Kadra Yosuf (born 16 June 1980), also known as Kadra Noor or Kadra Norwegian , is a Norwegian-Somali activist.
129-756: In 2000, she investigated female genital cutting in the Somali community in Norway in the documentary Norske jenter omskjæres for Rikets tilstand on TV 2 . Going undercover, she exposed the support of imams in Norway for the practice. For her efforts, she received the Fritt Ord Honorary Award , but has since been living in hiding. In April 2007 she called to reinterpret the Koran as far as it concerns Muslim women's rights. Several days later she
258-481: A dorsal slit ), which remains until blood flow has stopped. Finally, the foreskin is amputated . For older babies and adults, circumcision is often performed surgically without specialized instruments, and alternatives such as Unicirc or the Shang ring are available. The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes, so
387-522: A "self-enforcing social convention " to which families feel they must conform to avoid uncut daughters facing social exclusion. Ellen Gruenbaum reported that, in Sudan in the 1970s, cut girls from an Arab ethnic group would mock uncut Zabarma girls with Ya, ghalfa! ("Hey, unclean!"). The Zabarma girls would respond Ya, mutmura! (A mutmura was a storage pit for grain that was continually opened and closed, like an infibulated woman.) But despite throwing
516-429: A 1988 poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again. Despite the evident suffering, it is women who organize all forms of FGM. Anthropologist Rose Oldfield Hayes wrote in 1975 that educated Sudanese men who did not want their daughters to be infibulated (preferring clitoridectomy) would find the girls had been sewn up after
645-528: A 2014 review, the effect of circumcision on sexual partners' experiences is unclear as this has not been well studied. According to a policy statement from the Canadian Paediatric Society that was reaffirmed in 2021, "medical studies do not support circumcision as having an impact on sexual function or satisfaction for partners of circumcised individuals". There are popular misconceptions that circumcision benefits or adversely impacts
774-432: A child's sex by eliminating external traces of androgyny," Janice Boddy wrote in 2007. "The female body is then covered, closed, and its productive blood bound within; the male body is unveiled, opened, and exposed." In communities where infibulation is common, there is a preference for women's genitals to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive. Some men seem to enjoy
903-569: A contributing cause of the Bar Kokhba revolt . According to Silverman (2006), these restrictions were part of a "broad campaign" by the Romans to "civilize" the Jewish people, viewing the practice as repulsive and analogous to castration . His successor, Antoninus Pius , altered the edict to permit Brit Milah . During this period in history, Jewish circumcision called for the removal of only
1032-509: A form of preventive healthcare , as a religious obligation , or as a cultural practice . It is also an option for cases of phimosis , other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health. The procedure is associated with reduced rates of sexually transmitted infections and urinary tract infections . This includes reducing
1161-496: A joint statement in 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons". The procedures vary according to the ethnicity and individual practitioners; during a 1998 survey in Niger, women responded with over 50 terms when asked what was done to them. Translation problems are compounded by
1290-668: A mark of distinction for the elite: the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself. Circumcision is prominent in the Hebrew Bible . In addition to proposing that circumcision was adopted by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as
1419-408: A part of the prepuce, and Hellenized Jews often attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the second century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin, emphasizing the Jewish view of circumcision as intended to be not just
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#17327941440211548-554: A particularly low prevalence of circumcised males. This region has a disproportionately high HIV infection rate, with a significant number of those infections stemming from heterosexual transmission. As a result, the promotion of prophylactic circumcision has been a priority intervention in that region since the WHO's 2007 recommendations. The International Antiviral Society–USA also suggests circumcision be discussed with men who have insertive anal sex with men , especially in regions where HIV
1677-671: A placebo, but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques. A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell. The available evidence does not indicate that post-procedure pain management
1806-427: A pouch for the girl to wear. A single hole of 2–3 mm is left for the passage of urine and menstrual fluid. The vulva is closed with surgical thread, or agave or acacia thorns, and might be covered with a poultice of raw egg, herbs, and sugar. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks. If
1935-722: A prophylactic or treatment option in healthcare, circumcision plays a major role in many of the world's cultures and religions, most prominently Judaism and Islam . Circumcision is among the most important commandments in Judaism . It is widespread in Australia, Canada, the United States, South Korea, most of Africa, and parts of Asia. It is relatively rare for non-religious reasons in parts of Southern Africa, Latin America, Europe, and parts of Asia. The origin of circumcision
