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Thursday, June 24, 2010

FGM in the USA

I've tried not to write about this, but it just won't go away.

Warning: This will not be an easy read.

FGM is 'female genital mutilation'. It's also know as 'cutting' and 'female circumcision'.

The World Health Organization estimates that 100 to 140 million women world wide are currently living with the consequences of FGM.

If you've heard anything about FGM, you've probably associated it with Africa and parts of Asia.

In July, 2003 at its second summit, the African Union adopted the Maputo Protocol promoting women's rights including an end to female genital mutilation.

Having been ratified by fifteen members, it went into force in November, 2005. By December 2008, 25 member countries had ratified and deposited the Maputo Protocol.

And yet, the U.S. State Department estimates that the practice of FGM continues unabated. At the time of the ratification of the Maputo Protocol, a study revealed the prevalence in the following countries:
Egypt: 78 - 90% Type I, II and III

Ethiopia: 69.7%-94.5% Type I, II, III, and IV

Guinea: 98.6% Type I, II and III

Sudan: 91% Type I,II and III
There are more, but these countries are among the worst offenders.

A quick google check did not reveal a more recent study (although, I'm sure there are), but numerous recent articles and films on the subject which I found continue to claim that the laws have had little effect on curbing the incidence, claiming strong, ancient ties to cultural and religious tradition. 

I don't mean to shock you or disturb you - no, wait, I do want to disturb you - but just so we know what we're all talking about here, this is a graphic that shows the three different types of Female Genital Mutilation.

If you choose, you may click on the picture, to see the graphic in greater detail.

Type IV - as practiced in Ethiopia and other parts of Africa - consists of "other mutilation" such as pricking, piercing, incising, ripping, tearing, burning, scraping and cauterization. 

I don't know how anyone can look at this and 'soften' the term by calling it 'cutting'. And, let's not dignify it by calling it 'circumcision', please.

It's mutilation. Full stop.

In the United States, federal law prohibiting FGC was enacted in 1996. 17 states enacted similar laws between 1994 and 2006.

So, we can rest assured that no young girl or young woman is having her genitals mutilated in these United States, right?

Think again.

Just this past May, we came perilously close to allowing a form of FGM called "Nicking".
After suggesting that American doctors should be allowed to “nick” girls’ genitals if it would save them from being sent overseas to have a full female genital cutting procedure done, the American Academy of Pediatrics (AAP) has reversed its decision. Human rights group Equality Now decried the original announcement.
So, we can rest assured that no young girl or young woman is having her genitals mutilated in these United States, right?

Think again.

All we need do is look over to New York City - specifically, New York Presbyterian Hospital, Weill Medical College of Cornell University

Yes, in the heart of the city that is known as "The Capitol of the World," FGM is being conducted in the name of "research".

Can anyone say, "Tuskegee Syphilis Project"?

Alice Dreger and Ellen K. Feder recently (06/16/10) wrote an article in the online Bioethics Forum in which they compare the dehumanizing language of the Tuskegee Syphilis Project with the paper published in the 2007 Journal of Urology, “Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability” by Jennifer Yang, Diane Felsen, and Dix P. Poppas.
"Writing in the typically dry, quantifying language of modern medicine, the authors report why they believe Poppas, a pediatric urologist at New York Presbyterian Hospital, Weill Medical College of Cornell University, has left a group of girls still able to have sexual sensation after he has removed parts of the girls’ clitorises. With parental consent, these girls’ clitorises have been cut down in size after the physician deemed these clitorises too big."
As I dug deeper into the story, it seemed that some of these . . . "procedures". . . were being performed on children classified as 'intersex': "a group of conditions where there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries). The older term for this condition is hermaphroditism."

However, the preponderance of evidence suggests that this surgical procedure is being done primarily on girls, some as young as three years old - with full approval of the parents - for "cosmetic" reasons, because of their concern that their clitorises were too large.

As shocking as this is, there is another, shocking post operative aspect to this horrible "medical procedure" - all in the name of "research".

Here's what Dreger and Feder report:
"At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time."
While there are obviously many, many problems with this, one of the Very Big problems has to do with institutional oversight in the form of an IRB or Institutional Review Board, which approves and monitors all research done at the facility.

Dreger and Feder reveal that:
"Yang, Felsen, and Poppas report IRB approval for retrospective chart review (Are you kidding me????), but apparently have no IRB approval for the post-op “sensory testing.”
I don't know about you, but this makes me sick to my stomach. It boggles my mind that, in the year of our Lord, 2010, well-educated men and women who have taken an oath to "do no harm" could entertain such an idea, much less look the other way while human rights violations are happening in the name of 'research'.

