persons found guilty of this practice will face a five year prison term and a fine of one million Djibouti francs (approximately US$5,600).
- Egypt: There is no law in Egypt specifically against FGC. There are provisions under the Penal Code involving "wounding" and "intentional infliction of harm leading to death", however, that might be applicable. There have been some press reports on the prosecution of at least 13 individuals under the Penal Code, including doctors, midwives and barbers, accused of performing FGC that resulted in hemorrhage, shock and death. There also is a ministerial decree prohibiting FGC. In December 1997, the Court of Cassation (Egypt's highest appeals court) upheld a government banning of the practice providing that those who do not comply will be subjected to criminal and administrative punishments.
- Ghana: In 1989, the head of the government of Ghana, President Rawlings, issued a formal declaration against FGC and other harmful traditional practices. Article 39 of Ghana's Constitution also provides in part that traditional practices that are injurious to a person's health and well being are abolished. There is the opinion by some that the law has driven the practice underground.
- Guinea: FGC is illegal in Guinea under Article 265 of the Penal Code. The punishment is hard labor for life and if death results within 40 days after the crime, the perpetrator will be sentenced to death. No cases regarding the practice under the law have ever been brought to trial. Article 6 of the Guinean Constitution, which outlaws cruel and inhumane treatment, could be interpreted to include these practices, should a case be brought to the Supreme Court. A member of the Guinean Supreme Court is working with a local NGO on inserting a clause into the Guinean Constitution specifically prohibiting these practices.
- Nigeria: There is no federal law banning the practice of FGC in Nigeria. Opponents of these practices rely on Section 34(1)(a) of the 1999 Constitution of the Federal Republic of Nigeria that states "no person shall be subjected to torture or inhuman or degrading treatment" as the basis for banning the practice nationwide. A member of the House of Representatives has drafted a bill, not yet in committee, to outlaw this practice.
- Senegal: A law that was passed in January 1999 makes FGC illegal in Senegal. President Diouf had appealed for an end to this practice and for legislation outlawing it. The law modifies the Penal Code to make this practice a criminal act, punishable by a sentence of one to five years in prison. A spokesperson for the human rights group RADDHO (The African Assembly for the Defense of Human Rights) noted in the local press that "Adopting the law is not the end, as it will still need to be effectively enforced for women to benefit from it."
- Somalia: There is no national law specifically prohibiting FGC in Somalia. There are provisions of the Penal Code of the former government covering "hurt", "grievous hurt" and "very grievous hurt" that might apply. In November 1999, the Parliament of the Puntland administration unanimously approved legislation making the practice illegal. There is no evidence, however, that this law is being enforced.
- Tanzania: Section 169A of the Sexual Offences Special Provisions Act of 1998 prohibits FGC. Punishment is imprisonment of from five to fifteen years or a fine not exceeding 300,000 shillings (approximately US$380) or both. There have been some arrests under this legislation, but no reports of prosecutions yet.
- Togo: On October 30, 1998, the National Assembly unanimously voted to outlaw the practice of FGC. Penalties under the law can include a prison term of two months to ten years and a fine of 100,000 francs to one million francs (approximately US$160 to 1,600). A person who had knowledge that the procedure was going to take place and failed to inform public authorities can be punished with one month to one year imprisonment or a fine of from 20,000 to 500,000 francs (approximately US$32 to 800).
- Uganda: There is no law against the practice of FGC in Uganda. In 1996, however, a court intervened to prevent the performance of this procedure under Section 8 of the Children Statute, enacted that year, that makes it unlawful to subject a child to social or customary practices that are harmful to the child's health.
Ending Forms of female circumcision
Despite laws forbidding the practice, female circumcision has proven to be an enduring tradition difficult to overcome on the local level with deeply held cultural and sometimes political significance. For instance, prohibition of circumcision among tribes in Kenya significantly strengthened resistance to British colonial rule in the 1950s and increased support for the Mau Mau guerilla movement. During that period, the practice became even more common, as it was seen as a form of resistance towards colonial rule.
