U.S. Court’s dismissal of FGM/C charge in Michigan case is disappointing, but does not condone genital cutting

By Mariya Taher
Co-founder, Sahiyo

I was sitting in my office, reading a blog post submitted to Sahiyo by a woman doing research on Female Genital Cutting in India, when I received a phone call. I answered it, not thinking twice, not knowing that what I was to hear next would leave me dumbstruck.

The call was from a news reporter, who wanted my reactions to the latest news about the United States’ first legal case on Female Genital Cutting (FGC) — the Michigan case involving two doctors and six others brought up on federal charges of performing FGC on nine minor girls in the U.S. I hadn’t heard of the latest news yet. And then, the reporter dropped a bombshell.

It turns out, a U.S. District Judge has dismissed the FGC charges in the case and declared the federal legislation banning and criminalizing Female Genital Cutting in the U.S since 1997 as unconstitutional!

My immediate reaction was, “That’s crazy.” Then my mind shifted to what had happened to me on October 19th, at the inaugural screening of Sahiyo Stories, a collection of digital stories created by U.S. women who have undergone FGC or who have loved ones who have undergone it. After those videos were shown at the screening, a couple walked in, joined the audience, and began to counter the stories of the survivors. They stated that FGC was harmless, that the survivors sharing their stories must only be trying to get attention. I worry that because of what this U.S. District Judge has ruled, what happened at that screening of Sahiyo Stories, might become all too common when survivors share their FGC stories in the hope of preventing harm to future generations of girls.

As stated in the Detroit Free Press by Tresa Baldas

The U.S. District Judge concluded that “as despicable as this practice may be,” Congress did not have the authority to pass the 22-year-old federal law that criminalizes female genital mutilation, and that FGM is for the states to regulate. FGM is banned worldwide and has been outlawed in more than 30 countries, though the U.S. statute had never been tested before this case.

There is no doubt that the decision will be appealed by the government, but this response worries me because without the law, what can we point to, when parents and families are trying to do the right thing and not succumb to the community pressure they face in having their daughter undergo FGC? And at Sahiyo, we do hear from these parents. We hear from parents who tell us they have spared their daughters as well as parents who regret not doing more to protect their daughters, but felt pressured by the community, by members of their families, believing that they had to get it done. That social pressure is real and threatening and at Sahiyo we understand the fear of being ostracised from your family or your community for speaking against what others believe is a religious necessity.

This decision also concerns me because it will be used by proponents of FGC to further suggest that they are justified in pursuing FGC because FGC has been proven harmless. Even though, the fact remains, that this is not at all what the Judge has said in his decision to rule the FGC federal law unconstitutional. To the contrary, the decision made by the Judge clearly recognizes that FGC is a terrible crime.

What the Judge has stated is the following:

“As laudable as the prohibition of a particular type of abuse of girls may be … federalism concerns deprive Congress of the power to enact this statute,” Friedman wrote in his 28-page opinion, noting: “Congress overstepped its bounds by legislating to prohibit FGM … FGM is a ‘local criminal activity’ which, in keeping with long-standing tradition and our federal system of government, is for the states to regulate, not Congress.”

The Judge has ruled that the issue of FGC falls under state law jurisdiction (intrastate) versus federal (interstate). In other words, the judge’s ruling opens up a jurisdiction question and NOT a question on whether FGC is harmful or not.

If “local criminal activity” must be regulated by the state, then it goes to show just how vital it will be for all states in the U.S. to pass laws banning FGC. Currently, only 27 states in the U.S. have such laws. Massachusetts, the state I live in, does not. (See petition ‘Ban FGM/C in MA’).

Even when laws are passed, I believe that it will be important to remember that FGC will most likely still continue just as other forms of gender-based violence such as domestic violence and sexual assault unfortunately continue despite the presence of laws against them. FGC also continues because as a social norm entrenched in the culture, this harmful practice has been touted as a religious or cultural practice that is needed to control women’s sexuality.

This reality points to the importance of education and community engagement to help create social change within communities and amongst groups where FGC might be happening.

To that end, Sahiyo will continue to organize and participate in community events to educate our friends, family and community about the harms of FGC and why it should be abandoned.

Learn more about FGC in the U.S.

If you would like to write about your views on the Judge’s ruling or the Michigan case in general, send a write-up to info@sahiyo.com

 

બધા નુક્શાનો શારીરિક નથી હોતા અને દરેક ધર્મ સંપૂર્ણ રીતે નૈતિક નથી હોતો

(This essay was originally published in English on September 21, 2018. Read the English version here.)

લેખક : ઝીનોબીયા

ઉંમર : 27 વર્ષ

દેશ : ભારત

આજે સોશિયલ મીડિયા પર અન્ય બાબતોની સાથે-સાથે મહિલાઓને સશક્ત કરવા, પોતાનો નિર્ણય પોતે જ લેવા, વ્યક્તિની ગોપનીયતાના અને તેના શરીરના ઉલ્લંઘન વિષે અને સંમતિની ભૂમિકા વિષેના વિચારો અને અભિપ્રાયો સાથે ગુસ્સો વ્યક્ત થતો જોવા મળે છે.અમુક લોકો એવી વાતો કરે છે કે બળાત્કારીઓને ફાંસી દઈ દેવી જોઈએ છે તો અમુક લોકો જાતિય છેડછાડ અને મહિલાઓની છેડતી કરતા લોકોને સજા કરવા વિષેપણ વાતો કરી રહ્યાં છે જેથી, જમીની સ્તર પર યોગ્ય પગલાં લઈ શકાય અને આવા લોકો છોકરીઓને પરેશાન કરતા પહેલાં બે વાર વિચાર કરે.

પરંતુ, જ્યારે એક 7 વર્ષની અસહાય છોકરીનો બીજું કોઈ નહિં પણ તેમનું પોતાનું કુટુંબ અને સમાજ ગેરલાભ ઉઠાવે ત્યારે શું થાય છે? તેના માટે કોણ જવાબદારી લે છે?હું અહીં મારી પોતાની તકલીફો રજૂ કરવા નથી ઈચ્છતી પરંતુ, તમારી માહિતી માટે થોડી મૂળભૂત હકીકતો રજૂ કરવા ઈચ્છું છું. હું ભારતમાં મોટી થયેલી એક બોહરા મુસ્લિમ છું. જ્યારે વિશ્વ આપણને શાંત, શાંતિપ્રિય, વ્યવસાયમાં સમૃદ્ધ એવો સમાજ માને છે ત્યારે આપણે 6-7 વર્ષની નાનકડી છોકરીના અંગછેદનની એક ગુપ્ત પરંપરાને અનુસરીએ છીએ, જેને આપણે ખતના કહીએ છીએ.

આ પ્રથા પુરુષો માટે કેવી રીતે આરોગ્યની દ્રષ્ટિએ “જરૂરી” છે અને અંતે, તે તેમના સેક્સ જીવનમાં મદદરૂપ થાય છે તે વિષેની ઘણી દલીલો કરવામાં આવે છે પરંતુ, અધિકાંશ શિક્ષિત અને સંસ્કારી લોકો એ બાબત સાથે સહમત છે કે આ પ્રથા એક બૈરીના શરીરિક, માનસીક અને ભાવનાત્મક આરોગ્ય માટે નુક્શાનદાયક છે, ખાસ કરીને એટલા માટે કે તેના પર કોઈ દેખરેખ રાખવામાં આવતી નથી અથવા અધિકાંશ આવી પ્રક્રિયાઓ બૅસમેન્ટોમાં એક અશિક્ષિત બૈરી દ્વારા કરવામાં આવે છે.આ પ્રથાને વિશ્વના અન્ય પ્રદેશોમાં આધિકારીક રીતે “ફીમેલ જેનિટલ મ્યૂટિલેશન (એફજીએમ)” કહેવામાં આવે છે અને તેને અસહાય છોકરીઓ પર થતા અપરાધ તરીકે માનવામાં આવે છે.

