Right of Reply: female genital mutilation

28 September 2018 03:05 am - 0     - {{hitsCtrl.values.hits}}

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“Female Circumcision: An Islamic practice brings untold benefits to women” Article in Daily mirror of Tuesday September 18th 2018 by Asiff Hussein.  


This is in response to the above article in which the writer argues in favour of the controversial topic of female circumcision advocating “hoodectomy” (excision of prepuce) as opposed to “Female Genital Mutilation” such as “clitoridectomy”( excising the clitoris with the “hood”), and “infibulation”(excising clitoris and upper half of labia minora).   
We have identified three parts in this article:   
The first covers the Islamic basis and hence justification as proposed by the author for this procedure, the second covers the health benefits to the female and male partner as a result of this procedure. The third is a problem of semantics/nomenclature/ definition of the procedure as understood by the author.   


As to the first, we admit straightaway that we are not qualified at all to contest the learned author’s knowledge of the religion of Islam. What is indisputable is that religious scholars over the millennia have agreed that the “hadiths” which deal with female circumcision are at the very best ‘weak’. This means that they cannot be used to create an Islamic ruling since it is not certain whether they came from the Prophet or not. The Quran does not mention female circumcision, even though a whole sura (chapter) is devoted to the Islamic life of the female and protection of the health of the female. Moreover, a feature of concern is that there is evidence that the Holy Prophet Muhammad (Peace be upon him) did not subject his daughters to any of the procedures of circumcision as defined by Mr. Hussain. There is also an oft repeated narration that the Holy prophet once looked at his eldest daughter Fathima and tears poured from his eyes and that moment later he had looked at her again and smiled. When questioned as to why he wept and smiled soon after, he had said that a vision had appeared to him of her funeral and that tears had come to his eyes and that soon after a vision had come showing him meeting up with her in paradise, which had brought the smile to his face. We leave our readers to infer and to come to their own conclusions relevant to this discussion.   


Unfortunately the second part on “Medical Benefits” carries myths and errors which we find unacceptable. According to the World Health Organization (WHO), any type of female circumcision has no known health benefit. One needs to understand that the male and female genital anatomy are totally different in terms of structure, function and susceptibility to diseases and infections and what applies to one need not necessarily apply to the other.   
In the female, the clitoris is the uppermost organ in the perineum, a vestigial structure with no useful physiological function. It has a prepuce or “hood”. A little distance below it is the urethral orifice which transmits urine and does not get involved in sexual activity. Further below this is the vaginal orifice and passage which is a canal for sexual activity and the passage for childbirth. Sexually transmitted infections 
infect the vagina.   

 

"Unfortunately the second part on “Medical Benefits” carries myths and  errors which we find unacceptable. According to the World Health  Organization (WHO), any type of female circumcision has no known health  benefit."


The male organ, the penis on the other hand serves as a passage for urine, sperms and comes into direct mucosal contact with the vagina during intercourse. Mucosal to mucosal contact facilitates transmission of sexually transmittable diseases from female to male and vice versa. The male urethra (urinary passage) is thus vulnerable to sexually transmitted diseases, especially gonorrhea. Circumcision in the male exposes the distal end of the penis, the glans penis to outside air resulting in change of its outer covering from mucosa to stratified squamous epithelium. There is Level 3 (weak) evidence to show that such circumcision protects some males from HIV infections. The clitoris on the other hand, being some distance from the site of sexual activity, has no role to play in transmitting or receiving sexually transmitted diseases, or giving protection from urinary tract infections. Female circumcision therefore plays no part in protecting a female from these diseases including infection from the Human Papilloma virus (HPV). The example of Hollywood actor Michael Douglas “giving oral sex to women” and contracting the Human Papilloma (HPV) virus is totally irrelevant. HPV is commonly found in females who have unprotected sex with multiple partners, whether the female is circumcised or not. In any case there is a less painful and more reliable preventive strategy, a vaccine to prevent HPV infections in girls.   


Mr. Hussain also writes about smegma, unpleasant smells etc during oral sex due to smegma originating from the uncircumcised clitoris. He is probably unaware that there is more smegma produced under the labia and no amount of hoodectomy or washing only the clitoris is going to reduce this.   
The third point he makes is about semantics. The words “Hoodectomy”, “Clitoridectomy” and “Infibulation” are certainly meaningful to the informed. The complete typology and subdivisions of Female Genital Mutilation can be obtained From: http:/www.who.it/reproductivehealth/topics/fgm/overview/en/
The vital question is “Who is going to perform this operation? Would that person be aware of these different types and been trained with the knowledge and management of complications of scarring. Who maintains standards/ quality control? There is evidence that such scarring causes stricture or severe narrowing of vaginal passage giving rise to complications such as obstructed labour, foetal and even maternal death in the mutilated child later on in life. (http:/data.unicef.org)   


For males, there is the traditional village “Ostad” who has acquired expertise passing it from father to son or an acolyte through apprenticeship. Then there are MBBS doctors trained to carry this out usually under local anasthesia in an operation theatre environment. Thirdly there are even Consultant surgeons who carry them out. Circumcision is a therapeutic operation for a condition called “Phimosis” where the foreskin or prepuce cannot be retracted. One of us has over 50 years of experience in surgical practice. He has seen a fair number of young boys, even infants with horrendous injuries to the penis as a result of errors/ misadventures during the act of circumcision. These have occurred in spite of the male penis being very much larger and easily accessible when compared to the clitoris and its hood which is hidden in the labial folds, especially in children. Such injuries usually go undisclosed and the incidents are closely guarded as parents do not want negative publicity for and stigmatization of the unfortunate victim.   
During the times of “ignorance” before the birth of Islam, as propagated by Prophet Muhammad (Peace be upon him), female children were often killed soon after birth or even buried alive. Female circumcision too was a cultural practice prevalent in pre Islamic Arabia. One of the proud achievements of Islam is the banning and stopping of these barbaric practices, together with emancipation of the innocent little girl child and protection of women. We need 
not go back.   


Professor A.H. Sheriffdeen FRCS, Emeritus Professor of Surgery, Faculty of Medicine, Colombo and Dr. Ruvaiz Haniffa MD, Head, Family Medicine Unit, Faculty of Medicine, University of Colombo. 

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