The difficulty lies significantly in the fact that not only is the practice taken as an identifying feature of indigenous culture, but it is intimately associated with the "marriagiability" of young women. Thus for only one or a few families within a given locale to "deprive" their daughters (or, more typically, granddaughters) of the operation is to significantly disadvantage them in finding husbands, a fate with dire social and economic consequences for the traditional woman and her family.
Because the practice holds such cultural and marital significance, it is increasingly recognized that to end the practice it is necessary to work closely with local communities. What must happen, some have noted, is that marriage networks must give up the practice simultaneously so no individuals are handicapped, as happened, for example, under similar circumstances with the rapid abandonment of foot binding among the Chinese early in the 20th century.
A particularly encouraging example of successful efforts to end the practice is occurring in Senegal, initiated by native women working at the local level in connection with the Tostan Project. (http://www.tostan.org) Since 1997, 1,271 villages (600,000 people), some 12% of the practicing population in Senegal, have voluntarily given up FGC (female genital cutting) and are also working to end early and forced marriage. This has come about through the voluntary efforts of locals carrying the message out to other villages within their marriage networks in a self-replicating process. By 2003, 563 villages had participated in public declarations, and the number continues to rise. By then, at least 23 villages in Burkina Faso had also held such community wide ceremonies, marking "the first public declaration to end FGC outside of Senegal and showing the replicability of the Tostan program for large-scale abandonment of this practice".
This indigenous movement began with a few women who had participated in a literacy program that taught women skills in research, project management and social advocacy. The program also included neutrally presented facts about female reproduction and the health effects of female circumcision. Students did group projects as the culmination of their 18-month training and one such group chose the topic of FGC for their project. Having received assurance from their local imam during their research that the practice was a custom and not a religious requirement, they went on to create dramatic reenactments of the suffering and deaths the practice had brought to their own lives and to share them throughout their village. At the end of a year, their entire village of some 15,000 people joined in a public ceremony to collectively reject the practice for their daughters and prospective daughters-in-law. From there, the imam and other leaders in their village began visiting other villages within the local marriage network and sharing their story. As a result, the new practice began to spread.
Female circumcision in popular culture
The subject of female circumcision has been addressed by many prominent authors, singers and performers across the world. Some examples:
Also, a documentary entitled "Warrior Marks" has been done on the practice by Alice Walker, the author of The Color Purple. Walker subsequently wrote a book of the same name, which is about her travels and experiences while making the documentary.
- Female Genital Mutilation - A Human Rights Information Pack (http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm) by Amnesty International
- Female Genital Mutilation from the World Health Organization (http://www.who.int/inf-fs/en/fact241.html)
- The Female Genital Cutting Education and Networking Project (http://www.fgmnetwork.org/)
- U.S. State Department estimates of prevalence of FGC in Africa (http://www.state.gov/g/wi/rls/rep/9276.htm)
- Map:Prevalence of Female Genital Mutilation in Africa (http://www.afrol.com/Categories/Women/FGM/netscapeindex.htm)
- Article from ReligiousTolerance.org decrying FGC (http://www.religioustolerance.org/fem_cirm.htm)
-  (http://www.psurg.com/clitoris.html) A graphic image of elective type I circumcision (in addition labial reduction)
- A Human Rights Organisation called "Target", founded by Rüdiger Nehberg in 1998 (http://www.target-human-rights.com/)
- Medical Studies on Clitoral Hood Removal (http://www.geocities.com/hoodectomy/MedicalStudies.htm)
- Beyond the Veil: Male-Female Dynamics in a Modern Muslim Society (ISBN 0470596139)
- Infibulation Explained (http://www.lockmeup.com/cb/facts/pinkerton-infibulation.html)
- Tostan Project (http://www.tostan.org)
- Infibulation in the Horn of Africa (http://www.cirp.org/pages/female/pieters1)