Female circumcision

1. Female Circumcision (FC) and
Female Genital Mutilation
(FGM) in EGYPT
• Dr Muhammad El Hennawy
• Ob/gyn specialist
• Rass el barr central hospital and
dumyat specialised hospital
• Dumyatt – EGYPT
• www.geocities.com/mmhennawy

2. Names
• Female Genital Mutilation (FGM)
• female sexual castration (FSC)
• female genital cutting (FGC)
• Female circumcision (FC)

3. female genital cutting
)FC(
Female circumcision
)sunnah(
)FGM(
Female Genital Mutilation
For medical
reasons
Female Genital
Cosmetic Surgery
Transsexual Surgery
Type 1
Type 2
Type3

4. Incidence in Egypt
• an estimated 97 percent of Egyptian women
have undergone the harmful practice of female
genital mutilation ("circumcision"), which was
banned by the Minister of Health in 1996.
• A 1997 survey of Egyptian adolescents found
that 86 percent of girls between the ages of 13
and 19 had undergone FGM, indicating that
stopping it is a time-consuming effort.

5. Female Circumcision
(khafd or khitan)
(sunnah type(
• It is removing only the prepuce of the
clitoris. This is the only form that can
accurately termed circumcision. This is also
sometimes referred to as the ‘Sunnah’

6. Is a female circumcision safe?
FC (sunnah type(
• Circumcision is generally a safe surgical procedure if the
following conditions are met:
• The circumcision is done with care;
• The circumcision is performed by a trained, experienced
practitioner;
• The circumcision is done using strict aseptic (sterile)
technique;
• The circumcision is done only on a healthy, stable female
• There is no medical reason not to have circumcision
performed (Unstable or sick infant , Genital anomalies , Bleeding
problems ).
• Local analgesia should be given to reduce this pain.

7. Good or Bad?
• "Both Islam and medicine agree on its benefits. Uncircumcised
girls…are more liable to infections and cancers."
[Dr. Saed Thabet, professor gynecology at Cairo’s Kasr El Aini
Teaching Hospital, quoted in "Female Circumcision is Curbed in
Egypt," British Medical Journal, August 3, 1996]
• The ruling bans circumcision unless deemed necessary for a
female's health - swelling of the labia or clitoris, for instance. "I'm
a university professor and I can decide whether a patient needs to be
reduced or not. I will do it for medical reasons," he said with a
smile.
[Dr.Munir Fawzi, gynecologist, in news report, "Egypt court bans
female mutilation," 7 February 1998, Associated Press]
• Circumcision is cleanliness if used moderately and is useful to
women as well as men."
[Mohammed Tantawi, leading Islamic religious scholar, quoted in the
Arabic newspaper Asharq Al-Aswat, reported by Miriam Sami,
Associated Press Writer in "Cleric Eases Stand on Female
Circumcision, Alarming Activists," April 9, 1996

9. • Female genital mutilation, which involves the cutting
away of part or all external genitalia
• External genitals include the clitoris, labia, mons
pubis (the fatty tissue over the pubic bone), and the
urethral and vaginal openings.

10. • The practice, which anthropologists estimate has been
practiced for more than 2,500 years, is most common in
central Africa, spanning the sub-Saharan countries from
Mauritania in the west to Somalia in the east
• The first evidence of circumcision comes from early
Egyptian wall paintings that are more than 5000 years old.

12. Age of FGM
• The procedure is carried out at a variety of ages ,
ranging from shortly after birth-- infants, children,
adolescents, single, married . time during the first
pregnancy, and post-partum women. but most
commonly occurs between the ages of 7 – 10 years

13. Alone or group
• Some girls undergo genital mutilation alone, but
mutilation is more often undergone as a group of, for
example, sisters, other close female relatives or
neighbours. Where FGM is carried out as part of an
initiation ceremony,

14. Performed with?
• Most often performed without
anesthesia;
• with razor,
• scissors,
• sharp stone,
• broken glass

15. Site
• The procedure may be carried out in
• the girl's home,
• the home of a relative or neighbour,
• in a health centre,
• at a specially designated site, such as a
particular tree or river.

