Female Genital Mutilation: As the 'cutting season' approaches, end the silence

Popular culture’s depiction of the sexually liberated western woman is as mythic as it is material. Even our fake orgasms are canonised- who doesn’t remember Sally leaving Harry agog in the famous diner scene? Yet, for millions of women around the world, the possibilities of real sexual expression is brutally resected, often even before puberty, through female genital mutilation, a grotesque assault which impacts over 125 million women globally.

The World Health Organization classifies four categories of female genital mutilation/cutting (FGM/C)- clitiroidectomy; excision (of considerable variation of female genital tissue); infibulation (excising the clitoris and labia and stitching together the edges of the vulva to prevent sexual intercourse) and finally mutilation beyond even these classifications.

There is no health benefit to any of these procedures, despite entrenched beliefs to the contrary. The procedures are universally performed for cultural reasons, and frequently in the name of Islam, though the Quran contains no such mandate, and healthy sexuality is celebrated in Islam.

The new documentary Honor Diaries examines female genital mutilation in the context of honour violence directed against women. Viewers learn about Sudan’s Fahima Hashim as she shields potential victims of FGM/C through her advocacy work. We see how she negotiates with parents who would otherwise demand mutilation for the preservation of familial honour, misplaced values of purity and marriage prospects for their daughters and other female relatives.

Unsurprisingly, Honor Diaries has already touched a nerve, in some instances triggering disingenuous claims of Islamophobia. In the United States, some Muslim groups have encouraged censorship of screenings in three universities. While such actions may be political motivated, honour violence, and FGM/C in particular trigger keenly felt collective shame. This practice is so shameful, we, as a society, whether Muslim Majority, Muslim Diaspora or Non Muslim Westerners can quite literally not bear witness.

I have practiced medicine for 23 years, twice in Muslim societies. I treated patients in Riyadh Saudi Arabia, a predominantly conservative Muslim theocracy, and in Whitechapel, in England’s East London, home to the largest Bengali Muslim population outside of Bangladesh. In both societies, I was caring for Muslims adhering to some of the most orthodox expressions of Islam today, a hallmark of which is the profoundly unIslamic subjugation of women. Central to this subjugation is the female body that was both in London and Riyadh the vessel for familial honour.

Yet even as a seasoned physician by the time I practiced in Riyadh, I was yet to encounter women with FGM/C. One day just as I had finished admitting a patient to the intensive care unit, one of my senior nurses, Mary, a sun-worn Afrikaner from Johannesburg, approached me.

“She’s been cut”.

I looked at her blankly, uncomprehending.

“I just catheterised her bladder, doc. She’s cut - down there.”

In Mary’s unflinching gaze, I finally understood: my patient was an FGM/C victim. Asking me if I wanted to verify her assessment, Mary suggested I examine the patient’s genitalia. With instinctive aversion, I recoiled, never being able to bring myself to see her scars.

Now, with the benefit of additional maturity to my medical practice, I realise how deep my shame had been. As her physician, I was incapable of bearing witness to my patient’s mutilation. In over two decades, I cannot recall ever refusing to see the scars on any other patient. On the bodies of my patients, I have studied and recorded the scars of torture, homicide, motor vehicle accidents, catastrophic burns, deliberate self harm and the particularly malignant work of abusers. All of this I could see, but FGM/C I could not.

Certainly, FGM/C is seen mostly among ethnic groups in over 28 African nations. 2008 data shows that nine out of ten women in Dijibouti, Egypt, Guinea, Mali, Northern Sudan, Sierra Leone and Somalia have undergone FGM/C. My Saudi patient was one of many women in the Middle East and Asia who are also compelled to undergo FGM/C.

All of us whether physicians or not, must understand FGM/C is the absolute denial of a girl or woman a future as a sexual entity. In a few crude cuts her Self is erased, her sexual being excised. She will never be whole again. While much of the female sexual response is psychological, emotionally brokered by complex neurotransmitters, without an intact clitoris almost all female sexual gratification is absent. Certainly vaginal orgasm may still occur, serving to grip the penis during intercourse, and propelling sperm towards the waiting ovum, but devoid of labia, mucosal engorgement (which is both inviting to penetration and psychologically an enormous driver of female sexual desire) cannot occur.

In the most severe forms of FGM/C, sealing shut the introitus, menstruation, penetration and childbirth becomes painful and rife with major complications. Women are frequently left with urinary and fecal incontinence, and may develop humiliating fistulas connecting the bowel to the urogenital system- feces and urine can emerge from the vagina leaving her permanently with a sense of being unclean and often with very real infections.

FGM/C is nothing less than an excavation of the core female identity in every way, leaving the woman a mere husk of her potential self. Through FGM/C a woman or girl is de facto objectified, rendered a receptacle to service male gratification. Womanhood becomes only an instrument for procreation.

Increasingly as migration becomes more common, diaspora communities arriving to Western nations continue the practice. FGM/C prevalence is therefore rising among migrant residents of Norway, Australia, Canada, Sweden, Switzerland, Britain and the United States. Migrant families, often traveling with their young daughters in summer vacations to their native countries, have the procedure performed at grave risk of infection bleeding and death when non-clinicians perform this procedure. School holidays become 'The Cutting Season'.

Legislation is the most powerful deterrent to FGM/C. The first country to legislate against FGM/C was Sweden, prohibiting the practice in 1982. Other Western nations followed. Critically, legislation provides the opportunity to raise awareness, and empower women as they encounter a society which exiles the practice and denies it an entitled normalcy. European legislation has resulted in the prosecution of over 45 criminal court cases almost all followed by convictions subsequently. Because of these laws and our refusal as Western societies to normalise FGM/C, girls and women are finally given the chance to be physically intact, sexually whole.

Western women, and our devoted male supporters living in democratic climates where human rights are safeguarded, are in a unique position to impact the sexual integrity of hundreds of millions of women and girls. We have a responsibility and an urgency to act. We can end the Cutting Season.

To do so, we must bear witness to their suffering, we must become their voice, and we must shield their daughters and grand daughters as if they were our own. Honor Dairies, a movie every woman and girl should see, is an important tool in our armamentarium as we go to battle to end the Cutting. Our movie, and the movement it has inspired, serves the true honour of these women and girls and can help restore future generations the full dignity an intact womanhood can grant every woman, and inspire every girl. Join the Honor Dairies movement in exiling FGM/C. Its time to cut it out - not only from our societies, but from womanhood around the world. While at first many of us, like me, may fear confronting the painful reality, somehow we must find the courage and, like Meg Ryan showed us in that diner, if we can fake it, together we can make it.