શા માટે? શું કારણ છે?

અમુક લોકો પવિત્રતા વિષે તો, અમુક લોકો પિતૃપ્રધાનતા વિષે વાત કરે છે. અમુક લોકો તેને એક આદેશરૂપ પરંપરા હોવાને કારણે માને છે અને જો એક મૌલા તેને ફરજિયાત કહે તો તેને નામંજૂર કરવાની હિંમત કોણ કરે? અમુક લોકો દબાણને વશ થઈને માને છે તો, અમુક લોકો બ્લૅકલિસ્ટ થવા અથવા વીરોધીનું લૅબલ લાગવાના ડરથી માને છે.જે લોકો ઉત્તર માગે છે તેમના માટે એવો પ્રચલિત જવાબ આપવામાં આવે છે કે તે એક બૈરીની જાતિય ઈચ્છાઓને નિયંત્રણમાં અથવા અંકુશમાં રાખવા માટે કરવામાં આવે છે. એ બાબત સાચી હોય શકે કેજ્યારે આપણે રણોમાં અને સમૂહ (ટ્રાઈબ્સ)માં રહેતા હતા અને લોકો હંમેશા અન્ય વ્યક્તિની બૈરીને ઉપાડી જવા માટે આતુર રહેતા હતા તેવા યુગમાં, કદાચ આ પ્રથા મદદરૂપ થઈ હશે.

આજે કોઈપણ કારણ હોય તો પણ, શું તેનો કોઈ અર્થ છે ખરો? તમારો ઉદ્દેશસારોહોય તો પણ,એક બૈરીની સંમતિ વિના તેણીના શરીર સાથે શું કરવું એ નક્કી કરવાનો તમને કોઈ અધિકાર નથી.તમે કોઈપણ હો, તમારો ઉદ્દેશ કોઈપણ હોય તો પણ, નુક્શાન થયું છે અને તમે કોઈ ગુનેગારથી ઓછા નથી.

પિડીતો માટે તેનો અર્થ શું છે?

આપણા દ્વારા અનુસરવામાં આવતી પ્રથા આક્ષેપ અનુસાર ‘ટાઈપ 1’ પ્રકારની છે અને તે આફ્રિકન સમુદાયો દ્વારા અનુસરવામાં આવતી ‘ટાઈપ 2’ અને ‘ટાઈપ 3’ થી (ગંભીરતાના સ્તરના આધારે) અલગ છે.વર્લ્ડ હૅલ્થ ઑર્ગેનાઈઝેશનની માન્યતા મુજબ, ટાઈપ 1 પ્રકારના એફજીસીને ક્લિટોરલ હૂડ અને/અથવા ક્લિટોરિસ કાપવા તરીકે વર્ણવવામાં આવ્યું છે, જેના ઘણાં શારીરિક અને માનસિક દુષ્પરિણામો જોવા મળે છે જેમ કે, ચેપ લાગવા, વધારે પડતો રક્તસ્ત્રાવ થવો, પેશાબ કરતી વખતે બળતરા થવી વિગેરે. ઘણી જુવાન છોકરીઓ વિશ્વાસઘાત, અસહાય અને મૂંઝવણ મહેસુસ કરતી હોવાના કારણે,આ પ્રથા માનસિક આરોગ્ય પર પણ વિપરિત અસર કરી શકે છે. તેમજ, આ આઘાતના પરિણામે, બાળક જાતિય સંબંધ બાંધવામાં પણ ડર અનુભવી શકે છે અને તેમનામાં સમાજના સભ્યો પ્રત્યે અવિશ્વાસનું નિર્માણ પણ થઈ શકે છે.

પરંતુ, હજારો બૈરીઓએ આ પ્રથાને અનુસરી છે અને દાવો કરી રહી છે કે તેમને કોઈ જાતિય સમસ્યાઓનો સામનો કરવો પડ્યો નથી?

જે રીતે અધિકાંશ લોકો તેમના બેડરૂમમાં શું થાય છે તે વિષે અન્ય લોકોને વાત કરતા નથી, તેમ એફજીએમના સર્વાઈવરો પણ તેમની સેક્સ લાઈફ વિષે જાહેરમાં વાત કરતા નથી. તેમાંની ઘણી બૈરીઓ પીડાથી ચીસો પાડતી હોય છે અથવા “બેડરૂમમાં”એક આરોગ્યપ્રદ જીવન જીવી શકતી નથી.તેમાંની ઘણી બૈરીઓ ડૉક્ટરો, સેક્સોલોજિસ્ટ્સ, કાઉન્સેલર્સ અને થેરૅપિસ્ટ્સની નિયમિત દરદીઓ હોય છે.હાં, તેઓ ગર્ભવતિ થવાનું (જે આજે મરદ સાથે અથવા મરદ વિના કરવું વધારે મૂશ્કેલ નથી) મેનેજ કરી લે છે પરંતુ, શું એ પ્રક્રિયા પીડા મુક્ત છે? નહીં.

બધા લોકો ડિવોર્સનો દર વધવા વિષે વાતો કરે છે પરંતુ, આ દર શા માટે વધી રહ્યો છે તે કોઈ સમજતું નથી. તેઓ એ જોતા નથી કે બૈરીઓ પર તેમના ઉછેર દરમિયાન જ ઘણાં બધા નિયંત્રણો લાદવામાં આવે છે. મરદ હોય કે બૈરી, તેને સંબંધી બધી બાબતો પહેલાંથી જ નક્કી કરેલી હોય છે, આ એવું નથી લાગી રહ્યું કે આપણે એવા સમાજમાં મોટા થઈ રહ્યાં છીએ જ્યાં નેતાઓ અથવા સ્વતંત્ર નિર્ણયકર્તાઓને ઉછેરવામાં આવી રહ્યાં હોય. આપણે બ્રેઈનવૉશ કરેલા શિષ્યોના એક ટોળાં જેવા છીએ અને હાલનાં, #metoo ની ક્રાન્તિને કારણે બૈરીઓએ તેમનો અવાજ ઉઠાવવાની એક શરૂઆત કરી છે.

મારી સ્ટોરી

હાં, મારા પર પણ ‘ખતના’ પ્રક્રિયા કરવામાં આવી હતી. મને બધું તો યાદ નથી પરંતુ, અમુક બાબતો યાદ છે. મને “કોઈ આન્ટી” ને મળવા લઈ જવામાં આવી હતી અને મને યાદ છે કે ત્યારે મને કોઈ સારી લાગણી નહોતી થતી પરંતુ, આપણને જેમ કહેવામાં આવે તેમ આપણે કરીએ છીએ. અમે કલકત્તાના તેના અંધકારમય ઘરમાં ગયા અને તેણીએ મને ભારતીય શૈલીના શૌચાલય પર પહોળા પગ કરીને ઊભા રહેવા માટે કહ્યું અને મને લોહી નીચે પડતું દેખાયું. બસ મને આટલું જ યાદ છે.