2064-436: A reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men. There is some evidence that circumcision is associated with reduced risk of prostate cancer . A 2017 systematic review found consistent evidence that male circumcision prior to heterosexual contact was associated with a decreased risk of cervical cancer, cervical dysplasia , HSV-2, chlamydia, and syphilis among women. The evidence
2193-534: A result of the practice, because complications may not be recognized or reported. The practitioners' use of shared instruments is thought to aid the transmission of hepatitis B , hepatitis C and HIV , although no epidemiological studies have shown this. Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supplied
2322-606: A rite of passage into adulthood; or as a form of blood sacrifice. Historical campaigns of ethnic, cultural, and religious persecution frequently included bans on circumcision as a means of forceful assimilation, conversion, and ethnocide . Alexander the Great conquered the Middle East in the fourth century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making life for circumcised Jews living among
2451-477: A significant percentage of infibulated women and girls reported a less severe type. In 2017, during an international meeting of 98 FGM experts, which included physicians, social scientists, policymakers, and activists from 23 countries, a majority of the participants advocated for the revision of FGM/C classifications proposed by the WHO and other UN agencies. The experts agreed on legal prohibition of reinfibulation and ritual pricking. They also expressed worry over
2580-428: A spiritual concept, arguing literal circumcision to be unnecessary for Gentile converts to Christianity. The teaching that circumcision was unnecessary for membership in a divine covenant was instrumental to the separation of Christianity from Judaism. While the circumcision of Jesus is celebrated as a feast day in the liturgical calendar of many Christian denominations . Although it is not explicitly mentioned in
2709-423: A strong protective effect against penile cancer in later life. Penile cancer is a rare disease in the developed world but much more prevalent in the developing world . The penile tissue removed during circumcision is a potential origin for penile cancer. Risk-benefit considerations around the use of circumcision as a cancer-preventive measure are a source of debate. Penile cancer development can be detected in
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#17327941440212838-504: A study by Nigerian physician Mairo Usman Mandara, over 30 percent of women with gishiri cuts were found to have vesicovaginal fistulae (holes that allow urine to seep into the vagina). FGM harms women's physical and emotional health throughout their lives. It has no known health benefits. The short-term and late complications depend on the type of FGM, whether the practitioner has had medical training, and whether they used antibiotics and sterilized or single-use surgical instruments. In
2967-405: A traditional cutter using a blade, FGM is conducted from days after birth to puberty and beyond. In half of the countries for which national statistics are available, most girls are cut before the age of five. Procedures differ according to the country or ethnic group. They include removal of the clitoral hood (type 1-a) and clitoral glans (1-b); removal of the inner labia (2-a); and removal of
3096-405: Is a procedure that removes the foreskin from the human penis . In the most common form of the operation, the foreskin is extended with forceps , then a circumcision device may be placed, after which the foreskin is excised . Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress . Circumcision is generally electively performed , most commonly done as
3225-473: Is a risk that the circumcision scar may be tender. There is no good evidence that circumcision affects cognitive abilities. Circumcision is the oldest known surgical procedure. Depictions of circumcised penises are found in Paleolithic art , predating the earliest signs of trepanation . The history of the migration and evolution of circumcision is known mainly from the cultures of two regions. In
3354-502: Is also a belief that infibulation increases hygiene. Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure. In a study in northern Sudan, published in 1983, only 17.4 percent of women opposed FGM (558 out of 3,210), and most preferred excision and infibulation over clitoridectomy. Attitudes are changing slowly. In Sudan in 2010, 42 percent of women who had heard of FGM said
3483-593: Is also known in Arabic as khafḍ or khifaḍ . Communities may refer to FGM as "pharaonic" for infibulation and " sunna " circumcision for everything else; sunna means "path or way" in Arabic and refers to the tradition of Muhammad , although none of the procedures are required within Islam. The term infibulation derives from fibula , Latin for clasp; the Ancient Romans reportedly fastened clasps through
3612-405: Is also used to treat various pathologies. These include pathological phimosis , refractory balanoposthitis and chronic or recurrent urinary tract infections (UTIs). Circumcision is contraindicated in certain cases. These include infants with certain genital structure abnormalities, such as a misplaced urethral opening (as in hypospadias and epispadias ), curvature of the head of