16. Who Do It?
• is either carried out by
• a physician,
• a qualified midwife
• a traditional midwife or healer,
• designated woman from the community
• an older woman,
• a barber,

17. There Are Four Types of FGM
• In 1995, the World Health Organization (WHO) developed four broad categories
for FGM operations.15
• Type 1
• Excision (removal) of the clitoral hood with or without removal of part or all of the
clitoris.
• Type 2
• Removal of the clitoris together with part or all of the labia minora.
• Type 3 (infibulation)
• Removal of part or all of the external genitalia (clitoris, labia minora, and labia
majora) and stitching and/or narrowing of the vaginal opening leaving a small hole
for urine and menstrual flow.
• Type 4 (unclassified)
• All other operations on the female genitalia, including:
• Pricking, piercing, stretching, or incision of the clitoris and/or labia;
• Cauterization by burning the clitoris and surrounding tissues;
• Incisions to the vaginal wall;
• Scraping (angurya cuts) or cutting (gishiri cuts) of the vagina and surrounding
tissues; and
• Introduction of corrosive substances or herbs into the vagina.

18. Types
• There are three main types of FGM that
are practiced through the world :
• Type I FGM,
• Type II or excision,
• Type III or infibulation
• Type 4 (unclassified)

19. Type I -- FGM
• The first and mildest type of FGM is
Type I.. This involves the "removal
of the prepuce with or without the
excision of part or all of the clitoris

20. Type II - Clitoridectomy
• The second type of FGM, Type II,
involves the partial or entire removal
of the clitoris (both prepuce and
glans) , as well as the scraping off of
the labia majora and labia minora .

21. Type III - Infibulation or
Pharaonic Circumcision
• The third and most drastic type of FGM is
Type III.
• This most extreme form, consists of the
removal of the clitoris, the adjacent labia
(majora and minora), and the joining of the
scraped sides of the vulva across the vagina,
where they are secured with thorns or sewn
with catgut or thread. A small opening is kept
to allow passage of urine and menstrual
blood.
• An infibulated woman must be cut open to
allow intercourse on the wedding night and is
closed again afterwards to secure fidelity to
the husband

22. Type IV
• Type IV female genital mutilation encompasses a variety of
procedures,
• Pricking, piercing, stretching, or incision of the clitoris
and/or labia;
• Cauterization by burning the clitoris and surrounding
tissues;
• Incisions to the vaginal wall;
• Scraping (angurya cuts)
• cutting (gishiri cuts) of the vagina and surrounding tissues;
and
• Introduction of corrosive substances or herbs into the
vagina.

23. Why FGM is practised?
• Cultural identity is carried out as part of the initiation into adulthood ,it is extremely difficult, if not
impossible, for a woman to marry if she has not undergone mutilation.
• Gender identity is often necessary in order for a girl to be considered a complete woman by removal of
the clitoris and labia ' "male parts" of a woman's body ' is thought to enhance the girl's femininity
• Control of women's sexuality and reproductive functions the belief that it reduces a woman's desire
for sex, therefore reducing the chance of sex outside marriage.
• Beliefs about hygiene, aesthetics and health
Cleanliness and hygiene feature consistently as justifications for FGM. Popular terms for mutilation are
synonymous with purification (tahara in Egypt) unmutilated women are regarded as unclean and are not
allowed to handle food and water.
the milk of the mother will become poisonous if her clitoris touches the baby during childbirth
a woman's clitoris is dangerous, it is a poisonous organ and that if it touches a man's penis he will die. men
can become impotent by contacting a clitoris
Others believe that if the baby's head touches the clitoris during childbirth, the baby will die
women's unmutilated genitals are ugly and bulky
FGM prevents the face from turning yellow, prevents vaginal cancer.,
it enhances fertility, the more extreme believing that an unmutilated woman cannot conceive. In some
cultures it is believed that clitoridectomy makes childbirth safer.
• Religion
is not practised by the majority of Muslims
Christian missionaries have tried to discourage the practice, but found it to be too deep rooted.
. local custom Women are often heard saying that they are unwilling to change these customs

25. Religious beliefs
• are a strong predisposing factor for female genital
mutilations.
• A large percentage of women whose genitals are
mutilated are affiliated with the Islamic religion
• despite the fact that female genital mutliation is not
prescribed by the Islamic religion.
• Female circumcision is a pre-Islamic religious
practice with its roots in the officially banned
African faiths and practices which dominated Egypt
for thousands of years in pre-historic times

26. hadith
• Several sayings (hadith) of the Prophet Muhammad
indicate that it may have been the norm for women
to be circumcised (see al-Muwatta of Imam Malik)
but the extent of female circumcision( excision or
mutilation ) is not specified.
• In addition, the existence of female circumcision in
the community does not necessarily mean that it was
to be recommended or made obligatory.
• Indeed, it is possible to argue that any form of
female genital mutilation actually violates very
basic precepts in Islam.