મને બરાબર યાદ છે કે ત્યારપછી અઠવાડિયા સુધી મને પેશાબ કરવામાં પીડા થતી હતી. આ ચર્ચા રાત્રિભોજનની ચર્ચા જેવી ઔપચારિક ના હોવાથી, ત્યારપછી તે વિષે ક્યારેય વાત કરવામાં આવી નહિં. 16 વર્ષની ઉંમરે, જીન સૅસનની બૂક – પ્રિંસેસ દ્વારા મને આ ‘મુસ્લિમ પ્રથા’ વિષે ખબર પડી. સાઉદી અરૅબિયામાં બૈરીઓ સાથે કરવામાં આવતી ભયાનક બાબતોની સાથે-સાથે આ પ્રથાનું વર્ણન કરવામાં આવ્યુ હતું જેણે મારી યાદ તાજા કરી દીધી હતી.

પહેલાં તો હું ડરી અને ભયભીત થઈ ગઈ અને મને સમજાતું નહોતું કે આ માહિતીનું શું કરવું.મને એ બાબતસમજાઈ નહિં કે શા માટે કોઈ મારી સાથે આવું ભયાનક કૃત્ય કરે? તેનો ઉદ્દેશ શું હતો? શું કોઈ ધાર્મિક કારણ હતું? શું કોઈ તબીબી કારણ હતું? ધીમે-ધીમે હું મારી ઉંમરના અન્ય લોકોને તે વિષે પૂછવા લાગી.ઈન્ટરનેટ મારી મદદે આવ્યું અને મેં આ ‘જંગલી’ પ્રથાને વધારે સમજવાનું શરૂ કર્યું કે કેવી રીતે તે આપણા પિતૃપ્રધાન દુનિયાની એક બીજીસાઈડઈફેક્ટ છે જ્યાં કોઈપણ મરદ એ નક્કી કરી લે છે કે બૈરીઓએ કેવી રીતે જીવવું અને તેમના માટે શું યોગ્ય છે.

મને એ બાબત સમજાઈ નહીં કે કેમ એક માતા-પિતા તેમના બાળકો સાથે આવું થવા દે છે. જ્યારે તમારી દીકરી નિર્દોષતાની ચરમસીમા પર હોય અને ફક્ત તમારો નિસ્વાર્થ પ્રેમ ઈચ્છતી હોય ત્યારે, તમે તેણી સાથે વિશ્વાસઘાત કરો છો અને અંતે તમે તેણીને એવા રાક્ષસને સોંપી દો છો જે તેણી સાથે આવું કૃત્ય કરે છે?

તમારો ધર્મ તમને તેણીના શરીર પર અંગછેદન કરવાનું કહે છે અને તમને તેમાં કંઈ ખોટું નથી લાગતુ?અને તેના કારણે ઉત્પન્ન થતા શારીરિક, માનસિક અને ભાવનાત્મક પ્રત્યાઘાતોનું શું? જીવનભર તેણીએ આવી પીડાનો સામનો કરવો પડે છે. અને જો તમને ખરેખર આ બાબત ખોટી ના લાગતી હોય તો પછી શું કામતમે તેને આમ ગુપ્ત રાખો છો? શા માટે તેખાનગી રીતેકરવામાં આવે છે? તેના વિષે બધાને વાત કરો, તમે જેમ મિસાક ઉજવો છો તેમ તેની પણ ઉજવણી કરો? ફક્ત મિસાકની ઉજવણી જ શા માટે કરો છો? ખરેખર, કેટલાક અપવાદરૂપ લોકો પણ હોય છે. મારૂં સારૂં ઈચ્છતા ઘણાં લોકો મને સમજાવવાનો પ્રયત્ન કરે છે કે તેમાં મારો કોઈ દોષ નથી અને મારે એ બાબત વિષે ચિંતા કરવી જોઈએ નહીં અને મારો ઉત્તર હોય છે કે “હાં, હું જાણું છું કે મારો કોઈ દોષ નથી અને તેમ છતાં, મારે જ તેની કિંમત ચૂકવવી પડે છે”.

સૌથી દુઃખદ બાબત એ છે કે ઘણી બધી એવી છોકરીઓ છે જેને આજે પણ ખબર નથી અથવા યાદ નથી કે તેમની સાથે પણ આવું બન્યું છે. તેઓ એવા ખ્યાલ હેઠળ જીવે છે કે સેક્સ એ ખરાબ અને પીડાદાયક બાબત છે અને કદાચ તેમનામાં જ કોઈ સમસ્યા છે. અધિકાંશ રીતે આપણને આવું જ શિક્ષણ આપવામાં આવે છે. હું સહિયોની ખૂબ જ આભારી છું કે તેમણે બૈરીઓ માટે આવું એક અદભૂત પ્લૅટફોર્મ ઊભું કર્યું જ્યાં તેઓ તેમની સ્ટોરી રજૂ કરી શકે છે, સહાનુભૂતિ મેળવી શકે છે અને મારા જેવી છોકરીઓને કહી શકે કે હું એક જ એવી છોકરી નથી જેની સાથે આવું બન્યું છે અને મારે મને પોતાને એક પિડીત માનવીજોઈએ નહિં. સ્ટોરીટેલિંગ દ્વારા બૈરીઓને સશક્ત કરવાની આ બાબત, આપણી સંસ્કૃતિનો એક ગૌરવશીલ ભાગ હોય તેમ લાગે છે, જેને સહિયો આગળ વધારી રહ્યું છે.

 

Is the Dawoodi Bohra community truly as progressive as it claims to be?

By Saleha

Country of Residence: Canada
Age: 45

Having lived in South-East Asia, and being exposed to multiple races and cultures, I grew up in a very open-minded family. As a child, my family and I occasionally went to the local Bohra mosque to socialize with others in the community. I loved going to the “masjid” – there I got a chance to meet my best friend and also eat delicious Bohri food. It was wonderful to see all the aunties dressed up in “onna ghagra” which are colourful skirts with matching chiffon scarves draped around the head. After the prayers, everyone congregated outside and chatted into the late hours of the night.

Then suddenly in the early 90s it all changed. The upper echelons of the Bohra clergy instated new rules. The progressive Dawoodi Bohras were no more; instead, women were forced to wear a form of hijab called “rida” and men were made to sport a beard, wear a kurta, and “topi” or a cap on their heads. The clergy, headed by the Syedna, began to exert control over everything. Permission from Syedna was required not only for religious matters but in daily life as well. For example, permission was needed to start a business, get married or even to be buried. Female Genital Cutting or khatna was deemed necessary, even though that act of it is not prescribed in the Koran. If any of the rules were not followed, or if you protested and spoke against them, you were excommunicated or threatened to be. You’d lose all your ties to friends and family forever.

I can never forget the awful day, when I was seven, while on a holiday in India, my aunt asked me to go shopping with her. She took me to a dingy place where a Bohri man and woman took me inside. They asked me to undress waist down, and when I protested, the man held my hands while the woman removed my jeans and underwear and forced me to lie down. I saw the man take out a blade and I struggled and screamed for help, while they proceeded to cut me. I lay bleeding on the floor, unable to comprehend what had happened to me. It was horrific, painful, and demeaning. I hated what was done to me. I hated that my mom was not there. I was angry at my aunt for allowing them to hurt me.

I remember that experience vividly and to this day I am infuriated that I had to go through this ordeal as a child in the name of religion. While the majority of the Muslim communities around the world have spoken against this, the Dawoodi Bohra religious authorities urge continuing FGC under the guise of cleanliness. The worst part is that some women push this practise on vulnerable children too young to give consent, instead of protecting them as adults should.