3741-582: Is common, the practice's many variants are reflected in dozens of terms, often alluding to purification. In the Bambara language , spoken mostly in Mali, it is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath"). A common Arabic term for purification has the root t-h-r , used for male and female circumcision ( tahur and tahara ). It
3870-460: Is common. There is evidence that circumcision is associated with a reduced risk of HIV infection for such men, particularly in low-income countries. The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving communities affected by endemic HIV/AIDS to promote circumcision as an additional method of controlling the spread of HIV. Major medical organizations hold varying positions on
3999-660: Is concentrated in northeastern Africa, particularly Djibouti, Eritrea, Somalia, and Sudan. In surveys in 2002–2006, 30 percent of cut girls in Djibouti, 38 percent in Eritrea, and 63 percent in Somalia had experienced Type III. There is also a high prevalence of infibulation among girls in Niger and Senegal, and in 2013 it was estimated that in Nigeria three percent of the 0–14 age group had been infibulated. The type of procedure
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4128-625: Is increased. The WHO estimated in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM. The estimate was based on a study conducted on 28,393 women attending delivery wards at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III. The reasons for this were unclear, but may be connected to genital and urinary tract infections and
4257-504: Is known about that history. It has been speculated that circumcision originated as a substitute for castration of defeated enemies or as a religious sacrifice . In many traditions, it acts as a rite of passage marking a boy's entrance into adulthood . At Oued Djerat , in Algeria , engraved rock art with masked bowmen, which feature male circumcision and may be a scene involving ritual, have been dated to earlier than 6000 BP amid
4386-573: Is meatal stenosis, this is almost exclusively seen in circumcised children, it is thought to be caused by ammonia producing bacteria coming into contact with the meatus in circumcised infants. It can be treated by meatotomy . Effective pain management should be used during the procedure. Inadequate pain relief may carry the risks of heightened pain response for newborns. Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed. For adult men who have been circumcised, there
4515-417: Is needed. For adults, topical anesthesia , ring block, dorsal penile nerve block (DPNB) and general anesthesia are all options, and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal. Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations. In 2020,
4644-458: Is not known with certainty, but the oldest documentation comes from ancient Egypt . Around half of all circumcisions worldwide are performed for reasons of prophylactic healthcare. There is a consensus among the world's major medical organizations and in the academic literature that circumcision is an efficacious intervention for HIV prevention in high-risk populations if carried out by medical professionals under safe conditions. In 2007,
4773-824: Is often linked to ethnicity. In Eritrea, for example, a survey in 2002 found that all Hedareb girls had been infibulated, compared with two percent of the Tigrinya , most of whom fell into the "cut, no flesh removed" category. FGM is mostly found in what Gerry Mackie called an "intriguingly contiguous" zone in Africa—east to west from Somalia to Senegal, and north to south from Egypt to Tanzania. Nationally representative figures are available for 27 countries in Africa, as well as Indonesia, Iraqi Kurdistan and Yemen. Over 200 million women and girls are thought to be living with FGM in those 30 countries. The highest concentrations among
4902-482: Is removed; Type III is equivalent to the UNICEF category "sewn closed"; and Type IV describes miscellaneous procedures, including symbolic nicking. Type I is "partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans)". Type Ia involves removal of
5031-401: Is satisfactory or whether more is to be cut off. After the clitoris has been satisfactorily amputated ... the circumciser can proceed with the total removal of the labia minora and the paring of the inner walls of the labia majora. Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child
5160-411: Is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together. ... Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where
5289-536: Is the cutting or removal of some or all of the vulva for non-medical reasons. FGM prevalence varies worldwide, but is majorly present in some countries of Africa, Asia and Middle East, and within their diasporas. As of 2024 , UNICEF estimates that worldwide 230 million girls and women (144 million in Africa, 80 million in Asia, 6 million in Middle East, and 1-2 million in other parts of the world) had been subjected to one or more types of FGM. Typically carried out by
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5418-407: Is the inability to retract the foreskin over the glans penis. At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis). Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three. Less than one percent are still having problems at age 18. If
5547-554: Is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion . Adverse health effects depend on the type of procedure; they can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain , the development of cysts , an inability to get pregnant, complications during childbirth, and fatal bleeding. There are no known health benefits. There have been international efforts since
