Genital Mutilations; History and suggestions for change

Seham Abd el Salam
Independent anthropologist and medical doctor

Dr Salam is not directly connected with NORM-UK and any opinions expressed do not necessarily reflect those of NORM-UK

(This page does not contain medical advice)

Last updated on 14th November 2003

Presented at the International Meeting on the Women's and Girls' Rights to Prevent and Eliminate Female Genital Mutilation, Stockholm, Sweden. 10-14 November 2003

What is Genital Cutting?

The practice under question in this conference was given many names by different traditional cultures or modern activists. Whatever the term is used as a label of this practice -circumcision; genital cutting, genital mutilation, or any other equivalent local or international terms- it remains an excision of a healthy functional body part from a non consenting and vulnerable human being, whether this human is a male or a female. Such a procedure is violation to the human right of bodily integrity. When an integral body is unduly violated and injured, we can safely say that it suffered a mutilation. Thus, I will refer in this paper to such a practice when it is done to females as female genital mutilation (FGM) and when it is done to males as male genital mutilation (MGM).

The Significance of the Amputated Parts:

The importance of Addressing MGM along with FGM:

Activists against FGM used to focus on the relevance of the clitoris when they speak about the significance of the parts that are usually removed in the procedures, besides their tendency to underestimate or fully deny the significance of the male prepuce. Thus, people who used to perform FGM supported by some medical doctors- turned to removal of the female prepuce instead of cliroridectomy or infibulation. That is why it is important to explore and acknowledge the structure and function of the human male and female prepuce, if we are serious enough in our efforts to eradicate FGM.

Figure 1 1

The human Prepuce:

Christopher J. Cold and Kenneth A. McGrath (1999) studied the evolution, structure and function of the prepuce. They found that the prepuce is a common feature in the primate external genitalia of both sexes (see figures 1-3 1) It is likely that the prepuce has been present and has provided specialized functions for at least the last 65 million years of primate evolution.. It has an important sensory, protective and erogenous functions in both sexes.

According to the Cold and McGrath study, the prepuce provides a complete or partial covering of the glans clitoridis or penis in humans. Anatomical research has confirmed that both the penile and clitoral prepuce are richly innervated, specific erogenous tissue with specialized encapsulated (corpuscular) sensory receptors 2 (see figures 1&3 1). These receptors transmit sensations of fine touch, pressure, proprioception, and temperature. While free nerve endings (pain, itch, and temperature receptors) are found in most skin, the encapsulated receptors are concentrated in regions that require specialized touch sensitivity, such as at the fingertips, lips, external genitalia, perianal skin, and transition areas between skin and mucous membranes. Histological study of the human penile and clitoral prepuce, showed that corpuscular receptors are concentrated at the prepuce/glans penis and the prepuce/glans clitoridis interface. In the female, the prepuce/glans clitoridis interface contains many corpuscular receptors. In the male, the prepuce is known to have ten times more corpuscular sensory receptors than the glans penis. These characteristics of the male and female external genitalia have evolved over time to produce the most effective system of transferring sperm to ovum. This system needs to be wet and lubricated. That is why all of the genital organs are internal organs.

Rhesus Monkey Glans Penis and Prepuce (diagram)

Figure 2 1

Being located outside the pelvis, the external genitalia of both sexes are protected by the prepuce, which has also a sensory function. Cold and McGrath said that as all male and female primates retain a prepuce, it can be safely postulated that the prepuce provides a reproductive advantage and is not a disadvantageous trait. Male and female circumcision involves the removal and disruption of normal anatomical structures that are primary areas of sexual sensation (Cold & McGrath 1999)

Both male and female embryos develop prepuces. In infancy and early childhood the prepuce is naturally attached to the head of the penis or clitoris to protect them from irritation by excreta. Natural separation takes place gradually till it is completed when a child is between 4-17 years old. This anatomical fact was discovered in 1949, but many doctors are not aware of it, and they diagnose this natural phenomenon as a case of pathological adhesions that needs to be corrected by circumcision. Taylor and Cold (1996) carried out a more advanced histological study of the human male prepuce. They found that the prepuce is formed of five layers of tissues that are full of blood vessels and sensory nerves that are specialized to feel light touch. It is the most sensitive male organ, similar to the sensitivity of the finger tips, eyelids and lips. When we combine their findings with Cold and McGrath (1992) findings we can infer that the structure and functions of the male and female prepuces have more similarities than differences, with acknowledging their few specific gender difference. For example, because the male prepuce is part of the urethra, it contains muscle fibers that are similar to the fibers in the scrotum. The role of these fibers in infants and children is to protect the urinary tract from infection.

Human Clitoris and Clitoral Prepuce (diagram)

Figure 3 1

They act as a one-way valve that facilitates the passage of urine and prevents the entrance of any foreign body. As the male approaches puberty, these muscle fibers decrease in number and give way to an increase of elastic fibers, till both types of fibers reach an equilibrium that allows free mobility of the prepuce in sexual intercourse. However, both of the male and female prepuces have specified capsulated nerve receptors (see above), rich blood supply and immune cells that are considered a primary defense against microbes. Moreover, they secrete a lubricant material (semegma) to make sexual intercourse more comfortable. Therefore, MGM and FGM equally deprive their victims of all these advantageous natural resources.

Neither FGM nor MGM, therefore, is a valid scientifically justified procedure which cures diseases. In fact, both are "a surgery in search of a disease". Hence, the significance of bodily integrity to human rights.

Significance of Genital Mutilations to human rights:

Genital mutilation is not a minor issue. The number of circumcised males all over the world is estimated as 13.3 millions yearly, whereas 2 million females are circumcised every year. Most of the circumcised persons of both sexes are children (Denniston, 1997; DeMeo, 1997). Those millions of boys and girls suffer, and sadly, some of them die, without any justified rational cause. These millions of sufferings that occur in our modern time to satisfy the current patriarchal biases by means of a traditional practice that used to have to different significances in different time among different cultural groups, but it always served and is still serving the patriarchal social biases.