It was a difficult time for me. Having grown up with all the freedom in the world, it was  suddenly being taken away from me and I grew cynical of my Bohra culture and wanted no part of it. Today, I am happy I decided to leave the fold. It was not hard to leave. In fact, it was liberating. I was not comfortable with the more rigorous path that my community was taking. I am sure there are many other Bohri people out there who are quietly questioning many of the beliefs handed down to them – some so silly, useless, and others very damaging – Bohris must refrain from using Western toilets; Bohris cannot host or attend wedding functions in secular, non-Bohra venues; brides can apply mehndi only an inch below the wrist and cannot hold the traditional “haldi” functions; and all Bohris must carry a RFID photo ID which will monitor attendance to the mosque.

Humanity has achieved such remarkable progress. We have ventured into space, developed cloning and gene editing technologies, and most importantly, the Internet has resulted in globalization and interconnection between various cultures and communities. In this light, I wonder why we are still talking about FGC and the right to choose to do it to our daughters in this day and age? I am thankful that organizations like Sahiyo and We Speak Out have become a voice for children who are being hurt in the name of religion.

I look at my children and I see the most informed, connected, and progressive generation. Imposing impractical, harmful religious rules such as continuing FGM on such a generation will only drive them further from our culture. More and more Bohri women and men are speaking out against this harmful practise because whenever religion becomes too rigid, too corrupt, it begins to crack. My hope is that our community can find the strength to break free from all the rigid practices and once again become the most progressive community among the Muslims.

Trauma and Female Genital Cutting, Part 6: Effects of FGM/C on the Lower Urinary Tract System

(This article is Part 6 of a seven-part series on trauma related to Female Genital Cutting. To read the complete series, click here. These articles should NOT be used in lieu of seeking professional mental health and counseling services when needed.)

By Julia Geynisman-Tan, MD

Background

FGM/C has no known health benefits, but does have many immediate and long-term health risks, such as hemorrhage, local infection, tetanus, sepsis, hematometra, dysmenorrhea, dyspareunia, obstructed labor, severe obstetric lacerations, fistulas, and even death. While the psychological, sexual, and obstetric consequences of FGM/C are well-documented (refer to prior posts in this series), there are few studies on the urogynecologic complications of FGM/C. Urogynecology is the field of women’s pelvic floor disorders including urinary and fecal incontinence, dysfunctional urination, genital prolapse, pelvic pain, vaginal scarring, pain with intercourse, constipation and pain with defecation and many other conditions that affect the vagina, the bladder and the rectum. Urogynecologists are surgeons who can both medically manage and surgically correct many of these issues.

FGM/C and Urinary Tract Symptoms

One recent study from Egypt suggested that FGM/C is associated with long-term urinary retention (sensation that your bladder is not emptying all the way), urinary urgency (the need to rush to the bathroom and feeling that you cannot wait when the urge comes on), urinary hesitancy (the feeling that it takes time for the urine stream to start once you are sitting on the toilet) and incontinence (leakage of urine). However, the women enrolled in this study were all presenting for care to a urogynecology clinic and therefore all of them had some urinary complaints so it is difficult to tell from this study what the true prevalence of lower urinary tract symptoms are in the overall FGM/C population.

Therefore, given the significant number of women with FGM/C in the United States and the paucity of data on the effects of FGM/C on the urinary system, my research team studied this topic ourselves in order to describe the prevalence of lower urinary tract symptoms in women living with FGM/C in the United States. Publication will be available online in December 2018.

We enrolled 30 women with an average age of 29 to complete two questionnaires on Overactive bladder 1their bladder symptoms. Women in the study reported being circumcised between age 1 week and 16 years (median = 6 years).

  • 40% reported type I
  • 23% type II
  • 23% type III
  • 13% were unsure

Additionally, 50% had had a vaginal delivery; and 33% of these women reported that they tore into their urethra at delivery.

Findings:

A history of urinary tract infections (UTIs) was common in the cohort:

  • 46% reported having at least one infection since being cut
  • 26% in the last year
  • 10% reported more than 3 UTIs in last year
  • 27% voided ≥ 9 times per day (normal is up to 8 times per day)  
  • 60% had to wake up at least twice at night to urinate (once, at most, is normal)

Most of the women (73%) reported at least one bothersome urinary symptom, although many were positive for multiple symptoms:

  • urinary hesitancy (40%)
  • strained urine flow (30%)
  • intermittent urine stream (a stream that starts and stops and starts again) (47%) were often reported
  • 53% reported urgency urinary incontinence (leakage of urine when they have a strong urge to go to the bathroom)
  • 43% reported stress urinary incontinence (leakage of urine with coughing, sneezing, laughing or jumping)
  • 63%reported that their urinary symptoms have “moderate” or “quite a bit” of impact on their activities, relationships or feelings

What’s the Connection Between FGM/C and Urinary Symptoms?

Urinary symptoms like the ones described above can be the result of a number of factors. pee-night-400x322Risk factors for urinary urgency and frequency, incontinence, and strained urine flow include pregnancy and childbirth, severe perineal tears in labor, obesity, diabetes, smoking, genital prolapse and menopause.

However, given the average age of women in our sample and the fact that only half of them had ever had a vaginal birth, the rate of bothersome urinary symptoms are significantly higher than has been previously reported. FGM/C may be a separate risk factor for these symptoms. Interestingly, the prevalence of urinary tract symptoms in our patients closely resembled that of a cohort of healthy young Nigerian women aged 18-30, in which the researchers reported a prevalence of lower urinary tract symptoms of 55% with 15% reporting urinary incontinence and 14% reporting voiding symptoms. The authors do not mention the presence of FGM/C in their study population but the published prevalence of FGM/C in Nigeria is 41%, with some communities reporting rates of 76%. Therefore, it is likely that many of the survey respondents had experienced FGM/C, thereby increasing the prevalence of lower urinary tract symptoms in their cohort. In the study of women in Egypt referenced above, those with FGM/C were two to four times more likely to report urinary symptoms compared to women without FGM/C.

The connection between FGM/C and urinary symptoms can be understood from the literature on childhood sexual assault and urinary symptoms. Most women who experience FGM/C recall fear, pain, and helplessness. Like sexual assault, FGM/C is known to cause post-traumatic stress disorder, somatization, depression, and anxiety. These psychological effects manifest as somatic symptoms. In studies of children not exposed to sexual abuse, the rates of urinary symptoms range from 2-9%. In comparison, children who have experienced sexual assault have a 13-18% prevalence of enuresis (bedwetting) and 38% prevalence of dysuria (pain with urination). The traumatic imprinting acquired in childhood persists into adult years. In a study of adult women with overactive bladder, 30% had experienced childhood trauma, compared to 6% of controls without an overactive bladder. There is a neurobiological basis for this imprinting. Studies in animal models show that stress and anxiety at a young age has a direct chemical effect on the voiding reflex and can cause an increase in pain receptors in the bladder. Additionally, the impact of sexual trauma on pelvic floor musculature has been well described. Women who experience genital trauma often respond with an involuntary contraction of the pelvic floor, which can develop into non-relaxing pelvic floor dysfunction and subsequent urinary hesitancy, strained flow, retention, bladder pain and overflow incontinence.

These Conditions are Treatable

There are treatments for all of the conditions. Urinary hesitancy, strained flow, bladder pain, and urgency are often treated with pelvic floor muscle therapy. That is because many of these symptoms come from an unconscious, constant clenching of the pelvic floor muscles, which then prevents them from using their full range of motion and pinches off the nerves running through the muscles. Pelvic floor therapy focused on lengthening and stretching these muscles can completely change the way that you urinate and the sensation of pain in the pelvis. This kind of physical therapy is done by all female providers in a private room. The therapy consists of a combination of external and internal work on all of the muscles of your core and pelvic floor to release trigger points of tension and teach you how to relax and lengthen these muscles. Sometimes the therapists use biofeedback devices in the vagina to help you to recognize certain muscles groups. The sessions are usually one hour long and last for 6-12 visits. You can obtain a referral to a pelvic floor physical therapist from your local urogynecologist.