27. • Um Atiyyat al-Ansariyyah said: A woman used to
perform circumcision in Medina. The Prophet
(pbuh) said to her: Do not cut too severely as that is
better for a woman and more desirable for a
husband.
• This is known to be a "weak" hadith

28. The scholars
• specified in general terms that only a small
piece of skin (hood of clitoris) the size of a
"cock's comb" (the small appendage that
sits atop the head of a rooster) was to be
removed.

29. Fatwas are published opinions by
Muslim religious scholars
• . They are non-binding in law. But Muslim believers are expected
to follow them. In Egypt, a number of Fatwas have been issued by
the influential Egyptian Fatwa Committee on FGM:
• 1949-MAY-28: They decided that it is not a sin to reject female
circumcision.
• 1951-JUN-23: They stated that female circumcision is desirable
because it curbs "nature" (i.e. sexual drive among women). It
stated that medical concerns over the practice are irrelevant.
• 1981-JAN-29: The Great Sheikh of Al-Azhar (the most famous
University of the Islamic World) stated that parents must follow
the lessons of Mohammed and not listen to medical authorities
because the latter often change their minds. Parents must do their
duty and have their daughters circumcised

30. Some of the most influential religious
leaders
• including the two highest religious
authorities, the Mufti and the Sheikh of al-
Azhar, have stressed that the Koran, Islam's
holy book, remains silent on the subject.

31. 1959
• Ministerial decree in 1959 prohibited FGM,
making it punishable by fine and
imprisonment.

32. over the years
• Changes have been made.
• A series of later ministerial decrees allowed
certain forms of FGM but prohibited others

33. At some point
• doctors were also prohibited from
performing FGM in government health
facilities, and non-medical practitioners
were forbidden from practicing FGM
completely.

34. In 1994
• the then Ministry of Health (MOH) decreed
that FGM should be performed one day a
week in governmental facilities only by
trained medical personnel, and only if they
failed to persuade the parents against the
practice

35. By 1995
• Egypt's health minister, Ismail Sallam,
succumbed to pressure from local and
international women organisations and
banned female circumcision in government
hospitals.

36. In 1996
• the Ministry of Health and Population issued decree N° 261
finally forbidding the practice except for medical
indications, and only with the concurrence of a senior
obstetrician. The decree states:
• "It is forbidden to perform excision on females either in
hospitals or public or private clinics.
• The procedure can only be performed in cases of disease
and when approved by the head of the obstetrics and
gynecology department at the hospital, and upon the
suggestion of the treating physician.
• Performance of this operation will be considered a violation
of the laws governing the medical profession.
• Nor is this operation to be performed by non-physicians."

37. Legislation
• No specific penal law prohibits the practice of
FGM.
• However, approval and/or performance of FGM
is a violation of Act 240 of an existing Egyptian
penal law, which states that "any person who
injures another person or beats him/her in a way
that leads to cutting or severing, or impairing the
function of any body part, or leads to blindness,
shall be punished by 3-5 years imprisonment.
• In cases of previous deliberate intentions,
punishment would be hard labor for 3-10 years

38. On June 24, 1997
• an Egyptian administrative court decision
rejected a government ban on Female Genital
Mutilation. This decision overturns a July 1996
decree by Egyptian Health Minister Ismail Sallam
banning the procedure from being performed by
publicly funded doctors and health care workers.
• The court rejected the ban on the grounds that the
government does not have the authority to restrict
doctors' rights.