The patriarchal social system has two main biases: one is based on gender and the other is based on age. In both cases, the weakest party of any social relation suffers from discrimination. As for gender, it is the women who suffer most; and as for age, it is the children (Janeway, 1980). More recent studies associated circumcision with the patriarchal society as well. For example, Ashley Montagu stated in his article Mutilated Humanity (1991) that circumcision in both sexes is a tradition that appeared with the rise of patriarchy. Montagu observed that circumcision did not take place in pre-patriarchal societies that were based on sexual equality. For example, in communities of fruit gatherers

He explained that circumcision continues in our modern time because of the persistence of old patriarchal values, in spite of the different motives behind it in antiquity and present day societies. Montagu stated that the human being is the only creature that mutilates the bodies of its individuals in the name of reason, religion, customs and traditions, morality and/or law. Any reason for circumcision nowadays has hidden motives behind it, which are different from its ancient motives, since these motives are hidden behind heavy curtains of mythical, religious and mundane ritualistic justifications. Over time, old justifications give way to new ones based on new biases. That is why it is difficult to find a precise explanation of the origin of circumcision. Montagu concludes that no matter what the cultural origin of FGM and MGM, humans inflicted it on children as a tradition with the same motive: the predominance of males and their superior social status over females and children. Therefore, genital mutilations set the rule that states that it is naturally the powerful who has the upper hand, and makes it an established part of social reality (Montagu 1990).

By defeating the various justifications of FGM and MGM, we will be confronted with the patriarchal social bias that result into age and gender discriminations. Various declarations of human rights (including women and children rights) are antithetical to both age and gender discrimination. Consequently, corporal mutilation of the individual to satisfy group biases is a clear violation of human rights. Moreover, FGM and FGM are both traumatic experiences that violate the human right to freedom of torture. Trauma, according to the definition of the American Psychological Association, is described as "an event that goes beyond every day life experience of human beings, for example, physical violation, or torture, or anything that threatens the individual's safety." Physical violation on one hand, is any abuse to the body, whereas, torture, on the other hand, is an infliction of pain or extreme stress. Both cases are traumatic, even if the attack or injury are not done with the intention of violation or torture. The above definitions are descriptions of the act itself and the human reaction to it irrespective of the intentions of the violator. The younger the infant is, the more he is harmed by trauma (Goldman 1997).

According to Foucault's analysis, exposure of social traditions with relation to sexuality to discussion enhances social change for the benefit of the weak (Foucault 1984: 6-8).

The above mentioned studies of the structure and function of the male and female prepuce ring a bell for the human rights activists to revise their attitudes and act consistently, because denial of the rights of genital integrity for males will result in undermining the same right for females.

Socio-Cultural Background of Genital Mutilation:

Circumcision originally came from different areas of the world among various tribes and nations, although, it served the same social roles Bettelheim (1954). Some researchers have noticed similarities between MGM and FGM (Kennedy, 1970; Lightfoot Klein, 1997, Abd el Salam 1999). The following comparative table3 lists the most important similarities:

	FGM	MGM
Cutting?	YES	YES
Of the genitals?	YES	YES
Of babies?	NO	YES
Of children?	YES	YES
Without consent?	YES	YES
At parents' behest?	YES	YES
Removing erogenous tissue?	YES	YES
Supposedly beneficial?	YES	YES
Justified by aesthetics?	YES	YES
Justified by supposed health benefits?	YES	YES
Justified by religion?	YES	YES
Justified by sexual effects?	YES	YES
Justified by custom?	YES	YES
Justified by conformity?	YES	YES
Effects minimized by its supporters?	YES	YES
Performed by its adult victims?	YES	YES
Extremely painful?	YES	YES
Can cause harm?	YES	YES
Very severe damage?	USUALLY	SOMETIMES
Can cause death?	YES	YES
Legal in Western countries?	NO	YES

Male and female circumcision could have various cultural significances. Among Australian aborigines, male circumcision is a symbolic identification of the male to the female because it causes a flow of blood from the male genital organ. In African tribes, circumcision of both sexes could be explained by its being a symbol of sexual duality of creation. According to this belief, a human individual is born with both feminine and masculine attributes since the femininity is inherent in the male prepuce whereas masculinity exists in the clitoris (Montagu 1990). This argument is specifically valid to Egypt. MGM predated MGM in Egypt, and both of them predated the three monotheistic religions. MGM was a procedure carried out in Ancient Egypt in the 23rd century B.C. It was not carried out on all Egyptians but only on the higher priests in imitation to the supreme God Ra (Hastings 1980). Like smoking that was practiced by priests, then by the elite and finally by the common people, circumcision turned from a specific religious ritual for elite clergy to a general mundane tradition for the common public (Voskuil 1994). No trace of FGM in Ancient Egypt was detected before the Ptolemic period. I hypothesize that FGM was introduced to Egypt in the 25th dynasty, when people from around the origins of the Nile river in Africa invaded and ruled Egypt. Both MGM and FGM are Nilotic practices (contemporary Egyptians still through the severed parts in the Nile). The Nile was worshiped in Ancient Egypt as God Hapi, who used to be represented as a male figure with female breasts.

In cultures that perform FGM and MGM, the existence of a thing or a structure out of its traditionally accepted location is believed to be a sort of pollution4 (Douglas 1966). This may explain why FGM and MGM persist up till now, given that the Egyptian colloquial word for circumcision of both sexes is "tahara", i.e. purification. The concepts of pollution and purification differ from the concepts of dirt and cleanliness in that they involve a moral as well as a material aspect. Thus, oral pollution means inappropriate sexual conduct. Hence, FGM is thought to preserve the girl's virginity before marriage and ensure her marital fidelity as a wife; and MGM is thought to prevent masturbation, hence ensures more male virility and fertility.