If you have urinary leakage throughout the day or nighttime, this can also be treated. Your urogynecologist can help differentiate whether you have stress urinary incontinence (leakage with coughing, laughing, exercise, lifting) or urgency urinary incontinence (leakage that follows the urge to go to the bathroom or sometimes sporadic leakage without any urge). These types of incontinence are treated differently but both can be treated with a combination of medicine, office procedures or surgical treatments. To find a urogynecologist in the Unit, you can go to the website of the American Urogynecologic Society and click on patient services.

 

About Julia Geynisman-Tan

Julia is a Female Pelvic Medicine and Reconstructive Surgeon in the Department of Obstetrics and Gynecology at Northwestern. During her residency at New York Presbyterian – Weill Cornell, she founded the Survivor Clinic of New York City, a dedicated clinic for women who had experienced sexual violence, including trafficking, female genital mutilation, and torture in war. Now in Chicago, Dr. Geynisman-Tan has founded the Northwestern ERASE Clinic for survivors of human trafficking and is an asylum evaluator for Physicians for Human Rights. She is currently a co-chair of the American Women’s Medical Association Physicians Against Trafficking of Humans Committee, on the board of the America Hospital Association’s Human Trafficking Consortium and serves on the Cook County Human Trafficking Task Force.

To ban or medicalise? Sri Lanka grapples with debates on Female Genital Cutting

(Please note that a version of this article appears on LankaWeb.com. It has been republished here with permission from the author.)

By Fatima Yasmin  

Country: Sri Lanka

Muslim religious organisations in Sri Lanka have called on the government to medicalise female circumcision to ensure the procedure is done under hygienic conditions. In their submission before the Parliamentary Committee on Women and Gender early in September, the Muslim groups stated that the Muslim community was very concerned about moves to ban the procedure on the grounds that it was Female Genital Mutilation (FGM).  

Spokeswoman Noor Hazeema Haris has reportedly said that although Muslims wholeheartedly have supported the abolition of traditional practices harmful to women and children such as Female Genital Mutilation, the Islamic practice of female circumcision was very different.

She pointed out that the distinction is that female circumcision as practiced by Muslims in Sri Lanka, was a minor procedure, in which only the prepuce or hood of the clitoris was removed.

“It is something that is arranged and done by women. Those who say this is male oppression against women are mistaken. It is we who do it just like our mothers and grandmothers and countless generations of our women have done. We continue to practice it because we know it benefits us. Even educated Muslim women support it wholeheartedly,” she said. “If medical complications have arisen among some women circumcised by Osthamamis (traditional female circumcisors without medical training) as alleged by women’s rights groups, it is all the more reason to medicalise the procedure instead of prohibiting it, which will only drive the procedure underground and put girls and women at unnecessary risk.”

The move is a very dangerous one since it could lead to greater acceptability of FGM. There have been many complaints raised against traditional practitioners including the use of unsterile instruments and harming the clitoris in some cases. However, I believe the solution is to ban it altogether rather than medicalising it.

But analysts warn this could lead to an uproar from religious parties and have political implications since parties that come out against FGM risk losing a large and influential Muslim vote bank. The All Ceylon Jamiyyathul Ulama, an organization of religious scholars in the country issued a fatwa in 2008 stating that female circumcision was obligatory, and was among the parties that made representations to medicalise the practice early in September.

It is also a matter of concern to women’s rights groups that the said Parliamentary committee agreed to accommodate the representations and requested that medical evidence is submitted to prove that female circumcision of the type prescribed in Islam, as stated by these religious groups, causes no harm and benefits women.

A female doctor who performed the procedure before a health ministry circular prohibiting medical professionals from performing it came into effect in the country in October, and whose name has been withheld here by her request, said that she welcomed the move to medicalise it:

“I performed about 25 circumcisions a day in a private clinic, mostly infants. But there were women, too. Some were newly married and wanted to be circumcised at their husbands’ request. All I do is remove a little bit of skin covering the clitoris. I use a very fine instrument for the babies. It takes only a few minutes. In the case of adults, I inject an anesthetic before proceeding to circumcise them. My patients tell me it’s only the injection that hurts a bit and that after that they don’t feel a thing. It’s sore for a few days but heals fast. There is a huge demand for this service. It’s a shame that it’s now going back into the hands of untrained women who have no proper medical knowledge and who use unsterilized instruments for the purpose.”

A young mother who had her infant daughter cut by a traditional practitioner also agreed.

“Doctors refuse to do this now, and I was forced to get it done by an Osthamami. She took out a blade which looked as if it had been used many times and made a cut to my daughter’s genitals. Some blood came out. I could not bear to look. Later I checked it and noticed a cut had been made in the skin over the clitoris but the foreskin had not been removed. This is an improper circumcision according to my sister who is an Aalimah (religious scholar) and so I will have to get her circumcised again. Why are these so-called women’s groups against doctors doing it? We will practice it whether they ban it or not.”

However, a member of a prominent women’s organization said that prohibiting the practice is the right thing to do.

“FGM has been condemned as a violation of the rights of women and girl children by the World Health Organisation. WHO makes no distinction between FGM and the type of circumcision practiced here. It’s all the same. How can you cut these girls and call it a religious obligation? I understand there is a strong religious argument for the practice, but we cannot let religion affect the health of girls and women.”

And so the debate goes on – to ban or medicalise. One thing is for sure. It won’t be easy. Not only does the religious establishment in Sri Lanka, unfortunately, support the practice, but many local women are for continuing it, meaning the government and activists working to end FGM will face many challenges ahead before FGM can be abandoned in Sri Lanka.

Female Genital Cutting (FGC): Is it an Islamic Practice? (Part 2)

By Debangana Chatterjee

Though often being referred to as an Islamic practice, Female Genital Cutting (FGC) precedes both Islam and Christianity. It is believed to have originated in the Pharaonic era of Egypt. Elizabeth Boyle, author of Female Genital Cutting: Cultural Conflict in the Global Community, mentions in the book that before the advent of Islam, Egyptians, who valued FGC (particularly infibulation), introduced a strong slave system and expanded it towards the adjacent geographic region. At the onset of Islam in the Egyptian controlled region, Islam asserted a stringent prohibition towards enslaving other Muslims. Hence, non-Muslim were continued to be used as slaves, and since FGC was done to these non-Muslim women slaves to increase their worth and value as slaves, FGC was by extension spread to other parts of Africa by the slave traders. This remains one of the driving factors behind the spread of FGC in Africa simultaneous to the rise of Islam.

Despite FGC predating Islam, the myth of it being an Islamic practice persists due to the impressions of virginity and purity remaining closely associated with the religion’s values. There are ample reasons to challenge the unnecessary association of the practice with the Islamic culture. First, FGC was common among the Egyptian Coptic Christians and a number of Tanzanian Christian communities. In fact, FGC was also reportedly performed on Western women in the 1950s as a cure to nymphomania and depression according to L. Amede Obiora.

Secondly, the practice is rife only among a limited number of Islamic practitioners of the world. Islam is the world’s second largest religion with approximately 1.6 billion followers of the religion consisting of 23.2 percent of the world population. On the other hand, there are around 200 million reported cases of FGC worldwide which includes non-Islamic people as well. Even if one takes these numbers as absolute, merely 12 percent (approx) of the entire Islamic population is affected by the practice. Thus, FGC does not necessarily qualify as an Islamic practice, considering most of the followers of the religion either nullify FGC or even remain oblivious to it. Third: the Holy Quran altogether stands in opposition to inflicting harm; going by that logic Islam cannot be supportive of FGC inflicting mental/physical harm of any sort onto women/girls. Despite the Prophet being explicit about sunna (tradition) on male genitals, FGC’s existence within Islam remains debatable.