39. in December 1997
• the Egyptian High Administrative Court,
endorsed the decree and, accordingly, the
prohibition of FGM became total even in
the absence of a specific penal law against
FGM

40. The physical and psychological
effects of female genital mutilation
• Physical effects
• Effects on sexuality
• Psychological effects

41. Physical effects
• At the time the mutilation is carried out, pain, shock,
haemorrhage and damage to the organs surrounding the
clitoris and labia can occur.
Afterwards urine may be retained and serious infection
develop. Use of the same instrument on several girls
without sterilization can cause the spread of HIV.
the chronic infections, intermittent bleeding, abscesses and
small benign tumours of the nerve which can result from
clitoridectomy and excision cause discomfort and extreme
pain. pelvic infections, infertility, excessive scar tissue,
keloids (raised, irregularly shaped, progressively enlarging
scars) and dermoid cysts

42. Effects on sexuality
• first intercourse an ordeal for women. It can be
extremely painful, and even dangerous,
• adversely affect sexual fulfilment. Clinical
considerations and the majority of studies on
women's enjoyment of sex suggest that genital
mutilation does impair a women's enjoyment

43. Psychological effects
• feelings of anxiety, terror, humiliation and betrayal
• the most important psychological effect on a woman
who has survived is the feeling that she is acceptable
to her society, having upheld the traditions of her
culture and made herself eligible for marriage, often
the only role available to her.
• It is possible that a woman who did not undergo
genital mutilation could suffer psychological
problems as a result of rejection by the society

44. For medical reasons
• Female Cosmotic
Plastic Surgery
• - Labia minora reduction
-Remodeling of labia majora &
pubis
-Vaginal reconstruction
-External genital reconstruction
-Intersex (hermaphodites, genital
deficiencies)
• Transsexual
Surgery
• Gender reassignment
-Male to female
-Female to male

45. labial reduction surgery
(labiaplasty, labioplasty(
• for women with enlarged, hypertrophic, or
asymmetrical labia minora.
• Some women are uncomfortable with their
enlarged labia minora (lips), which can lead to
discomfort with wearing certain clothing,
performing certain exercises, or during sex.
• The enlarged labia can have a protuberant and
abnormal appearance to some, and this can lead
to self-consciousness.
• TTT by a special reconstructive plastic surgical
technique to reduce the large or uneven labia
minora

46. Remodeling of labia majora
and pubis
• Patients with abnormalities of the labia
majora include asymmetry, loss of fullness,
and overly large labia majora. These
complaints are evaluated on an individual
basis, and surgery is varied according to
need
• If a woman has excessively large labia
majora due to an excess of skin, this excess
skin can be removed without leaving a
visible scar.
• Loss of fullness of the labia majora can be
corrected by fat injections or by insertion of
various graft materials

47. reconstruction -External genital
• Deformities of the external genitalia from cancer
surgery , female genital mutilation or other causes
are not uncommon.
• Reconstruction with major improvement is
possible for many of these deformities.
• Each case is evaluated and treatment individually
determined.
• Plastic surgical techniques are applied to solve
these problems

48. Intersex
• Intersex refers to a variety of patients with different genital
deformities such as hermaphrodites, pseudohermaphrodites,
and inadequate genitalia.
• there is the situation where at birth a baby has genitals that
are 'ambiguous' (i.e. not typical of either of the two
currently recognized sexes) such that questions arise about
the appropriate sex of rearing and about whether surgery
should be employed to reinforce the chosen gender,
• and secondly there is the situation where the child is clearly
at the female end of the male/female continuum of genital
appearance but has a larger than average clitoris.
• Reconstruction to create normal functioning genitalia is
performed using many different techniques.

49. Transsexual Surgery
•Gender reassignment
-Male to female
-Female to male
• Once the psychiatrist has certified surgery can be
undertaken
• Not accepted in Islamic Country

50. Female To male Gender
Reassignment

51. Male To Female Gender
Reassignment

52. My Opinion

53. • Even though female circumcision and
female genital mutilation has been banned
in Egypt since 1997 and a campaign against
it was launched here with 2003 named the
“Year of the Girl,” most Egyptian girls still
undergo the painful practice

54. • all the Hadiths that mention female circumcision
(not female genital mutilation) and shown that
they are all very poor in authenticity
• In addition, the existence of female circumcision
in the community does not necessarily mean that
it was to be recommended or made obligatory.
• If a Muslim truly believes that female
circumcision is a part of the Sunnah
And if female insisted or her family – it is better to
do FEMALE CIRCUMCISION ( not FGM)