Douglas suggested that the more deep rooted the beliefs about the pollutedness of something are, the more difficult it is to change. Thus, over time, people develop a stronger bias against what they consider polluted. When new ideas threaten to bring about a change in such bias, they tend to ignore or object to it so that these new concepts do not disturb their universe.

Also, change might upset the distribution of power roles and endanger the established familiar system. In less sophisticated societies, positions of power and danger are defined by the interaction of order and chaos. Not to mention that the concept of pollution as a danger to the social system would be impossible except in a society with clearly defined borders. Thus, an individual who transgresses his/her predefined borders is considered polluted. Beliefs concerning pollution reinforce the well established social moral system, because transgression of the pollution taboo is severely punished. These beliefs define the rules of what is considered socially as the correct individuals' behavior. If an individual is polluted and yet harmless to others, he/she still is not socially accepted and is punished. Such rituals as bathing, incense and removal of the polluting agent purify the individual from pollution. FGM and MGM involve of these rituals.

Accordingly, a non-circumcised person is considered lacking in her/his femininity/masculinity, hence they are considered socially inept, sexually immature, ritually polluted, potentially infertile and not fit as a full fledged adult member of the social group. Thus, by circumcision, a male or female lose their childhood impure individuality and become social beings. When the symbolic masculine part of the female body and the symbolic feminine part of the male body are cut off; males and females searches for a reunion that can only take place through marriage. Therefore, FGM and MGM are traditional pre-requisites of marriage (Montagu 1990).

Genital Mutilations as a Means of Social Control of Sexuality:

In the procedure of circumcision in both sexes, a sensitive healthy part of the body is amputated of a child who does not have a chance to say no, defend itself nor express consent. In both cases, it is the society that is imposing its control over the children's sexual drives. Several studies have dealt with the relation between the traditional practices that are performed over the human body and politics of social control. The human body is a good medium for social control of the individuals by shaping their bodies to fit the socially acceptable image. Nancy Scheper-Hughes (1987) described three levels in dealing with the human body that start from the concrete to the abstract. The first and the most concrete level is the individual body. On this level, the body is treated as a human body that feels pain and pleasure. This is the level on which the individual is able to experience and respond to subjective concrete sensations. The second level is the social body, on which the body is treated as an abstract object without any individual attributes. On this level, society can inscribe its symbols on the body. The third level is the body politics, on which society interferes to define and control the limits of what an individual can do with his/her body and what is forbidden.

Although sex is associated with the body at the individual level as it is socially defined, sexuality is not an expression of physical drives only but it is a very complex construct of cultural symbols and social conceptualizations of the individuals' bodies, including the social conceptualizations of femininity and masculinity and their relation to how men and women should appear and act in the specific social and cultural context. Therefore, sexuality, as a social concept, is a mediator between the individual physical and group social aspects of the gendered body (Abd el Salam, 1998). Thus, sex is a physical function which is used by power holders in modern patriarchal society as a means of control over the weaker especially women and children. Genital mutilation is a means of this control to fulfill an accepted communal socio-cultural image of femininity and masculinity, irrespective of the individuals' will and best interests.

The Theological Debate on FGM and MGM:

Since circumcision is considered a sacred ritual by the followers of various religions, Sami Aldeeb Abu-Sahlieh's works (1994; 2000) have a special significance because he discusses it in terms of religious arguments.. In this book, the author reviewed the various opinions of theologians in the three monotheistic religions: Judaism, Christianity, and Islam starting from early days of Judaism till the present decade. The author said that the three religions always interacted and impacted each other. The discourse of circumcision progressed from one Holy Book to the other. In the Old Testament, it was obligatory; in Christianity, it was not considered a sacred procedure; and in Islam, it was not mentioned at all in Quran because Islam stressed the concept of divine perfection of creation. Abu-Sahlieh elaborately reviewed the discourse on circumcision in the three sacred books, Prophetic tradition, and the writings of men of wisdom, theologians, and men of Fiqh (Islamic theology), all of whom depended on what is stated in Ch. 17 of the Book of Genesis in which Jehovah ordered Abraham to be circumcised and to do the same procedure on his sons. Jehovah promised them the sacred land because they are God's chosen people. Moreover, they are identified by circumcision. The researcher considered this procedure as a political convention which is carried out by means of surgery, and described it as "Politicization of a Surgical Operation." Sanctification of male circumcision transfers Jehovah from a divine creator to a simple shepherd who needs a physical sign to identify his people out of all the other human beings; like a shepherd identifying his herd. Other scholars explained that the circumcision of the male child on the 8th day is to purify him from birth pollution. Contact between the child and his mother's body and after-birth are both considered polluting. In fact, there are laws in Judaism that admit the hazards of infant male circumcision. Therefore, some rabbis exempt some Jews from this procedure, on condition that the child has 2 brothers or a maternal male cousin who died during circumcision. Abu-Sahlieh explained that the Old Testament was gathered together and documented in the 9th century B.C., that is approximately after 4 centuries of Moses' death and 10 centuries of Abraham's death. Therefore, it included various other traditions from the different cultures over this period,. That is why some scholars of Judaism doubt the historical origin of the events that took place in the Old Testament. Abu-Sahlieh said that circumcision goes back further than the Old Testament because historical documents were found that proved that circumcision was a procedure carried out in Ancient Syria in the 28th century B.C. and in Ancient Egypt in the 23rd century B.C. In the latter, it was not carried out on all Egyptians but only on the priests. This is proved by the Roman Emperor Hadrian, who forbid this procedure on everyone in the 2nd century A.D, but he exempted the Egyptian priests.