I am a fervent supporter of cultural diversity. I have learned so much from my sisters and brothers around the world which has opened my Western mind to different perspectives of the human enterprise. I am an avid supporter of many Eastern medicine practices and find many of the medicinal, herbal practices in the Global South to be nothing short of genius. I continue to be in awe of the resilience of the human body.

I am, however, sick unto death of the accommodation of cultural and religious differences which violate the rights of women and children.

Polygamy in the Global South, sadly understood and tolerated as a way to counter the effects of poverty on women.

Foot binding in China as an "intensely erotic" experience for men.

Breast Ironing in Cameroon as a way for mothers to protect their pre-pubescent daughters from rape.

My worst fear is that these "good doctors" are operating out of an ethic of doing "less harm" to these girls who, I suspect, are the children of parents from countries where FGM is widely practiced.

Like "nicking", I suspect these "good doctors" believe that they are sparing these young children from a return to their home countries to be mutilated in a village hut by women for whom this is their only source of income.

Or, perhaps it is all a part of our insane obsession with plastic surgery to 'perfect' what God has created.

Someone is saying, "Hang on! We circumcise infant boys all the time in the name of cultural and religious diversity. Isn't that wrong, as well?"

You will get absolutely no argument from me on that issue.

A quick check into google reveals that "The American Medical Association report of 1999, which was "…confined to circumcisions that are not performed for ritualistic or religious purposes," states that
"Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

And yet, the World Health Organization estimates the prevalence of male circumcision in the United States and Canada at 75% and 30%, respectively. Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.

Clearly, there is much work to be done - in this country and around the world.

As for me, I'm starting across the Hudson.

I have written a letter to New York Presbyterian Hospital, Weill Medical College of Cornell University at 525 East 68th Street New York, NY 10065 (their telephone number is (212) 746-5454), expressing my outrage at these blatant violations of human rights..

I encourage you to do the same thing.

The best way to fight poverty, prejudice, bigotry, oppression, cruel abuse and extremism is to educate and empower girls and women, who will teach and equip the next generations of women and men to live fully into the enterprise of being full, whole, complete human beings.

The horrors of FGM and other human rights abuses to women will not go away just because we don't want - or refuse - to think about them.

"Women," the old Chinese saying goes, "hold up half the sky."

May that become our passionate and persuasive cry to end the sexism and misogyny which results in the mutilation and oppression of some of God's most beautiful creatures.

Lest half the sky fall.

UPDATE:  Sign the petition to stop FGM at Cornell.


Unknown said...

I'm glad you mentioned circumcision of boys, too. I think there has been recent research indicating that babies *do* feel pain (huh? they thought before that babies *didn't?). The move against circumcision of boys among Jews has been a matter of slow momentum, mainly supported by a few women, who get it. Didn't Alice Walker write a hair-raising novel including a character who had undergone FGM?
Thanks for all you do.

Göran Koch-Swahne said...

Horrible, horrible, horrible is all I can say. May this violence cease immediately among all people!

Paul said...

I spotted a recent headline about this in the US and my heart sank. May this barbaric cruelty end soon.

Chris Medeiros said...

If we need a lesson in any of this, it is that if a child's genitals are working and not causing them physical pain or illness, even if they don't look exactly like they are "supposed" to look, LEAVE THEM ALONE!

What happens to normal healthy little girls in some cultures is absolutely shameful and tragic, no amount of cultural sensitivity should change our minds on that. So called "female circumcision" is clearly the brutal mutilation of girl's body, pure and simple.

I also think cutting healthy skin off of a baby boy's penis in circumcision is a completely unnecessary surgery that only can harm a child. Subjecting a baby boy to infection, tissue damage nerve damage, etc. for no medical reason seems quite wrong to me. The health problems of uncircumcised men are overblown. The majority of men in the world have lived uncircumcised quite happily.

Children who are born intersex, for whom their gender (whatever that exactly is) is unclear, are constantly have their genitals cut and reshaped or having their young bodies flooded with artificial hormones. This happens not because the child is ill, but because parents want to have children who are more clearly male or female because of their own discomfort. There is no reason parents can pick a gender to raise a child while keeping things open and listening to their child as they grow without medically altering a child's body. These intersex children are routinely mutilated and pumped up with drugs and hormones by parents must know whether their child is a boy or a girl. Talking to adults who under went these "treatments" as children is heart breaking. The psychological scars are awful and lifelong, and often times their bodies have been so distorted that they cannot enjoy any kind of intimate contact with anyone.

