AskDoctorKT

I have received tonnes of questions regarding female circumcision but I have only given short answers to most of them. I also wrote a short article on this topic in 2016 on my blog here
Today, I am posting this out there to present a more explanatory answer and I hope it will clear your doubts once and for all.

The terminology “female circumcision” has been largely replaced by “Female Genital Mutilation” or “Female Genital Cutting” which has a broader definition and portrays it as a criminal offence. The aim of most circumcisions is to remove the prepuce (fore-skin) of the clitoris. This is believed to confer honour on the girl and keep her chaste until she gets married. However, many cultures and individuals have gone overboard with the practice, which resulted in the outcry within the medical community and various social circles. Till date, FGM is still widely practiced in many parts of Africa and the Middle East.

The World Health Organization (WHO) defines FGM as ”all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”. Over 140 million girls and women have undergone FGM with hundreds of thousands of them living with adverse consequences directly related to it. Mortality rates of up to 2.3% has been reported in some parts of Africa (Erskine K. BMJ, 2014)

Note the caveat in the above definition – “…for non-medical reasons”. This tells us that some forms of genital “cutting” could be done for medical reasons. A quick example is the surgical removal of excess tissue in girls who have enlarged clitoris. This and other similar procedures are medically necessary because such female genital structures may look ambiguous, almost confused with the male phallus.

FGM has been criminalised due to the serious short and long term complications that have been observed in girls and women who have undergone it. Before we talk about these complications, let’s look at the classification of FGM. (Some basic knowledge of the female genital anatomy is required for better understanding)

Type 1 – clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce.

Type 2 – excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.

Type 3 – infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

Type 4 – other: all other harmful procedures to the female genitalia for non-medical purposes – eg, pricking, piercing, incising, scraping and cauterising the genital area.

(FGM and its management, RCOG (May 2009)

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From this classification, it is clear that even the mildest form of cutting, ie. removal of the prepuce is unnecessary from a medical perspective. Because female circumcision has been banned in many parts of the world, people often resort to untrained persons to get the job done. The procedure is often done in dirty environments with the use of non-sterile instruments. Antiseptics and anaesthetics are rarely used. Apart from excessive bleeding and infections, other complications include :

*Extensive damage of the external reproductive system with cosmetic disfigurement

*Swellings, such as Cysts and neuromas.

*Increased risk of vesico-vaginal fistula.

*Complications in pregnancy and childbirth.

*Psychological damage.

*Sexual dysfunction.

*Difficulties in menstruation.

My advice to parents who desire to have their girl’s prepuce removed is that they should follow the rules of their country. Ask yourself why you want the procedure done. If there seems to be an unsightly extra mass of tissue around her genitalia, or there is any form of ambiguity, contact the appropriate medical practitioner for further advice. But if there is no medical indication and you only want to do it for religious or traditional purpose, you may wish to think carefully before you go ahead.

Moreover, if you live in a country where FGM is a crime, you have only 2 options – to leave the country or to leave the practice. In countries like the UK, even if you leave the country for the purpose of getting the circumcision done in Africa or the Middle East, you may still get into trouble should the authorities find out that you have circumcised your girl!

What is the bottomline then?

Female genital cutting has no proven benefit when done for non-medical reasons. But it remains a widely accepted practice in some parts of the world. People need to understand why there are campaigns against the practice – concerns about the serious harmful effects of the practice.

For me, I would maintain a middle course between medicine and culture/religion. One of the basic tenets of medicine is to do no harm. This principle was also highlighted by the Prophet (peace be upon him) when he said, “Do not cause harm or return harm.”
(Sunan Ibn Mājah 2340, graded authentic)
Where the risk of harm outweighs the expected benefits, what would you rather do?

While female circumcision was an established practice during his time, the Prophet explicitly warned against genital mutilation. Umm ‘Atiyyah says that the Prophet said to a “circumciser”: “Do not make the operation too invasive; do not harm the woman or do anything that would not allow her to feel pleasure” (Abu Dawood)

Scholars of Islām have also stated that it’s not compulsory to have female children circumcised and as such no parent would be sinful for abandoning it. Ibn Qudaamah said in Almughnee, “As for circumcision, it is obligatory for men and honourable – not obligatory – to women”

Every case should be treated individually and it is wise to get a verdict from a trusted medical practitioner. Muslims who wish to practice the Sunnah should consult an experienced muslim medical doctor who understands the Sunnah as well as the boundaries between a necessary excision and genital mutilation. Do not take the poor girl to a quack who could subject her to immediate risk or a lifetime of psychological distress.

©KT
2020