The Jews used circumcision politically over the years. It was a procedure that was carried out on a relative basis and not done on everyone. Historians state that this procedure was not obligatory to Jews except after their return from exile in the 6th century B.C. A group of Jews made an agreement with surrounding nations in the 2nd century B.C. They stopped observing circumcision, and hid the signs of the procedure by pulling down the skin of the penis to cover its head. They could do so because in ancient times circumcision did not include a complete amputation of the prepuce, as is the case now. It was the outer layer that was cut only. The anti-circumcision trend appeared again in the 2nd century A.D. The rabbis, though, created a new way of circumcision by amputating the two layers of the prepuce as a counter reaction to the mentioned trend. Moreover, in 1842, a group of German Jews questioned the obligatory imposition of circumcision; but they retreated under pressure of conservative Jewish clergy. In 1869, Jews who had emigrated to the United States started to discuss the exemption from circumcision of men who converted to Judaism as adults. The exemption was authorized in 1892 because it was said that in the Old Testament, when Abraham was ordered to undergo this procedure, it was not an obligation to all Jews throughout history, and also because of the fact that Jews are identified by their maternal ancestors, regardless of whether they are circumcised or not. Thus, a circumcised Jew cannot be considered a Jew if his mother is from another religion. These modernists also viewed that circumcision did not comply with other Old Testament instructions that forbid harming the body. Modern Jewish feminists noticed the patriarchal political nature of male circumcision. Abu-Sahlieh quotes some of them. One of them is Miriam Pollack, who refutes that circumcision has a religious significance. She says that it has a political background in general and is specially significant to gender.

Circumcision is based on men's domination of women. By this procedure, the child is separated from his mother who does not have any authority on him any longer. This harms the child, for at this stage he needs his mother most and she cannot defend him, in spite of the fact that they are attached to one another at this early age. The knife that is pointed to the child is in fact pointed to the heart and soul of the mother. Circumcision is actually an injury to the mother; it is humiliating to her since it implies that 'Your authority over males is limited; moreover, this child belongs to the male community.' In this manner, the relationship between man and woman is disturbed and similarly the relationship between mother and child. The child's separation from the mother is a preparation for his separation from her when he is recruited by the army. (Aldeeb Abu-Sahlieh, 2000)

In spite of these political arguments, the rabbis stress the importance of circumcision considering the non-circumcised a polluted person who should live in isolation. Moreover, he is forbidden the entrance to Eden. Some Jews believe that God will forgive many of their sins because they have been circumcised. Some Jews also admit that the procedure is a means of a cruel way of controlling the child's sexual drives. The Jewish doctor Moses Maimonides, who lived in the 13th century, was one of them. He said that circumcision diminishes male sexuality but does not affect reproduction. He also said that a female desires to have continuous sexual intercourse with non-circumcised male, and he considers this immoral. He finds it wiser and better to circumcise a male child when he is 8 days old and is helpless. Moreover, his parents are not yet too emotionally attached to him to refrain from circumcising him. I agree with Aldeeb Abu-Sahlieh that people of the West do not object to MGM as much as FGM because of the fact that the Jews have power over the mass media and financial resources that are considered the main tools of social action. Thus, people in the West avoid the accusation of being anti-Semitic that may create problems for them.

Aldeeb Abu-Sahlieh discussed circumcision in Christianity. Christians who observe circumcision as a tradition justify it by that it was practiced on Christ himself. This anecdote did not appear except in Luke's Gospel. Some interpreters said that even if Christ had been circumcised when he was a child, it was because he was born a Jew. But when he became a Prophet, he cancelled some of the pre-established rules of the Old Testament, one of these laws was an eye for an eye. He also defined pollution in different terms; a pollutant is what comes out of the mouth not what enters it. Jews who had converted to Christianity tried to impose circumcision on newly converted Christians from polytheistic religions. Paul, the apostle, argued against them by considering circumcision as not having a religious significance. Other priests interpreted circumcision symbolically. They said that circumcision in Christianity means refraining from sexual sins and that it did not imply the amputation of the prepuce. Jews who converted to Christianity, in Aldeeb Abu-Sahlieh's opinion, failed to establish circumcision in Christian thought because they were not a power in the Roman Empire. But Jews who converted to Islam, succeeded in establishing Jewish principles "isra'iliyyat" in Islamic thought because they enjoyed cultural and economic powers in the Arab Peninsula and the surrounding countries in early Islamic period.

Aldeeb Abu-Sahlieh proceeded to review the religious controversy concerning circumcision in Islam. He began with the fact that the Qur'an does not mention anything on the subject, though, some men of Fiqh interpreted some verses with controversial connotations "Ayat Mutashabihat" that could be relevant to circumcision. These verses are the ones that order Muslims to follow Ibrahim's traditions which originated when Allah put him to the test by ordering him to follow His instructions. Certainly, Allah's imprint on the human body is the best. The author explained in detail the various points of view of men of Fiqh in their interpretation of these verses. Some said that the holy verses implied circumcision; whereas, others considered the contrary. Therefore, it is clear that there is a contradiction between their interpretation and some of the "Sunna." Some theologians said that it is mentioned in the "Sunna" that Adam was the first to have been circumcised and not Ibrahim. Others believe all Prophets were born naturally circumcised, which is another contradiction to what is implied in the verses concerning this matter. Aldeeb Abu-Sahlieh believed that Ka'ab il Ahbaar who was a Jew converted to Islam has a great deal of influence on these interpretations because many of the Islamic concepts were shaped by his Jewish thought "Isra'iliyyat." This theological conflict extends to the 19th and 20th century thinkers such as El Shawkani, Muhamed Abdu, Mahmoud Shaltut, Wahba El Zoheily and Selim El 'Awwa. Most of these thinkers did not believe in female circumcision, though they insisted on male circumcision because of its assumed hygienic benefits, although it contradicts the Qur'anic verses that mention the perfection of Allah's creation. Moreover, the Prophet forbid any modification to the human figure, even if this is made by just tattoo or piercing. For example, Abu-Saheleya quotes sheikh Shaltut's view that says:

The way I see it is that the opinion of Shari'a (Islamic law) on circumcision is not subject to a written text, but is subject to the common view that considers it wrong to inflict pain on anyone except when necessary according to their best interests, which should overweigh the inflicted pain. After reviewing all opinions on circumcision, we have reached the conclusion that it does not have any religious significance according to Sunna, let alone its existance in Fiqh. This conclusion was reached by some early theologians. One of them expressed it as follows: "There is no valid reference neither through stories nor Sunna (Prophetic tradition) - to circumcision

Aldeeb Abu-Sahlieh explained that those who believe in male circumcision base their ideas on "Sunna" which is considered the secondary source of Islamic law. However, many theologians critically revised the prophetic traditions "Ahadeeth Nabaweyya." According to Abu Haniifa, only 17 of these Prophetic traditions were accepted as authenticated. Al Imam Malik could not approve more than 300 of these Prophetic traditions. Moreover, stories concerning the Prophet Mohammad's -May the blessings and peace of God be upon him- circumcision were varied; some considered that he was born already circumcised. Some said that Gabril did this procedure to him, others said that it was his grandfather who circumcised him. Believers in circumcision depend on a Prophetic tradition relayed by Shi'ites that states that the Prophet -May the blessings and peace of God be upon him- circumcised his grand children, El Hassan and El Hussein, on the 7th day of their birth. Aldeeb Abu-Sahlieh said that this was neither mentioned in the six books of Sunna nor in Ibn Hanbal's religious reference. One of the most recent controversies between men of Fiqh appeared when El Sheikh Gad il Haq Ali Gad il Haq said that this story is not an authenticated Prophetic tradition, whereas, El Sheikh Tantawi used it as a reference to stress the importance of male circumcision in contrast to female circumcision, which he did not believe was an Islamic requirement.

Aldeeb Abu-Sahlieh went further to review the biographies of the Companions of the Prophet Mohammed and stories about them, some of which suggested that circumcision was a pre-Islamic Arab custom. Other stories suggested that the Arabs were not keen on it nor was the Prophet -May the blessings and peace of God be upon him- For example, Osman Ibn Abi il 'Aas refused to attend a celebration for circumcision because of the fact that neither the Prophet -May the blessings and peace of God be upon him- nor his companions did attend or hold such celebrations. Abu El Hassan il Basary said that the Prophet -May the blessings and peace of God be upon him- did not care to check whether newly converted Muslim males were circumcised or not, no matter what their color or ethnicity was. The matter was of no importance to him. Whereas, Ibn il Munzir said: "There is no valid reference -neither through stories nor Sunna (Prophetic tradition)- to circumcision" "La yougad fil khitan Khabaron Yourga' Ilaeh wala Sunna Tuttaba.'" However, in the early Islamic period, the policy was that non-Muslim citizens were obliged to pay a certain sum of money as a tax (gizya) to the Muslim government (beit il maal). There is a story referring to Omar Ibn Abd Il Aziz's disagreement with the ruler of Kharasan, who suggested that those who wished to be converted to Islam should be circumcised, so that their conversion is made more arduous in order to retain the taxing system (gizya) of Islam. Justifying his principle, Omar Ibn Abd Il Aziz said that Allah sent the Prophet Mohamed -May the blessings and peace of God be upon him- to guide people on the right path but not to circumcise them.

Gamal el Banna is another intellectual who wrote his opinion on this subject in an article entitled A Point of View About Male and Female Circumcision (1999). He denied that circumcision is a mandatory Sunna. According to him, mandatory Sunna is what the Prophet was told to do by Allah, or what he said as an explanation to what has been stated in the Qur'an. Neither case applies to circumcision. Moreover, El Banna considered circumcision a contradiction to the concept of the perfection of creation that was stated in the Qur'an. Circumcision does not add anything to the human body but on the contrary it is a sort of amputation. Therefore, we should not impose it on children, and deprive them of what Allah gave them, for it is the child's right to keep his whole body intact.

Dr. Nawal El Sa'adawi said that El Raazi, who was a Muslim Arab doctor who lived in the 10th century A.D., objected to any interference with the healthy human body, including circumcision. She mentioned that El Raazi's books were forbidden from circulation in Egypt. If these books were available, people would have known that the call against circumcision was not from a Western origin, but it was an old indigenous call that dates back to the earliest debate between rationality and irrationality. Rosal Youssef magazine in 1998

Medicalization of Genital Mutilations: Historical Overview

Medicalization of FGM and MGM goes hand in hand. Traditional tribal leaders, priests and magicians used to carry out the ritual of circumcision in old cultures, whereas the medical professionals took it up in the modern era. This is not strange, because with the historical development of the medical institution, and with the shift of the epistemological paradigm from religion to science, physicians and surgeons took over the power of controlling the human body. This explains why efforts short of acknowledging FGM and MGM as one integral issue of gender power politics leads to medicalization of genital mutilations. Wallerstein (1980) how MGM and FGM were introduced into modern medical sciences in England in the second half of the 19th century, in the reign of Queen Victoria, then, it spread to other medical institutions in the colonies and other English-speaking countries. Gollaher (1994) explained that in the Victorian era the modern theories of various diseases had not yet been developed as they are today. Germs as a cause of disease and antibiotics as a cure were not discovered yet. Victorian physicians suggested that a disease results from nervous reflexes. This theory explained that the stimulation of the sexual organs is reflected on higher levels of the nervous system and that was a cause of various diseases, such as paralysis, epilepsy, and insanity. Based on this theory, amputation of various parts of the body became common to cure mental disorders, examples of such surgical procedures was the removal of the ovaries, clitoris and prepuce in both sexes. Thus, FGM had been promoted by modern western doctors till about the 1950s5.