If we left children alone, and only did only those procedures that are "medically" necessary for health and life of child and let the children decide at adolescence or adulthood what types of medical intervention they want done to "their" bodies we would be truly raising the children God gave us. God only lends us children and we are to raise them.

Parents are not evil and I have no doubt having and a intersex child is difficult. These parents need help with their own fears and misconceptions around sexuality and gender, but they should not enforce their notions on a child's innocent body.

Prior Aelred said...

FWIW, there is a Facebook Group against FGM (which I joined ages ago).

Also, the Chief Imam of Egypt AND the Coptic Patriarch issued a joint statement opposing the practice (which, I suppose, demonstrates that religion & culture are not the same).

Unknown said...

I have read of medical procedures done on intersex infants to make them resemble on or the other sex, based on the doctor's recommendations. Infants! How many of these children have grown up confused about their own sexual identity? Why not leave well enough alone, assuming the urinary tract is whole, and let nature take its course so the individual can decide which sex he or she is, and the adolescent hormones will probably confirm the choice. The arrogance and presumptiousness of some doctors and surgeons is incredible.

Elizabeth Kaeton said...

Thanks, Prior. If you are on FB, you can find the group here:!/group.php?gid=136407289706975

Elizabeth Kaeton said...

Thanks to all of you for all your comments. I hope you all go and sign the petition to stop FGM at Cornell.

This is important on so many levels - for women, for intersex children, for medical ethics . . .

I still find my body shaking every time I think about it.

Geeklet said...

To harm a child is abhorable. I read some bits on a the shakesville and Sociological Images blogs about the whole Cornell thing. Genital mutilation and sexual assault of a minor in the name of can that even be justified?

Mutilation in the name of tradition or science is still mutilation. For a country which claims to be in support of children, we sure do a hell of a job of living up to it.

And we wonder why people have such screwed up relationships with their own bodies - it starts at birth! UGH!

Kirkepiscatoid said...

Elizabeth, thanks for spreading the link I gave you. It is a very good article from a group I believe to be one of the top-notch bioethics forums in the US. When they weigh in, I usually listen.

What I would not have given to be a mouse in multiple medical staff surgery dept. meetings. What I would not have given to have been a mouse in the IRB meetings. What I would not give to see a few sets of files.

I have a sick feeling this was all hidden in plain sight, with very technical language and boring clinical run-on sentences.

I find it interesting that Poppas' co-authors bailed on him. People don't generally bail on a new surgical procedure they have helped propose. unless they no longer believe in what they are doing or are proved wrong. I wonder if at some point Yang and Felsen realized they had been duped themselves.

We now know you can't simply "surgically assign" a physical sex to an intersex child. The child has to grow up with his/her own sexual awareness of self.

My guess is these families are simply looking for relief from the difficulties associated with raising an intersex child, or, as Chris says in an earlier comment, a desire to relieve their own discomfort. I am also well aware of the ways physicians (and clergy) can "couch" a discussion in an attempt to sway a family to a particular mindset. I would love to be a mouse in the room when Dr. Poppas explains his surgery to parents.

And what I would not give to be on an IRB that looks him right in the eye, and says, "Ok, Doctor. Help me out here. My understanding of the federal regulations of research on children is that it is legal in the following ways...(recite the four conditions in which have been deemed where the benefits outweigh the risks for the patient, society, medical knowledge and knowledge of a disease state)...Ok. Explain to me how you can prove that the act an adult male applying a stimulatory device of which the result is a sensation universally perceived as sexual pleasure, to a little girl's genitals is less harmful to her psychologically than the perceived stigma of her intersex condition. Explain to me the means by which you have tested your assertions that this child's genitals, as they now are, will be a problem in the future. Cite me some studies on this using adult subjects. Show me some data here. Because until you can do this to my satisfaction, you don't have a snowball's chance in hell of getting this past my IRB."

The wisest pediatrician I trained under in my clincal years often remarked to families in a wide variety of difficult medical circumstances other than this one, "Don't treat your children to fix yourself."

Elizabeth Kaeton said...

In some ways, I wish you and others who sent me to the Bioethics Forum hadn't. After reading that article, I could have easily dismissed it as "media spin" - tucked the whole, horrible idea away from my heart and mind and hoped that it was just some journalist trying to grab a headline and sell some newspapers.

These two women clearly know what they're talking about. As do you.

The important thing is that we get this guy to stop. Now.

Hopefully, this kind of exposure will do just that.

Thanks for all your help, Doc.

IT said...

I am not a cultural relativist. Some things are just wrong, and "tradition" does not excuse them.

As for the abuse of the children at Cornell, it's truly abhorant.