5676-966: The Bubaline Period ; more specifically, while possibly dating much earlier than 10,000 BP, rock art walls from the Bubaline Period have been dated between 9200 BP and 5500 BP. The cultural practice of circumcision may have spread from the Central Sahara , toward the south in Sub-Saharan Africa and toward the east in the region of the Nile . Based on engraved evidence found on walls and evidence from mummies , circumcision has been dated to at least as early as 6000 BCE in ancient Egypt . Some ancient Egyptian mummies , which have been dated as early as 4000 BCE, show evidence of circumcision. Evidence suggests that circumcision
5805-807: The Indonesian Ministry of Health and Indonesian Ulema Council both say the clitoris should not be cut. The prevalence rate for the 0–11 group in Indonesia is 49 percent (13.4 million). Smaller studies or anecdotal reports suggest that various types of FGM are also practised in various circumstances in Colombia , Jordan , Oman , Palestine , Saudi Arabia , Malaysia , the United Arab Emirates , India, and among Kurdish communities in Iran but there are no representative data on
5934-465: The Kono people of Sierra Leone , who in 1992 underwent clitoridectomy as an adult during a Sande society initiation, argued in 2000 that it is a male-centred assumption that the clitoris is important to female sexuality. African female symbolism revolves instead around the concept of the womb. Infibulation draws on that idea of enclosure and fertility. "[G]enital cutting completes the social definition of
6063-576: The UNICEF , international FGM rates have risen significantly in recent years, rising from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many effected countries. Aid agencies define the prevalence of FGM as the percentage of the 15–49 age group that has experienced it. These figures are based on nationally representative household surveys known as Demographic and Health Surveys (DHS), developed by Macro International and funded mainly by
6192-540: The United States Agency for International Development (USAID); and Multiple Indicator Cluster Surveys (MICS) conducted with financial and technical help from UNICEF. These surveys have been carried out in Africa, Asia, Latin America, and elsewhere roughly every five years since 1984 and 1995 respectively. The first to ask about FGM was the 1989–1990 DHS in northern Sudan. The first publication to estimate FGM prevalence based on DHS data (in seven countries)
6321-486: The World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions. Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection , affecting both men and women. While most infections are asymptomatic and are cleared by the immune system , some types of
6450-424: The clitoral hood only. This is rarely performed alone. The more common procedure is Type Ib ( clitoridectomy ), the complete or partial removal of the clitoral glans (the visible tip of the clitoris) and clitoral hood. The circumciser pulls the clitoral glans with her thumb and index finger and cuts it off. Type II (excision) is the complete or partial removal of the inner labia , with or without removal of
6579-413: The prophylactic efficacy of the elective circumcision of minors in the context of developed countries . Literature on the matter is polarized, with the cost-benefit analysis being highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects them. The World Health Organization (WHO), UNAIDS , and American medical organizations take
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#17327941440216708-430: The urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces to seep into the vagina). This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility . Painful periods are common because of the obstruction to the menstrual flow , and blood can stagnate in
6837-507: The 15–49 age group are in Somalia (98 percent), Guinea (97 percent), Djibouti (93 percent), Egypt (91 percent), and Sierra Leone (90 percent). As of 2013, 27.2 million women had undergone FGM in Egypt, 23.8 million in Ethiopia, and 19.9 million in Nigeria. There is a high concentration in Indonesia, where according to UNICEF Type I (clitoridectomy) and Type IV (symbolic nicking) are practised;
6966-467: The 1970s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are often poorly enforced. Since 2010, the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. The opposition to
7095-575: The 1980s, FGM was widely known in English as "female circumcision", implying an equivalence in severity with male circumcision . From 1929 the Kenya Missionary Council referred to it as the sexual mutilation of women, following the lead of Marion Scott Stevenson , a Church of Scotland missionary. References to the practice as mutilation increased throughout the 1970s. In 1975 Rose Oldfield Hayes , an American anthropologist, used
7224-506: The DPNB. They are more effective than EMLA (eutectic mixture of local anesthetics) cream, which is more effective than a placebo . Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group. For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a sucrose or non-sucrose pacifier are more effective at reducing pain than
7353-497: The Egyptians for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage , performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been