Practical experience though proved that such procedures did not cure diseases nor did it prevent masturbation in children that used to be considered one of the causes of harmful nervous reflexes that may destroy brain centers. Therefore, the value of circumcision changed from a cure to a prevention, and remained to be considered as a beneficial "preventive" surgery. As pathological theories changed from the previous theory that stressed the importance of the nervous reflexes to the significance of bacteriology, the amputation of female genitals ceased but MGM remained to be common. It was only medical doctors who could fight diseases both surgically and medically, that is why "preventive" surgeries spread to include circumcision because they could rid the body of any potential septic focus; such as the adenoid, tonsils, gall bladder of typhoid carriers, and the prepuce that was considered a place for accumulation of dirt. However, the prepuce secretes a material which is called in Latin "smegma," which means "detergent." Gollaher said that most of the opinions on the subject of circumcision were mentioned in a book by Remondino in 1881 on the history of circumcision, in which he mixed folklore, his subjective views and incorrect information. For example, Remondino said that the prepuce is nothing more than a developmental rudiment. It has no function in modern men's bodies. Moreover, he described the prepuce as an extra structure with extremely malignant effects. According to him, such malignant effects are invisibly done, like the acts of evil spirits and djin of Arabian tales, who can remotely harm their prey. Similarly, the prepuce makes a male prey to diseases and other problems all his life long. It makes him good for nothing; neither for work nor marriage. It turns him into a miserable person by making him vulnerable to continuous scolding and punishment. As a child, it causes him to have nocturnal enuresis and indulge in masturbation that weakens his body, mind and moralities. He may even end up in jail or a lunatic asylum. Thus, a male has to get rid of this evil body part to ensure leading a good life. With the end of the 19th century, circumcision in the United States ceased to be a ritual and became considered a medical procedure. Some of the factors that lead to the spread of circumcision was the fact that anesthesia, disinfectants and medical care in hospitals were becoming more common in the United States. Childbirth was no longer a family event that took place at home. Obstetricians were technical practitioners rather than scholars. They learned the techniques through observation of their seniors and repeated them without critical thinking. Thus, they believed in routine surgical procedures. Doctors who were convinced about circumcision increased, which is why the procedure became more widely spread and accepted by people. It was found that the most important factor that increases the prevalence of any surgery anywhere was the increase in the number of the medical professionals in the area who were ready to do it. This can be applied to procedures such as Cesarean section and circumcision. But Gollaher believed that mere technology without scientific basis could be more harmful than beneficial. As a principle, science serves knowledge, whereas mere technology without solid scientific basis serves control over the human body.

This adds to my conviction that all forms of FGM will not stop except when we take the issue of genital mutilations in its integrity, because medical doctors extend all of the historical medical fallacies on MGM to FGM, hence, FGM is increasingly done by medical personnel in an earlier age. For example, the Egyptian DHS 2000 shows that median age of circumcision of daughters of respondents who are 45-49 years old was 10.1 yesrs, and that 59.5% of these daughters were circumcised by a medical personnel; in contrast to a mdian age at circumcision of 7.9 years for daughters of women who are 25-29 years old, and that 68% of these daughters were circumcised by a medical personnel. IT was found also that FGM performed by medical personnel was 49% in rural areas and 76% in urban areas.

Literature on medicalization of MGM may help us to infer the impact of medicalization of FGM. Literature suggests that increased medicalization of the MGM resulted in its widespread in USA. Paige (1978) reviewed the development of rationales that are used by the modern American medical institution to justify MGM. These justifications emerged only after the widespread use of medicalized male circumcision in the USA. MGM started in the West with the masturbation mania that prevailed in the West in the period of transformation from agricultural to industrial economy between 1700-1914. Masturbation used to be considered a sin since as early as the Biblical era. However, it did not start to be considered as a medical problem before the time of modern industrial transformation. This medical theorization appealed to middle class parents because it provided them with an explanation of what they considered bad children's behaviors, such as rudeness, rebellion, nervousness and interest in the opposite sex. Thus, establishing masturbation as a danger to be feared and controlled by various means served work, family, and parental institutions. British and American doctors suggested various treatments for this "problem," which included types of food and drinks to suppress sexual drives, different forms of chastity belts to prevent children from touching their genitalia, recommendation of intimidation and punishment of accused children, plaster splints or leather and rubber sheaths to entrap the penis, cauterization of genitalia, and in extreme cases doctors castrated the "sick" masturbators. In terms of these circumstances, circumcision was considered a more merciful alternative to some of these types of "treatment." Doctors promoted that circumcision ensures better health for the boy, improves his work capabilities, ensures more longevity, protects the boy from tantrums and diseases, and consequently saves money and time that would have been spent on medical consultation and therapy. In 1890 some American surgeons established the Orificial Surgery Society. Its main task was promotion of genital surgeries for males and females. Such surgeries gave parents a tool to control their children's sexuality, and gave doctors a chance to emphasize their authority over children and women's bodies. After masturbation mania in the West had faded, by 1925 writings that recommended horrible means to prevent masturbation decreased. However, male circumcision persisted with the emergence of a theory in 1932 about its preventive significance against cancer. This theory depended on research that was carried out by a medical doctor who concluded that cancer of genitalia is less prevalent among Jews and Muslims because they perform male circumcision. This theory helped to spread infant male circumcision in order to protect adult men from cancer, i.e. the strong controls the body of the weak whom he believes to be polluted. It was proved that this research had flawed methodology, and hence, its results were invalid. In this research, religion was the only variable that was taken into consideration. Other variables such as socio-economic standards and health habits of the sample's population were neglected. Even the relative representation of Jews in the community, i.e. their percentage, was not taken into account. Another justification for circumcision was beautification. Paige quoted a doctor who said, "the circumcised penis appears as if it were erected even if it is not so. Thus it is a proof of manhood." However, social biases changed, as did the justifications for circumcision throughout the decades. For example, in the last decades of the 19th century and the first decades of the 20th, masturbation and sex in general were not encouraged; and doctors at that time considered circumcision as a tool to control sexual drives. Yet, on the contrary, in the late 20th century, when sex and masturbation were considered good and normal, doctors said that circumcision was done to increase the sexual sensitivity of both males and females. When a procedure is justified by contradictory reasons, that means that it represents mythic ritualistic thought, which is irrational and non-scientific.

