Female genital cutting complications

by Todd Neale

Clinicians should actively persuade families not to participate in the ritual cutting of female genitalia, the American Academy of Pediatrics urged.

However, the organization suggested that legislatures and doctors might ultimately consider legalizing ritual “nicks” to satisfy cultural or religious demands without more serious and problematic cutting.

The centuries-old practice, which is illegal in the U.S. and several other developed countries, carries with it a host of physical and psychological problems, according to a policy statement from the AAP’s bioethics committee.

But the custom of ritual cutting or alteration of the genitalia of female infants, children, and adolescents — performed with a variety of tools such as knives, razor blades, broken glass, or scissors — persists in some cultures, primarily in Africa and in some communities in the Middle East and Asia.

Researchers don’t know how prevalent female genital cutting is in Western societies, but U.S. clinicians may encounter immigrant families whose daughters have undergone the procedure or who request to have it done in a sterile environment by a healthcare professional.

“Although physicians should understand that most parents who request female genital cutting do so out of good motives, physicians must decline to perform procedures that cause unnecessary pain or that pose dangers to their patients’ well-being,” the statement read.

The AAP “urges its members to provide patients and their parents with compassionate education about the harms of female genital cutting while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.”

Female genital cutting has various degrees of severity, from the removal of skin surrounding the clitoris to removal of the clitoris to stitching together the labia to create a vaginal opening no wider than a pencil.

There are various cultural and religious reasons for the practice, such as the preservation of virginity, the easing of cultural integration, and the maintenance of cleanliness and health.

Some form of the female genital cutting has been performed in many major religions, including Christianity, Islam, and Judaism, according the AAP statement.

But in recent years the World Health Organization and several physicians organizations have condemned the practice because of its adverse health effects.

There are numerous complications associated with the practice. They include hemorrhage, shock, local infection, failure to heal, septicemia, tetanus, trauma to adjacent structures, and urinary retention in the short term. Potential long-term problems include development of painful subcutaneous dermoid cysts and keloid formation along excised tissue edges and difficulty with vaginal childbirth.

More serious complications include pelvic infection, dysmenorrhea, hematocolpos, painful intercourse, infertility, recurrent urinary tract infection, and urinary calculus formation.

There has been little research on the psychological, sexual, and social consequences of female genital cutting, but personal accounts have reflected anxiety, terror, and a subsequent lack of sexual pleasure during intercourse.

On the other hand, some young women have described the experience positively “as a communal ritual that inducted them into adult female society,” according to the AAP statement.

Several countries, including the U.S. and the U.K., have banned the practice. The U.S. also outlaws “ritual nicks” as a compromise to the more severe forms of female genital cutting.

However, according to the AAP statement, “the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting” and may serve to build trust with immigrant communities and prevent more severe forms of cutting.

“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the authors wrote.

Pediatricians should seek to educate patients and parents about the harms of female genital cutting in a culturally sensitive way, the statement read, and clinicians serving communities in which the practice is common should be aware of counseling centers.

Todd Neale is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more pediatrics news.

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  • NO

    How about No. Just say no. No, you cannot continue this custom in this country, or go out of the country to do it, and if you come back, you are sent back, or got to jail. Jail for a long, long time. NO ACCOMODATION AT ALL.

    There is no acceptable purpose for this, as there arguably is for circumcision which actually does have some hygiene benefits and protection against STDs for women and penile cancer in men.

    THere is no benefit to be had. And this “good motive”- maintenance of cleanliness and health – listed above is flatly absurd. The opposite is true.

  • Doc99

    That the AAP would contemplate tolerating this barbaric treatment of women for the sake of political correctness is simply abhorrent. What are they thinking? It’s high time the real Feminists in this country speak out forcefully against the treatment of women as second class citizens. I’ll stop now.

    • http://pulse.yahoo.com/_BFYYKHKHRDHKQMU4PDNAVIMBEY Carmen

      As a feminist, and a future pediatrician, I agree it is a difficult situation.

      I do believe the statement was written not for the sake of political correctness, but because the ethical and legal situations the pediatricians find themselves in.

      There are pediatricians who see parents that want this done to their girls, and the first thing pediatricians do is refuse and educate. 

      Then there are those families that insist and that leaves the pediatrician with 2 options. Which one is worse?
      Option A) The pediatrician refuses. So then the family then takes the girl back to their home country where some random person who may or may not know what a clitoris is, grabs a dirty broken glass bottle and cuts away. There are complications. Does the child make it back to the US where a pediatrician can try and help her after all the trauma and dies, or does the girl die in the home country?

      Option B) The family indicates that they will do whatever it takes to get their little girl cut. The pediatrician, having seen the grim result of “Option A” and has the technical and procedural knowledge to do some sort of less traumatic ceremony that fulfills a family’s criteria, without causing massive trauma to the child makes an attempt compromise. Will the little girl be traumatized less by having her clitoris pricked gently by a physician who does NOT want to cause harm to the child in the first place, but face legal action that could end their practice?

      I would NEVER want to send a little girl to a random person to perform a heinous procedure and cause her trauma for life, but I wouldn’t want to have my license revoked for trying to choose the lesser of two evils.

      That is a heart-wrenching choice to me.

  • Brian Loveless, DO

    2 points here:
    1) notice the change in terminology, used to be called female genital mutilation, now it is just cutting.
    2) the AAP had to do this in order to be consistent with their stance on male genital cutting. How sad that they would sacrifice women in order to maintain, what, the income of the circumcisionists?

    The answer is that all children (or adults for that matter) have a right to genital integrity. If they choose at an adult age to mutiliate themselve, then so be it.

  • http://www.silvercensus.com/ Steffan Lozinak

    … …
    You know, I try hard to understand differences in custom, and at least try to see where ideas come from…

    But… why???? ouch…
    I mean, at least when certain cultures of south America performed blood letting on their Penises, it was in attempt to communicate with their Gods.. Still… Ow…And at least it was theirs, and not their children’s…

  • ninguem

    Are we seeing that here in the USA?

    Wow. I mean, I see babies in my practice, and the population is ethnically diverse, but I guess not with the ethnicities that do that sort of thing.

    Actually, the ethnics I get prefer to leave the junk the way The Lord Made It, which is fine with me.

  • http://aebrain.blogspot.com Zoe Brain

    I’m Intersexed.

    And while FGM may be illegal for most, it’s routinely performed in many neonatal hospitals on Intersexed children. Including castration, bilateral orchidectomy of functional testes in the absence of a functional penis, and radical clitoridectomy in the case of Congenital Adrenal Hyperplasia in women.

    While surgery is sometimes a medical necessity to relieve pain or ensure urinary and fecal continence, usually it’s not. Most often it is performed to relieve the discomfort of the parents, and in some cases, the medical team, who don’t inform the parents what they’re doing, to “spare their feelings”.

    The evidence is that rather than early intervention being useful for a successful outcome, later intervention (in most conditions) leads to minimal scarring, and maximised sensitivity.

    We (Intersex patient organisations) therefore recommend minimal surgical intervention until the child is at least of school age, and so (amongst other things) they can tell us their sex. If there is a danger of parental rejection of a child that looks too different, that should be addressed as a separate issue. Parents from certain cultures or with strong religious beliefs should be warned that the law takes a dim view of child neglect and infanticide, and that such children are human, not witches nor demonic. If they wish to dispose of them, that must be done through child welfare agencies. Surgical solutions to such problems are not appropriate.

    I, and others, have to clear up the debris from such misguided surgical intervention. I’m sick of it.

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