In many countries, Islamic traditions often remain debatable, including discussions on FGC. In the documentary The Cutting Tradition, an imam from the Harar region of Ethiopia is heard explaining how it already existed among various communities and the Prophet merely advised a sunna way of cutting where only the nicking of the clitoral prepuce is permitted. In the same documentary the Grand Mofti of Egypt, Fadilet Al-Mofti Ali Gomma repudiates any religious basis for FGM/C, though in 1994 a religious decree was issued in the country in favour of the practice stating it as an honourable deed for women. In fact, the decree, issued by one of Egypt’s prominent clerics Sheikh Gad el-Haqq, admittedly mentioned that FGC is not obligatory in Islam but should be followed due to the traditional rituals attached to it.

Even in the Afar region of Ethiopia, religious leaders are seen invoking Islamic scripture and text to counter continuation of FGC among practicing community members.

The practice came to South-East Asia in the 13th century, due to the advent of Islam in the region after the change in regime. The Shafi school of Sunni Islam in Indonesia and Malaysia considers FGC an Islamic practice, yet they are culturally influenced by the region where Yemen and Oman are situated, countries that have considerable FGC prevalence.

At a time in the world when right-wing politics riles up with growing Islamophobia, it is important not to straightjacket Islam in order to avoid its unnecessary vilification and mindless demonization. Islam, as it grew, got entangled with cultural traditions in such a manner that it often looks inseparable. But a close and nuanced study of the matter opens it up for further scrutiny and leaves room for potential dialogic engagement with the communities practicing female genital cutting so that in time these communities will come to abandon it.

 Read Part 1 – What Islam says about Female Genital Cutting and how far are these texts invincible?

More about Debangana

Debangana is a doctoral scholar at the Centre for International Politics Organisation and  Disarmament (CIPOD), Jawaharlal Nehru University. Through her research, she is trying to locate the existing Indian discourse surrounding the practices of FGM/C and Hijab into the frame of international politics. If you would like to connect with Debangana, you can reach her at debangana.1992@gmail.com.

Female Genital Mutilation/Cutting: Work of the devil?

By: Koen Van den Brande
Age: 56

Country: India

I rarely speak of the devil.

In Germany they have a saying:

Du sollst den Teufel nicht an die Wand mahlen
Literally this translates to ‘Don’t paint a picture of the devil on the wall’.

Loosely translated it means that you should not invite evil by talking about it.

But maybe there are times we have a duty to alert others to the devil’s work.

What I mean by that is not that anyone in particular is a devil but rather that maybe at times the devil has a hand in misleading people.

My efforts to get to the bottom of the origins of the practice of ‘khatna’ – what the rest of the world calls ‘Female Genital Mutilation’ (FGM) – in the Suleimani community, recently led me to the inevitable conclusion that the devil has had a hand in twisting the words of the Prophet PBUH, to mean the opposite of what He was saying.

My attention was drawn to some research carried out by learned members of the Muslim community. Let me present the facts to you so that you may come to your own conclusion.

Early on in my own research I came across a Hadith – a reported saying of the Prophet – which was being quoted as evidence of tacit approval of this ancient practice, which predated Islam and may have been initiated in the distant past to subdue the sexual urges of female slaves.

My discussions with members of the Suleimani community had made it clear that the Daim-ul-Islam is the rulebook to which many show an unquestioning allegiance.

Of course such blind faith can have dire consequences. The Daim-ul-Islam does indeed refer to the Hadith in question. Following is an extract from a paper published on www.alislam.org, with the title ‘Female circumcision and its standing in Islamic law’.

Al Islam quote

But it turns out this is not the full Hadith.

In full, the Hadith seems to leave little doubt as to where the Prophet stood on this matter. The authors of the report quote from Al-Kafi, a respected Shiite book of traditions.

Koen article quote

Was the Prophet endorsing, encouraging or even mandating that women should be cut?

Or was he signaling his disapproval and in the face of a long-established tradition, trying to limit the harm done to women? Given what he says, is it correct to claim, as some do, that he should have forbidden it, if he really felt it was wrong?  

I will leave it to you to draw your own conclusion.

For me these words of Mohammed, now in full view, are consistent with other issues where he championed the rights of women in the face of a culture which at that time saw no reason to do so.

Who decided to shorten the hadith and to what end? And at which point did a woman who ‘used to circumcise women slaves’ become a woman who ‘used to circumcise girls’? There is a substantive difference is there not?

Just as with the modern day suggestion that Mohammed condoned wife-beating, when in fact he counseled restraint and suggested several alternative ways of resolving marital disputes or the insistence by some on the validity of ‘triple talaq’ divorce, where in fact careful mediation over a period of time is prescribed, one can only conclude that the devil himself has repeatedly sought to undermine the Prophet’s cause as champion of the rights of women!

Today we call this ‘fake news’ and we are learning day by day, how it is used to mislead those who believe without questioning.  

Witness how the young parents of our community are systematically fed disinformation, building on that same principle of blind faith. But blind faith in whom?

I quote from the website www.islamqa.com.

Koen article quote2

Search for the term ‘khatna’ and the following question is addressed, among others:

Koen article quote3

This is how the scene is set:

Koen article quote4

I wonder what a properly qualified medical practitioner would make of some of the advice given.

Koen article quote5

Need I say more ?

How do we tackle such blatant attempts at misleading parents of young girls?

Surely the best strategy must be to focus on facts and truth. So I am attempting to find a consensus across the Suleimani community around the following statement.

“I as a member of the Suleimani Jamaat, in the interest of young parents and their girls, want to reflect what I believe to be the truth about the practice of khatna. 

Fact is …

  1. It is a tradition which predates Islam 
  2. It is not mentioned in the Quran at all 
  3. It is not practiced by all muslims 
  4. It has been declared a crime in several Muslim majority countries 
  5. It is considered a health hazard by the World Health Organization
  6. It is considered a crime against a child by the United Nations

Truth is, in my humble opinion, that the Prophet Mohammed PBUH frowned upon this practice and sought to prevent harm from being done to women.

I believe that these facts should be endorsed by our leadership and communicated to all of the Jamaat ‘s young parents. 

The Daim-ul-islam states that ‘khatna’ is not obligatory and that it should not be performed before a girl is 7-years-old. 

I believe that it would be in line with this rule to recommend to parents that any decision to proceed with this practice should be postponed until the age of consent. 

And in line with the Prophet’s guidance, at a time when it was a more common practice, I believe that when and if it is performed, it must be done symbolically only and cause no harm.”

I hope you can join the effort by endorsing this statement.

And if you cannot, I invite you to propose an alternative.

At least let’s start by banning the use of http://www.isllamqa.com

Let us work together to undo the work of the devil.  

 

What Islam says about Female Genital Cutting and how far are these texts invincible? (Part 1)

By Debangana Chatterjee

A journey through religious texts helps us to validate or disprove the claims that there are religious justifications for traditional cultural practices. A similar logic applies to the claims that Female Genital Cutting (FGC) is an Islamic practice.