Egyptian Efforts Against Genital Mutilations:

Earlier Efforts (before the 1950s):

The vast majority of efforts against genital mutilations in Egypt focused on FGM. The earliest voices against FGM up to my knowledge- started in the 1920s. In 1928, the great Egyptian surgeon, Ali Pasha Ibrahim, stated in a medical conference in Cairo that female circumcision is not recommended, that he never performed it, nor lectured his students about it. He added that he knew about it from the people who seek his help to save their daughters who bleed or get shock after circumcision. In the 1930s and 1940s, some intellectual periodicals published articles on female circumcision as a social problem.

In the 1950s:

In May 1951, a popular health periodical "Al Doktoor" distributed a booklet on the health hazards of female circumcision. Two women's periodicals; "Bent El Nile" and "Hawaa" published some articles against female circumcision in sporadic issues from 1956-1958.

The 1950s efforts culminated into the ministerial decree # 74 in 1959, where the minister of health prohibited the performance of female circumcision in the governmental health facilities. However, it allowed doctors to perform "a partial type of female circumcision" in their private clinics.

In the 1980s-1994:

In 1979, the world celebrated the International Children Year. In this occasion, WHO held a conference in Khartoum, Sudan in February 1979 on traditional practices harmful the health of women and children. Ms Marie Assaad participated by a research on female circumcision in Egypt (Assaad 1980). This study was the basis of a seminar conducted by the Society of Family Planning in Cairo in October 1979. Many other scholars and activists from different disciplines (medicine, social, social sciences, legal sciences and theological studies wrote and spoke about the hazards and necessity of FGM. This seminar resulted into a wide media and field educational campaign conducted by the Society of Family Planning in Cairo in 1981. In 1985, the Society of Family Planning became a member of the Inter-African Committee that worked for eradication of all traditional harmful practices to women and children. A subcommittee was formed under the auspices of the Society of Family Planning to act specifically on traditional harmful practices to women and children. This subcommittee turned to be an independent NGO (The Society Against Harmful Traditional Practices to Women.

From 1994-1999:

In 1994, the International Conference on Population and Development was held in Cairo. FGM was one of the issues to be discussed in this conference. The task force against FGM was formed by some NGOs, independent thinkers and activists, and some interested governmental bodies, e.g., the ministries of health and social affairs. Ms Marie Assaad was chosen as a coordinator of the FGM Task Force. The task force worked under the auspices of the National Committee for Population and Dvelopment (NCPD), a semi governmental body that was formed by an initiative from the minister of population to help NGOs to implement ICPd's and Bijjing's recommendations to empower women and improve their social conditions. The founding members of the FGM task force worked through 3 subcommittees: The committee of research and studies, the committee of work with the decision makers, and the committee of work with NGOs. The members of the research group conducted some researches, and established an information resource center on FGM and violence against women. The group of work with policy makers held a conference to introduce the issue to politicians, medical doctors, media persons, educators, art makers, and writers. The group of work with NGOs addressed the NGOs that participated in the ICPD, held 3 workshops to introduce the issue to them, identify their needs, and coordinate their work. Its members helped in providing NGOs with relevant material and discussion sessions. By 1995, the task force was membered by 60 NGOs, as well as some governmental representatives and independent individuals. TF used to meet monthly to exchange experience, seek consultancy, plan future activities, and coordinate work. The information resource center was established because the NGOs reported their need to it. Some member NGOs collaborated to file a suitcase against the ex-ex minister of health, Dr. Ali Abd el Fattah, who allowed FGM to be performed in the governmental facilities. When the minister changed, the new minister Dr. Ismael Sallam canceled the previous ministerial decree. Some conservative Islamist activists filed a suitcase against Dr. Sallam, and won in the first tribunal round. Dr. Sallam appealed, and won the appeal. Te FGM Task Force supported Dr. Sallam, though its members kept criticizing the compromising nature of his decree that states that FGM is forbidden "except for cases who need it, as decided by the head of the gynecological department of a hospital".

The task force developed the comprehensive social approach to address grassroots about FGM. This approach ,unlike the pure medical approach, address the cultural biases of the people and gives them different interpretation of their traditional beliefs. Some Task force members created the "open your heart sessions". Such a session is conducted as part of the activities of the TF educational workshops each session is attended by a small group (4-5 persons) of the same sex and different resedintial areas (to avoid embarrassment and ensure confidentiality). A session conductor (usually one of the TF founders) leads the group and participates with them to exchange experience and feelings on FGM. After the small group sessions, a large plenary session is held to state the results of the group discussions (without mentioning names or attributing a statement to the person who said it). The resource center helped many researchers and activists from Egypt and other countries by availing relevant resources to them. The TF prepared a training manual on reproductive health with focus on FGM and the ministry of health adopted this manual to train its personnel.

After 1999:

After 1999, the monthly TF meetings became quarterly, then irregular, because of lack of facilities. However, some of its NGOs members and individuals remained active.