7482-981: The FGM status of all their living daughters. The highest concentrations among girls aged 0–14 were in Gambia (56 percent), Mauritania (54 percent), Indonesia (49 percent for 0–11) and Guinea (46 percent). The figures suggest that a girl was one third less likely in 2014 to undergo FGM than she was 30 years ago. According to a 2018 study published in BMJ Global Health , the prevalence within the 0–14 year old group fell in East Africa from 71.4 percent in 1995 to 8 percent in 2016; in North Africa from 57.7 percent in 1990 to 14.1 percent in 2015; and in West Africa from 73.6 percent in 1996 to 25.4 percent in 2017. If
7611-564: The Fulani in Chad, while in Nigeria the Fulani are the only large ethnic group in the country not to practise it. In Sierra Leone, the predominantly Christian Creole people are the only ethnicity not known to practice FGM or participate in Bondo society rituals. Kenyan FGM ceremony — Stephanie Welsh, Newhouse News Service Dahabo Musa, a Somali woman, described infibulation in
7740-733: The Greeks and later the Romans very difficult. Restrictions on the Jewish practice by European governments have occurred several times in world history, including the Seleucid Empire under Antiochus IV and the Roman Empire under Hadrian , where it was used as a means of forceful assimilation and conversion . Antiochus IV's restriction on Jewish circumcision was a major factor in the Maccabean Revolt . Hadrian 's prohibition has also been considered by some to have been
7869-472: The USA. These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin ( preputial epithelium ) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires
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#17327941440217998-518: The United States. Minor complications are reported to occur in three percent of procedures. Severe complications are rare. A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification. Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age. Significant acute complications happen rarely, occurring in about 1 in 500 newborn procedures in
8127-579: The United States. Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports. Where a Plastibell device is used, the most common complication is the retention of the device occurring in around 3.5% of procedures. Other possible complications include buried penis , chordee , phimosis, skin bridges , urethral fistulas, and meatal stenosis . These complications may be partly avoided with proper technique, and are often treatable without requiring surgical revision. The most common long-term complication
8256-498: The WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that they recommended adolescent and adult circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes " informed consent , confidentiality , and absence of coercion " — known as voluntary medical male circumcision, or VMMC. In 2010, this
8385-472: The WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria and Niger. These were removed from the WHO's 2008 definition because of insufficient information about prevalence and consequences. Angurya cutting is excision of the hymen , usually performed seven days after birth. Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour, and other conditions. In
8514-673: The carcinoma in situ (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage. There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself. Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally. Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision. The mitigating effect circumcision has on
8643-602: The case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once (for example, to close an opening regarded as too wide or re-open one too small). Common short-term complications include swelling, excessive bleeding, pain, urine retention , and healing problems/ wound infection . A 2014 systematic review of 56 studies suggested that over one in ten girls and women undergoing any form of FGM, including symbolic nicking of
8772-402: The child squats on a stool or mat while adults pull her legs open; a local anaesthetic is applied if available: The element of speed and surprise is vital and the circumciser immediately grabs the clitoris by pinching it between her nails aiming to amputate it with a slash. The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed
8901-481: The clitoral glans and outer labia . Type IIa is removal of the inner labia; Type IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM. — Swiss Medical Weekly Type III ( infibulation or pharaonic circumcision), the "sewn closed" category, is the removal of the external genitalia and fusion of
9030-404: The clitoris (Type IV), experience immediate complications, although the risks increased with Type III. The review also suggested that there was under-reporting. Other short-term complications include fatal bleeding, anaemia , urinary infection , septicaemia , tetanus , gangrene , necrotizing fasciitis (flesh-eating disease), and endometritis . It is not known how many girls and women die as
9159-465: The clitoris. An infibulated girl may be left with an opening as small as 2–3 mm, which can cause prolonged, drop-by-drop urination , pain while urinating , and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but
9288-629: The countries for which national figures were available in 2000–2010, most girls had been cut by age five. Over 80 percent (of those cut) are cut before the age of five in Nigeria, Mali, Eritrea, Ghana and Mauritania. The 1997 Demographic and Health Survey in Yemen found that 76 percent of girls had been cut within two weeks of birth. The percentage is reversed in Somalia, Egypt, Chad, and the Central African Republic, where over 80 percent (of those cut) are cut between five and 14. Just as