The Holy Quran and the hadiths, evolving from the deeds of the Prophet Muhammad, form the basis of Sharia or the Islamic law. Whereas the Quranic scriptures are unquestionable, hadiths require authentication as they are the dynamic source of evolving Islamic practices. Hadiths are the Prophet’s verbal instructions which were documented by various narrators after the Prophet’s death. The actual narration of the text is called the matn and the insad contains the trail of narrators to support the authentic transmission of Prophet’s instructions over generations. Hadiths can be classified as either mutawatir or ahad. Mutawatir hadiths are substantiated and backed up by multiple reporters documenting his guidelines and thus, is adequately acknowledged within the Islamic circle. Praying namaz, donating, fasting and going for Hajj are few of the mutawatir hadiths which are considered fully authentic. On the contrary, although a few ahad hadiths are thought to permit a limited form of female genital cutting, they are deficient of authenticity borne through insad.

According to a Baihaqi hadith, circumcision ennobles women. But many suggest it to be advisory rather than obligatory. One of the Bukhari Sharif hadiths considers circumcision as one of the acts of fitra (human acts inspired by God) like the removal of pubic hair, trimming the moustache, removing armpit hair and shortening nails. In Islam there has been much controversy whether fitra is binding. One Jami at-Trimidhi hadith suggests that there must be an essential bath after sexual intercourse between the two circumcised genitals of opposite gender. Though the supporters here take circumcision as a prerequisite to sexual intercourse and hence to marriage, the commandment of the hadith lies at the fact of taking a shower after sexual intercourse where circumcision may be spoken of as a natural presupposition. Written in Arabic, this hadith may have been toldto a community that was culturally inclined towards FGC at the time it was said. Hadiths by Abu Dawud, Al-Tabrani and Al-Khatib al-Baghdad seem to suggest conducting a plain cut of the clitoral prepuce, as according to them it beautifies a woman’s face and makes her even more desirable to her husband. Primarily even if the hadith  indicates FGC, it eliminates the severe forms of it such as infibulation and only promotes the least severe form.

Other interpretations of this hadith suggest that rather than taking it as the Prophet’s order, one may read this hadith as suggesting it is merely a desirable option. In contradiction, a hadith reported by Abu Sa’id al-Khudri and documented by Ibn Majah and Al-Daraqutni with an authenticated line of insad seems to unequivocally reject any practice amounting to harm.

In Shia Islam, taharat (purity) concerning the notions of hygiene, cleanliness and purity is sometimes put forward to justify FGC. It is believed that due to the clitoral unhooding the excess building up of smegma is addressed. Yet, effective measures of washing and cleanliness are more than adequate to address this issue.Removal of healthy tissues for it does not seem to be credible enough.

In India, Dawoodi Bohras, the largest Bohra sect belonging to the Tayyibi Ism’aili branch of Shia Islam, who practice khatna, consider the Da’i al-Mutlaq, also known as Da’i, to hold an authoritative, infallible status in the community. As the Da’i considers Daim-ul-Islam as the binding religious text for the Bohras, diktats of the text are taken as truth by devout community members. In this text, the Prophet is believed to advise for a simple cut of a woman’s clitoral skin as this, according to certain translations of the text, assigns chastity to a woman and makes her more ‘beloved by their husbands’. Though supporters of FGC cite this as the reason for the continuation of khatna, scholars have shown that da’is have never been as invincible historically, as has occurred in the recent past. In fact, changes in the provision that khatna is required, would add dynamism to the religion.

Islam as a whole neither complies with the practice nor endorses FGC. Despite repeated invocation of religious references as a justification for FGC, considering the myriad number of Islamic texts, the grounds for such justification hold little or almost no merit.

 Read Part 2 – Female Genital Cutting (FGC): Is it an Islamic Practice?

More about Debangana

Debangana is a doctoral scholar at the Centre for International Politics Organisation and  Disarmament (CIPOD), Jawaharlal Nehru University. Through her research, she is trying to locate the existing Indian discourse surrounding the practices of FGM/C and Hijab into the frame of international politics. If you would like to connect with Debangana, you can reach her at debangana.1992@gmail.com.

Trauma and Female Genital Cutting, Part 5: The “C” Word… and I Don’t Mean Circumcision

(This article is Part 5 of a seven-part series on trauma related to Female Genital Cutting. To read the complete series, click here. These articles should NOT be used in lieu of seeking professional mental health and counseling services when needed.)

By Joanna Vergoth, LCSW, NCPsyA

Since the ritual of Female Genital Cutting (FGC)  involves the clitoris, it seems important to learn more about this organ and its function. But first a bit of history, or—more appropriately—herstory.

In over 5 million years of human evolution, only one organ exists for the sole purpose of providing pleasure — the clitoris. Yet, from ancient times to the present, the anatomy of the clitoris has been discovered, repressed, and rediscovered. Hippocrates, the Greek physician, born circa 460 B.C., called the clitoris “columella”: the little pillar. About 500 years later, Galen, an anatomist renowned in Rome, denied its existence. Centuries later, the 1901 edition of Gray’s Anatomy included a drawing of the female pelvis in cross-section, showing a small protrusion with the label “clitoris” (Gray, 1901). In the 1948 edition of Gray’s Anatomy, there is an analogous illustration of female genital anatomy (Goss, 1948). Yet, the label of the clitoris is now gone. The clitoral protrusion of the older illustration is also removed. As a result, the clitoris has now been erased (Moore & Clarke, 1995).

Just The Tip of The Clitoris

In reality, what we generally think of as the clitoris—what we can see and feel—is just the pea size tip of the clitoris, called the “glans”. The glans, located at the top of a woman’s vulva, at the point where the labia majora meet (near the pubic bone), contains approximately 8000 sensory nerve fibers—more than anywhere else in the human body. In fact, the amount of sensory nerve fibers in the glans is twice the amount found on the head of a penis.

More Than Meets The Eye

Many people assume that all there is to the clitoris is the glans, but with the clitoris, what you see is not what you get. Helen O’Connell, an Australian urologist, and her colleagues have corrected that misconception (O’Connell, Sanjeevan, and Hutson, 2005). Using modern imaging techniques such as Magnetic Resonance Imaging (MRI), O’Connell has shown that there is much more to the clitoris than what meets the eye. They discovered that the glans of the clitoris is simply the tip of an extensive organ.

In fact, three-quarters of the clitoris is inside the body. As shown below, the clitoris is a MRI clitwishbone-shaped structure that is about 3 ½ in. (9 cm) in length and 2 ½ in. (6 cm) in width. The glans extends backward into the clitoral body. The glans then split into the two leg-like parts, the crura, which are composed of erectile tissue and are next to the vagina and urethra (see MRI photo below of internal clitoris). The vestibular bulbs are two elongated masses of erectile tissue situated on either side of the vaginal opening.

The Clitoris and Its Place within the Vulva

The vulva is a single term used to describe all the external female genital organs. These sub parts internal clitorisorgans include the labia majora, the labia minora, the clitoris, the vestibule of the vagina, the bulb of the vestibule, and the glands of Bartholin. The two sets of labia (lips) form an oval shape around the vagina. The labia minora are smaller and surround the vagina. The labia majora are larger, and, after puberty, the outer part of the labia majora is covered with pubic hair.

Since there are large portions of the clitoris extending through the pubic area, sexual responsiveness is not limited to direct or indirect stimulation of the clitoral glans (Wallen and Lloyd, 2011). Due to this extended internal structure, the clitoris can respond to stimulation of the external vaginal labia, the vagina itself, and the anus. As a woman draws closer to orgasm, the clitoris can swell by 50 percent to 300 percent. According to O’Connell, “The vaginal wall is, in fact, the clitoris.” If you lift the skin of the side walls of the vagina you will find the bulbs of the clitoris (O’Connell 2008). O’Connell proposed the notion that during vaginal intercourse it is the “clitoral complex” that is stimulated.