In 1999-2000 Some members of TF cooperated with the ministry of health to produce a group of booklets based on the comprehensive social approach to be used by the ministry of health.

Some members of TF cooperated with ministry of health and population to establish and implement a curriculum to educate sheikhs and priests about reproductive health and women's rights. More than 600 men of Islamic and Christian religions from all areas of Egypt were trained.

It is worth mentioning that the Coptic Society for Social Services and Training in Beni Suef; and the Center of Women Education on Legal Affairs in Cairo are adopting the "positive deviance approach", i.e., they identify the intact girls in their local vicinity, study why they remained intact, and recruit them and their families to work against FGM in their area.

Other NGO members as CARITAS, CEOSS are also continuing their efforts

Work of the national Council of Childhood and Motherhood:

Some TF members participated with the National Council of Childhood and Motherhood; and the UNDPA to establish "the National Project to Eradicate FGM". This project is known as " FGM free village model", and is carried out in 60 villages from 6 governorates Upper Egypt. 12 NGOs (most of them are TF members) work to implelement this project in the 6 governorates . They are: the Coptic Evangelical Organization for Social Services in Menya; the Coptic Society for Social Services and Training in Beni Suef; The Young Muslim Women Society in Beni Suef; CARITAS Egypt, Quena branch; Upper Egypt Society for Development and Education in Souhag.

Activists for Genital Integrity for all

In 1998 I participated, as a TF member, in the 5th International Symposium for Genital Integrity in Oxford, UK. I was always skeptical about MGM as well as FGM MGM. Through my work on establishing the resource center I had the chance to be exposed to different resources on MGM and FGM. When I returned from the conference, I started to disseminate the information that I got. Some men and women (some of whom are members of TF) got interested in genital integrity for all, and expressed enthusiasm to work from this perspective. This group is still unorganized and less vocal than the original FGM TF, because of the reluctance of most intellectuals who work against FGM to speak against MGM, on the assumption that it is not feasible to adopt two causes at a time. I and the other Genital integrity for all members disagree to this attitude.

MGM is more common than FGM, whether in Egypt or on the international level. It is worth of mentioning how I started to be aware of this issue. I was a newly graduated medical doctor in 1972, and was appointed as a surgery trainee house officer, when I saw for the first time in my life a circumcision being done. The victim was a healthy baby boy of about one month old. While a senior resident demonstrated circumcision to the trainees, that child screamed loudly. I could see signs of shock on him; like pale face and profound sweat. The signs of shock that I saw on the child's face convinced me deeply that male circumcision is similar to female circumcision, both are savage butchery. There is no reason to perform an operation on a healthy child, especially that it involves a shock experience.

In my experience, as a junior doctor in the emergency unit, I admitted many male and female children with symptoms like severe bleeding and surgical shock after having been circumcised, and that added to my convictions.

After the silence that had been broken on the subject of FGM in 1994, the press issued articles on victims who had experienced complications made by circumcision in both sexes. This supported my convictions. Moreover, wherever I went to discuss FGM, I was asked many questions on male circumcision. Even, several young men of my acquaintances told me confidentially that they suffered hazards after their circumcision which are similar to FGM hazards. They never dared to express this suffering except when I encouraged them and listened carefully and respectfully to their experience.

I argue that men and women intellectuals who lead advocacy against FGM on the basis of reason and the human right of bodily integrity, but justify MGM using the same irrational justifications that were being used to justify FGM are less likely to convince people to stop FGM. We should be consistent, and start by negotiating our own socio-cultural biases before we ask people to change their traditional convictions and behaviors. The group of Genital Integrity for All believe that consistency in defending the rights of children of both sexes is more likely to convince people that FGM is neither safe nor necessary. This is because some medical doctors spread rumors saying that female circumcision by removing the hood of the clitoris partially or totally is similar to male circumcision. They claim that MGM is a useful procedure and not harmful to the male. Accordingly, they claim that the suggested procedure is not harmful to the female.

Notes

The figures are from Cold & McGrath 1999
Such as Meissner's corpuscles, Pacinian corpuscles, genital corpuscles, Krause end bulbs, Ruffini corpuscles, and mucocutaneous corpuscles.
From www.circumstitions.com
We still define dirt and cleanliness in the same old way. Dirt means to us the presence of a thing or the performance of a behavior out of their appropriate location or context. The things or behaviors might not necessarily be considered filthy in themselves. For example, a drink is considered dirt when it drops on a dress, and people feel disgusted from a person who laughs in a funeral, even though drinks and laughter are not dirty in principle.
For example, an article entitled "Circumcision in the Female: Its Necessity and How to Perform It", by Benjamin E. Dawson, MD, Kansas City, MO. American Journal of Clinical Medicine vol. 22, no. 6, June 1915, pp.520-523 states: "The same category of diseases having their origin in nerve-waste, caused by a pathological foreskin in the male, may be duplicated in the female, from practically the same cause, and in addition, other diseases peculiar to females." In another article entitled Circumcision of the Female, by C.F. McDonald, MD, Milwaukee, WI GP, vol.XVIII, no. 3, September 1958 pp. 98-99 we read: "If the male needs circumcision for cleanliness and hygiene, why not the female? The procedure is easy. The same reasons that apply for the circumcision of males are generally valid when considered for the female.". A third example is an article entitled: Female Circumcisions, Indications and a New Technique, by W.G. Rathmann, MD, Los Angeles, CA. GP, vol.XX, no.3, September 1959, pp.115-120: "Redundance or phimosis of the female prepuce can prevent proper enjoyment of sexual relations; yet some modern physicians overlook indications for circumcision. Properly carried out, circumcision should bring improvement to 85-90% of cases - with resulting cure of psychosomatic illness and prevention of divorces." From www.circumstitions.com

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