9417-539: The country a national prevalence of eight percent. The practice is sometimes an ethnic marker, but it may differ along national lines. For example, in the northeastern regions of Ethiopia and Kenya, which share a border with Somalia, the Somali people practise FGM at around the same rate as they do in Somalia. But in Guinea all Fulani women responding to a survey in 2012 said they had experienced FGM, against 12 percent of
9546-582: The culture that practices FGM and learn that their condition is not the norm, but within the practicing culture, they may view their FGM with pride because for them it signifies beauty, respect for tradition, chastity and hygiene. Studies on sexual function have also been small. A 2013 meta-analysis of 15 studies involving 12,671 women from seven countries concluded that women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report dyspareunia (painful sexual intercourse). One-third reported reduced sexual feelings. According to
9675-528: The current rate of decline continues, the number of girls cut will nevertheless continue to rise because of population growth, according to UNICEF in 2014; they estimate that the figure will increase from 3.6 million a year in 2013 to 4.1 million in 2050. Surveys have found FGM to be more common in rural areas, less common in most countries among girls from the wealthiest homes, and (except in Sudan and Somalia) less common in girls whose mothers had access to primary or secondary/higher education. In Somalia and Sudan
9804-407: The data. FGM's origins in northeastern Africa are pre-Islamic, but the practice became associated with Islam because of that religion's focus on female chastity and seclusion. According to a 2013 UNICEF report, in 18 African countries at least 10 percent of Muslim females had experienced FGM, and in 13 of those countries, the figure rose to 50–99 percent. Male circumcision Circumcision
9933-408: The development of phimosis. Phimosis is also a complication that can result from circumcision. An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis . Most cases of these conditions occur in uncircumcised males, affecting 4–11% of that group. The moist, warm space underneath the foreskin is thought to facilitate
10062-500: The effort of penetrating an infibulation. The local preference for dry sex causes women to introduce substances into the vagina to reduce lubrication, including leaves, tree bark, toothpaste and Vicks menthol rub . The WHO includes this practice within Type IV FGM, because the added friction during intercourse can cause lacerations and increase the risk of infection. Because of the smooth appearance of an infibulated vulva, there
10191-418: The following: (1) cut, no flesh removed (symbolic nicking); (2) cut, some flesh removed; (3) sewn closed; or (4) type not determined/unsure/doesn't know. The most common procedures fall within the "cut, some flesh removed" category and involve complete or partial removal of the clitoral glans. The World Health Organization (a UN agency) created a more detailed typology in 1997: Types I–II vary in how much tissue
10320-548: The foreskins or labia of slaves to prevent sexual intercourse. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan and as Sudanese circumcision in Egypt . In Somalia , it is known simply as qodob ("to sew up"). The procedures are generally performed by a traditional cutter ( exciseuse ) in the girls' homes, with or without anaesthesia. The cutter is usually an older woman, but in communities where
10449-598: The fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people. A narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus , but physical circumcision is not part of the received teachings of Jesus. Circumcision has played an important role in Christian history and theology . Paul the Apostle reinterpreted circumcision as
10578-549: The grandmothers arranged a visit to relatives. Gerry Mackie has compared the practice to footbinding . Like FGM, footbinding was carried out on young girls, nearly universal where practised, tied to ideas about honour, chastity, and appropriate marriage, and "supported and transmitted" by women. FGM practitioners see the procedures as marking not only ethnic boundaries but also gender differences. According to this view, male circumcision defeminizes men while FGM demasculinizes women. Fuambai Ahmadu , an anthropologist and member of
10707-445: The growth of pathogens, particularly when hygiene is poor. Yeasts, especially Candida albicans , are the most common penile infection and are rarely identified in samples taken from circumcised males. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in
10836-410: The harm presented by "the lawfulness of both female genital cosmetic surgeries and male circumcision" in the negation of FGM/C prevention campaigns. The participants, however, differed in their views on the ban of female genital cosmetic surgeries and regular vulvar checkups of female children. Standard questionnaires from United Nations bodies ask women whether they or their daughters have undergone
10965-436: The help of the "little knife". This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis. Type IV is "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization. It includes nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into