It is representative of a culture, that is our own, that is still preoccupied with enforcing strict gender binaries and with controlling women's sexuality. It tangles up with all the sexist and homophobic behavior we endure in other realms.

I am sure, when hearing about this physician, I"m not the only one reminded of the sad case of David REimer, who was raised as a girl when his "well-meaning" doctor decided that was how to deal with the damage to his penis. Because of course everyone agreed that children have no gender that is not culturally imposed.

Or Walter Freeman, who threw himself into lobotomizing patients with icepicks, leading to that period of medical history where being depressed or gay was sufficent to torture you and destroy your brain.

How this Cornell guy gets away with it, is the big question. And the parents should also be ashamed of themselves.

Elizabeth Kaeton said...

The David Reimer story always, always breaks my heart. He ultimately committed suicide. Someone - Dr Money, most likely - needs to be charged with manslaughter.

Long ago, as a nursing student at Taunton State Hospital (now closed), I cared for people who had had lobotomies. They were walking reminders of the abuse of the psychiatric medical system. Tragic, tragic situations.

As for the parents - I'm sure shame is a powerful dynamic for some. What is one to do when a physician tells you that this is best for your child? I tend to be more empathetic with them.

I'm not so empathetic with parents who think they are 'saving' their child from more 'primitive' surgeries in their homeland. Mutilation is mutilation. Period. End of sentence.

Parents who do this for cosmetic reasons, however, should be - at the very least - brought up on child abuse charges.

June Butler said...

Tough read. Thanks for calling attention to the barbarism.

The important thing is that we get this guy to stop. Now.

Yes. said...

thank you all for caring and helping to end this!

unfortunately, it neither starts nor ends wih cornell nor poppas. these mutilations are happening on a daily basis in virtually every children's hospital in the "western world", and have been considered "best practice" by medical authorities worldwide for more than 50 years! the victims of these "correcting surgeries" have denounced this inhumane practice for almost 20 years, unfortunately without getting too much attention.

let's hope this might finally start to change now ...

i'd like to urge everbody to educate yourselves and then others and press to end this suffering globally and eventually hold the doctors accountable.

as victims of these mutilations have been going on about for years: "it's a human rights issue!"

thanks for standing up for future children.

seelenlos /

Kirkepiscatoid said...

Well, and that's the deal, Elizabeth. I normally don't get wound up about those sorts of articles in the popular press because they are often ignorant of the medical science. But when I started Googling, and the Hastings Center weighed in, I had to start doing my homework. I spent several hours Googling over the next couple of days.

I am eventually going to write a letter to their IRB as a member of another IRB, as professionally and sternly as possible, but I have to get a lot more steam out of my ears first. I plan to discuss this with my medical student society sometime this year as a good bioethics case. I also will use it to be a tool to keep myself more mindful when I get a little bored on our IRB, as a reminder not to let things in plain sight slip through. I am grateful our IRB has far less controversial proposals!!!!

Lapinbizarre said...

Appalled - truly appalled - that this is countenanced at NY Presbyterian or that there appear to be ways of slipping it under the legal wire in the US. Got myself into a spot of trouble at another site a couple of years back, for condemning male infant circumcision, which is not remotely on the same level of atrocity, but..... So I'll consider my bit as having been said on that topic and hush up.

Patricia Robinett said...

Elizabeth, thank you for telling secrets, It's so true that we are sick due to our secrets. I didn't realize I'd been circumcised until I was over 50 years old. My life has improved now that I know what happened and have begun to heal the trauma.

Yes, genital cutting of little girls in the USA is not new. In 1888, a Seventh Day Adventist doctor J. Harvey Kellogg of Battle Creek, MI, wrote In his book, "Plain Facts for Old and Young":

“A remedy [for masturbation] which is almost always successful in small boys is circumcision... The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed...

“In females, the author has found the application of pure carbolic acid [phenol] to the clitoris an excellent means of allaying the abnormal excitement."

In 1951, another Seventh Day Adventist doctor, Harold Shryock, advocates female circumcision in, "On becoming a woman":

"The Creator has seen fit to arrange the organs of a woman in such a way that the clitoris and vagina are very sensitive. Delicate contact with these areas produces exciting sensations... there are teen-age girls who... have fallen into the habit of manipulating these sensitive tissues as a means of excitement. This habit is spoken of as masturbation...

"There is an anatomical factor that sometimes causes irritation about the clitoris and thus encourages a manipulation of the delicate reproductive organs... Oftentimes the remedy for this situation consists of a minor surgical operation spoken of as circumcision. This operation is not hazardous and is much to be preferred to allowing the condition of irritation to continue."

