Female genital cutting.(GUEST EDITORIAL)

Female genital cutting, a practice seen in parts of Africa and Asia, is becoming more relevant to health providers here in the United States.

More than 130 million women worldwide have undergone female genital cutting (FGC), and approximately 228,000 women and girls in this country are either living with the results of or are at risk of undergoing FGC. As more such women enter this country, ob.gyns. will need to familiarize themselves with the cultural, ethical, and medical issues surrounding FGC.

As a Sudanese-American who grew up in a country where this practice was very prevalent--and as an ob.gyn.--I strongly believe that we should work toward the eradication of FGC. But it is only through a deeper knowledge and understanding of the cultural, ethical, and medical issues surrounding this practice, and of our patients who have undergone it or are at risk of it, that we can hope to stop it.

The importance of providing culturally competent, holistic care for this patient population cannot be stressed enough. Women who have been circumcised worry that practitioners lack the experience to provide quality care for them. And if we fail them in this regard, we will have failed in having any influence in terms of stopping FGC and ensuring a healthy life for those who have undergone it. The debate over terminology used to describe this procedure offers insight into the complexity of the issue. Although many, including women who have undergone the procedure, refer to it as "female circumcision," others have argued that this term is anatomically inaccurate.

Circumcision refers to the removal of only the prepuce and grossly understates the damage that is done with most forms of FGC, which include the removal of the clitoris and in some cases all of the external genitalia, and closure of the remnant tissue (infibulation) to leave only a narrow opening. Some people use the term "female genital mutilation," but the word "mutilation" lacks neutrality. Indeed it condemns and inflames--and many women who have undergone this procedure are offended by the reference. They insist they are not mutilated, but in fact have been made more beautiful because of it.

This indeed touches on the cultural roots of this issue. Rather than considering FGC a form of torture, as many Westerners view it, many cultures consider it a necessary and inevitable component of womanhood--a rite of passage similar to the pains of childbirth. Girls often request to undergo the procedure, which typically is performed between the ages of 4 and 12. Other cultures use FGC as a means of preserving virginity until marriage. Girls who are ...