11094-454: The inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option. This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin. Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO. The procedure may also be used to prevent
11223-437: The incidence of cancer-causing forms of human papillomavirus (HPV) and significantly reducing HIV transmission among heterosexual men in high-risk populations; its prophylactic efficacy against HIV transmission in the developed world or among men who have sex with men is debated. Neonatal circumcision decreases the risk of penile cancer . Complication rates increase significantly with age. Bleeding, infection, and
11352-513: The incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3–10 times (100 circumcisions prevents one UTI). Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects, and may be used to treat recurrent UTIs. There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at
11481-415: The inner and outer labia and closure of the vulva (type 3). In this last procedure, known as infibulation , a small hole is left for the passage of urine and menstrual fluid , the vagina is opened for intercourse and opened further for childbirth. The practice is rooted in gender inequality , attempts to control female sexuality , religious beliefs and ideas about purity, modesty, and beauty. It
11610-660: The insult back, the Zabarma girls would ask their mothers, "What's the matter? Don't we have razor blades like the Arabs?" Because of poor access to information, and because practitioners downplay the causal connection, women may not associate the health consequences with the procedure. Lala Baldé, president of a women's association in Medina Cherif, a village in Senegal, told Mackie in 1998 that when girls fell ill or died, it
11739-771: The lands south and east of the Mediterranean, starting with Central Sahara, Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites , and then by the Jews and Muslims. In Oceania, circumcision is practiced by the Australian Aboriginals and Polynesians . There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas, but little
11868-413: The likelihood of multiple infections. As of 2012 , there was no strong evidence that it reduces the rate of new HPV infection, but the procedure is associated with increased clearance of the virus by the body, which can account for the finding of reduced prevalence. Although genital warts are caused by a type of HPV, there is no statistically significant relationship between being circumcised and
11997-708: The male barber has assumed the role of health worker, he will also perform FGM. When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks, and fingernails. According to a nurse in Uganda, quoted in 2007 in The Lancet , a cutter would use one knife on up to 30 girls at a time. In several countries, health professionals are involved; in Egypt, 77 percent of FGM procedures, and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016. The WHO, UNICEF, and UNFPA issued
12126-582: The more extensive FGM procedures. Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby's size. In women with vesicovaginal or rectovaginal fistulae, it is difficult to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such as pre-eclampsia harder. Cervical evaluation during labour may be impeded and labour prolonged or obstructed. Third-degree laceration (tears), anal-sphincter damage and emergency caesarean section are more common in infibulated women. Neonatal mortality
12255-559: The neonatal period when it is less expensive and has a lower risk of complications. The American Academy of Pediatrics and Centers for Disease Control and Prevention stated that the potential benefits of circumcision outweigh the risks. The World Health Organization in 2010 stated: There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men. Circumcision
12384-426: The penis ( chordee ), or ambiguous genitalia , because the foreskin may be needed for reconstructive surgery. Circumcision is contraindicated in premature infants and those who are not clinically stable and in good health. If an individual is known to have or has a family history of serious bleeding disorders such as hemophilia , it is recommended that the blood be checked for normal coagulation properties before
12513-408: The position that it carries prophylactic health benefits which outweigh the risks, while European medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk. Advocates of circumcision consider it to have a net health benefit, and therefore feel that increasing the circumcision rate is "imperative". They recommend performing it during
12642-421: The practice is not without its critics, particularly among anthropologists , who have raised questions about cultural relativism and the universality of human rights. According to the UNICEF, international FGM rates have risen significantly in recent years, from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many affected countries. Until
12771-403: The practice should continue. In several surveys since 2006, over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, the Gambia, and Egypt supported FGM's continuance, while elsewhere in Africa, Iraq, and Yemen most said it should end, although in several countries only by a narrow margin. Against the argument that women willingly choose FGM for their daughters, UNICEF calls the practice