Clitoral anatomy and FGC: Removing the glans of the clitoris does not mean the whole organ is destroyed.

The issue of clitoral anatomy is also significant concerning the practice of image5clitorectomy. Type 1 FGC: Often referred to as clitoridectomy, is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in some cases, only the prepuce or hood (the fold of skin surrounding the clitoris). The clitoral hood varies in size, shape, thickness, and other aspects of its appearance from woman to woman. Some women have large clitoral hoods which appear to cover the clitoral glans. Others have much smaller hoods which leave the clitoral glans exposed. While the biological function of the clitoral hood is simply to protect the clitoral glans from friction and other external forces, this body part is also an erogenous zone. It provides natural lubrication, which makes stimulation of the clitoral area more pleasurable. As the clitoral glans itself is often too sensitive to touch, many women gain pleasure from having the glans indirectly stimulated through the clitoral hood. 

Although female sexual pleasure is often hindered by clitoridectomy, many women report that they are still able to enjoy sex (Lightfoot-Klein, 1989, Kelly and Hillard, 2005). One researcher has found that even infibulated women may still have the ability to achieve orgasm. Dr. Lucrezia Catania, who has studied and treated FGC-affected women in Italy for two decades, has found that when some of the sensitive tissue of the labia minora and clitoris remain intact, infibulated women can experience orgasm, while others cannot and instead feel pain.

Pelvic Nerve

The clitoris has enormous potential for arousal, but what may affect sensitivity is the supply of nerve endings and the individual pattern of each clitoris, which explains the variation in women’s preference for stimulation. The pelvic nerve branches in individual ways for every woman. The pathway distribution is quite different and far more diffuse from male sexual wiring, which is much more uniform.

Some women’s nerves branch more in the vagina while other women’s branch more in the clitoris, or in the perineum (the skin between the anus and vagina) or in the mouth of the cervix. No two women—not even identical twins—have the same pattern and distribution of nerves. This complex system of nerve endings extends into the pelvis and is in fact far larger on the inside than it is on the outside. When stimulated, the erect clitoris tightens around the vagina. This means that “vaginal orgasms” are actually caused by the clitoris, not nerves on the vaginal walls themselves. Whether brought on by penetration or external stimulation, all orgasms are clitoral. 

Not only can the anatomical facts of the clitoris help alter cultural biases and mythologies, but correct knowledge of clitoral anatomy may help enhance a woman’s appreciation and experience of her body.


The information for this article was sourced from:

  • Blechner, Mark, J., “The Clitoris: Anatomical and Psychological Issues.” Studies in Gender and Sexuality, 18:3 (2017): 190-200.
  • Wolf, Naomi. Vagina A new Biography. New York: Harper Collins, 2012
  • https://en.wikipedia.org/wiki/Clitoris

The images included were researched from internet sources.

About Joanna Vergoth:

Joanna is a psychotherapist in private practice specializing in trauma. Throughout the past forma logo15 years she has become a committed activist in the cause of FGC, first as Coordinator of the Midwest Network on Female Genital Cutting, and most recently with the creation of forma, a charity organization dedicated to providing comprehensive, culturally-sensitive clinical services to women affected by FGC, and also offering psychoeducational outreach, advocacy and awareness training to hospitals, social service agencies, universities and the community at large.

Let there be no more victims like me

By Anonymous
Country: Sri Lanka

I am a victim of Female Genital Cutting – some might want to call it circumcision, I call it Mutilation. Not quite the way that the proponents want to depict it as what always happens in Africa (infibulation) with horrific scars, but in the way, it happened to me in Sri Lanka where there are still scars, tiny, almost unnoticeable. But in all the ways that matter, it has damaged me no less than the most severe forms of mutilation.

To those who want to medicalize the procedure, let me say that I was cut by a qualified doctor, in a sterile environment, when I was seven-years-old. I remember that day clearly and it is I who have had to live with the consequence of what was done to me in the name of religion.  Not my religious leaders, not my elders, and not that doctor. ME, the woman who that child without a voice grew up to be.

Let me now take the arguments I’ve heard in support of the procedure and give you my perspective as someone who has first-hand experience of the negative impacts of FGC. I will use the term female genital cutting (FGC) since irrespective of what one wants to call it, that is what is done to a lesser or greater degree, depending on who holds the pin, blade or knife.

A. Sex lives as Adults

To the women who say that they have better sex lives due to FGC, I ask you this: what is your point of reference? Have you had sex with the same partner before and after your FGC to arrive at this conclusion?  Have you ever considered the possibility that you have been very lucky, and that whoever performed the FGC on you spared you any real damage? It is also very presumptuous for you to assume that NONE of the billions of uncircumcised women around the world enjoy great sex the same as you.

To the women who don’t have a horrific memory related to their own FGC and who don’t understand what all the fuss is about: let me tell you that neither do I. I don’t have any horrific memories of that day. My Mom who accompanied me held me gently, the doctor looked very professional and it was over before I knew what was being done. I felt a pinch, no bleeding that I can remember – just some cotton wool that smelled of antiseptic placed there after I was cut. And I walked out, confused, uncomfortable but definitely not traumatized. Sounds familiar?

It wasn’t until I was as an adult that I realized the impact of what was done to me. I feel pain during intercourse. Most of you may not. But does that mean you are not damaged? Have you ever considered the fact that intercourse is supposed to be more than just “pleasant” or something you put up with when your husband feels so inclined? In my case, I have been examined by a doctor who has seen the tiny scars and helped me understand the impact of those scars on my ability to enjoy sex.

Initially, I wondered whether what happened to me was a mere unfortunate mistake by this doctor. I have since then come across stories of others in Sri Lanka who were cut by the same and other doctors who share similar tales. So no, I was not an unfortunate accident – the doctor and others like him/her knew exactly what they were doing and did it nonetheless.

B. The need to perform the procedure on a child

All the literature shared by the supporters of this practice alludes to adult women enjoying their sex lives. However, I still have yet to come across any argument to support as to why the procedure needs to be performed on seven-year-old girls who have a long way to go before they begin their sex lives.

So, what is being promoted is, in fact, the sexualizing of children. News flash: these organs don’t stay dormant and get activated only when one gets married.

Personally, I find the very idea of parents allowing strangers to access to their daughter’s private parts for non-medical reasons and letting them alter her genitals, an extremely troubling thought. I’m more inclined to believe that in their hearts, they know that they are in fact desexualizing her. What they want in reality is to keep her pure and innocent until she could be given away. There is no thought given to the fact that she then has to live with a damaged body and fulfill marital obligations that she may not enjoy as much in their effort to keep her pure and innocent until she was given away.

C. The Religious Argument

Who decides on one’s religious belief? The individual or the individual’s parent?

Yes, the parents would bring up the child within the religious norms they follow, and yes in most cases the child would continue with that belief till the end, but this is not always true for everyone.

Hence, how do you justify altering a child’s body, without any medical reason, to be in alignment with the parents’ religious belief, when that child is yet to determine what path she would take or which God she will follow once she has learned enough to make that decision?

As for me, I don’t believe that the God who created me required any man or woman to tamper with my body, with the assumption that they can make it better. I believe the Quran when it says that all of God’s creations are perfect. I won’t let any man or woman tell me otherwise.

But my body has been altered irrevocably – it’s no longer the way God created it to be. My body is now in conflict with my religious beliefs. It has ended up representing the beliefs of others and not mine. The religious belief of others has also denied me pleasure that was my right and right given to me in the Qur’an. How can that be a just outcome by anyone’s standards?