My book, "The Rape of Innocence: FGM & Circumcision in the USA" and my blog at tell more... my story and others'. I lost a clitoris, prepuce and labia.

Because of my book, I have met other WASP women who were also cut - one as late as 1970. Blue Cross Blue Shield insurance covered clitoridectomy until 1977. A surgeon told one man whose mother had been circumcised in the early 20th century that FGM was big business in Manhattan.

My concern is the psychological effects and the diminished quality of life: PTSD, anger, grief, anxiety, depression, night terrors, suicide, etc... Is it a coincidence that the only three cultures that circumcise their young are at war in the Middle East?

So I grieve for all children whose cultures, religions, doctors and parents rush to cut their healthy genital tissue. Circumcision is a wound that bleeds for a very long time.

JCF said...

The combination of patriarchy & power cuts (or doesn't) in both ways: the same gender binary that would cut HEALTHY children "to fit", also makes life difficult (even impossible) for Trans & GenderQueer people by REFUSING to give them the surgery/hormones they ASK (nay, BEG) for! [Or makes them pay out-of-pocket, for "cosmetic" surgeries. BS!]

MackBeemer said...


Ordinarily I'd love your invitation to "come on in" and enter into the "conversation."

But the screaming beautiful baby girl... and we're to have a conversation??!

Elizabeth Kaeton said...

Yes, Mack. Precisely. About that screaming baby girl

Ern said...

Dix P .Poppas, M.D.
525 E 68th St
New York NY 10065
P: (212) 746-5337

IT said...

Here's another barbarism: trying to "convert" girls by treating female babies in utero with androgen blockers.

Patricia Robinett said...

There they go again, playing God.. trying to manipulate nature. I feel so sorry for the CAH kids. They are the genital tinkerers' delight.

The author of this article, Alice Dreger, was the source as well of the article two weeks ago - see - that brought the Cornell clitoris reduction surgery (and highly questionable annual 'testing' of the remaining sensations) to light. Then again, she created quite a ruckus. Dreger is someone to keep on the radar. On the androgen blocker issue she says:

"Needless to say, we do not think it reasonable or just to use medicine to try to prevent homosexual and bisexual orientations. Nor do we think it reasonable to use medicine to prevent uppity women, like the sort who might raise just these kinds of alarms. Consider that our declaration of our conflict of interest."

i love the irony of names. Dreger dredges up icky ethical issues. Robinett is french for 'little faucet' but I understand it is slang for... the male organ. Since my book and videos are aimed at protecting children from genital cutting, French readers must get a chuckle.

JCF said...

You beat me to it, IT!

I have a book called "The Stronger Women Get, The More Men Love Football."

Who knew it would devolve into, "The Stronger Women (and other XX People, not to mention LGBTs generally) Get, The More That Patriarchy* Will Want to Cut Off Our Clits and Warp Our 'Disinterested in Babies' Brains To Fit"

* Patriarchy, represented by medical doctors, male AND female! :-0

Anonymous said...

Sexual amputations on ALL children (including boys!) are EQUALLY horrifying.

"People in the West tend to overestimate the detrimental effects of female circumcision and underestimate the effects of male circumcision. All civilized people should, of course, oppose the cutting of any person's genitals without their consent."

-Eliyahu Ungar-Sargon, Chicago Filmmaker

Elizabeth Kaeton said...

I agree, Anonymous. Next time, Please leave your name if you can.

Anonymous said...

This is wrong I agree
but what made people think it was ok to cut off the end of my penis
No one ever thinks of that

Unknown said...

The only difference between Male Genital Mutilation and Female Genital Mutilation is that the first victim is male, while the second is female. Genital Mutilation is Genital Mutilation.

Unknown said...

Thank you, Elizabeth, for posting this information. I just signed the petition. That these kinds of experiments are taking place in the US is shocking indeed.

I have been reading a great deal about FGM over the last few months and find it one of the most horrific and barbaric practices I have ever heard of. As a result of my own research into this matter, I am now connected with many women and organizations working to stop it. I must take solace in the fact that there are people who are working against it everyday.

What happens to girls and women around the world because of their gender is absolutely sickening.

We must all work together to raise awareness and let people know what they can do to help eradicate FGM.

Anonymous said...

I think any form of Genital Mutilation should be a capital crime and receive the death penalty. I'm with Ayaan Hirsi Ali and Nasal EL-Saadawi (both FGM victims) on this- both FGzm and MGM should be banned.

Anonymous said...

Plenty of people have actually- luckily 2/3rds of Generation Z oppose it