12900-729: The presence of genital warts. Studies evaluating the effect of circumcision on the rates of other sexually transmitted infections have, generally, found it to be protective. A 2006 meta-analysis found that circumcision was associated with lower rates of syphilis , chancroid , and possibly genital herpes . A 2010 review found that circumcision reduced the incidence of HSV -2 (herpes simplex virus, type 2) infections by 28%. The researchers found mixed results for protection against trichomonas vaginalis and chlamydia trachomatis , and no evidence of protection against gonorrhea or syphilis. It may also possibly protect against syphilis in MSM. Phimosis
13029-596: The presence of scar tissue. According to the study, FGM was associated with an increased risk to the mother of damage to the perineum and excessive blood loss , as well as a need to resuscitate the baby, and stillbirth , perhaps because of a long second stage of labour . According to a 2015 systematic review there is little high-quality information available on the psychological effects of FGM. Several small studies have concluded that women with FGM develop anxiety, depression, and post-traumatic stress disorder . Feelings of shame and betrayal can develop when women leave
13158-588: The prevalence in these countries. As of 2023 , UNICEF reported that "The highest levels of support for FGM can be found in Mali, Sierra Leone, Guinea, the Gambia, Somalia, and Egypt, where more than half of the female population thinks the practice should continue". Prevalence figures for the 15–19 age group and younger show a downward trend. For example, Burkina Faso fell from 89 percent (1980) to 58 percent (2010); Egypt from 97 percent (1985) to 70 percent (2015); and Kenya from 41 percent (1984) to 11 percent (2014). Beginning in 2010, household surveys asked women about
13287-513: The procedure is attempted. The foreskin is the double-layered fold of tissue at the distal end of the human penis that covers the glans and the urinary meatus . For adult medical circumcision, superficial wound healing takes up to a week, and complete healing 4 to 6 months. For infants, healing is usually complete within one week. For infant circumcision, devices such as the Gomco clamp , Plastibell and Mogen clamp are commonly used in
13416-551: The remaining hole is too large in the view of the girl's family, the procedure is repeated. The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. In some areas, including Somaliland, female relatives of the bride and groom might watch the opening of the vagina to check that the girl is a virgin. The woman is opened further for childbirth ( defibulation or deinfibulation ), and closed again afterwards ( reinfibulation ). Reinfibulation can involve cutting
13545-456: The removal of either too much or too little foreskin are the most common acute complications, while meatal stenosis is the most common long-term. There are various cultural, social , and ethical views on circumcision. Major medical organizations hold variant views on the strength of circumcision's prophylactic efficacy in developed countries. Some medical organizations take the position that it carries prophylactic health benefits which outweigh
13674-407: The risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men. Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men and
13803-488: The risks, while other medical organizations generally hold the belief that in these situations its medical benefits are not counterbalanced by risk. Circumcision is one of the world's most common and oldest medical procedures. Prophylactic usage originated in England during the 1850s and subsequently widely spread, becoming predominately established as a way to prevent sexually transmitted infections. Beyond use as
13932-403: The sexual pleasure of the circumcised person. Neonatal circumcision is generally a safe, low-risk procedure when done by an experienced practitioner. The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin. These complications occur in approximately 0.13% of procedures, with bleeding being the most common acute complication in
14061-415: The situation was reversed: in Somalia, the mothers' access to secondary/higher education was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan, access to any education was accompanied by a rise. FGM is not invariably a rite of passage between childhood and adulthood but is often performed on much younger children. Girls are most commonly cut shortly after birth to age 15. In half
14190-445: The skin has been removed are well approximated. The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus. The amputated parts might be placed in
14319-408: The task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with
14448-758: The term female genital mutilation in the title of a paper in American Ethnologist , and four years later Fran Hosken called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females . The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children began referring to it as female genital mutilation in 1990, and the World Health Organization (WHO) followed suit in 1991. Other English terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those who work with practitioners. In countries where FGM
14577-432: The tip of the penis (the urinary meatus ) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacterial population. Not being circumcised is the primary risk factor for penile cancer . Pre-adolescent circumcision has
14706-573: The tools to make their own decisions. In 1997, using the Tostan program, Malicounda Bambara in Senegal became the first village to abandon FGM. By August 2019, 8,800 communities in eight countries had pledged to abandon FGM and child marriage . Surveys have shown a widespread belief, particularly in Mali, Mauritania, Guinea, and Egypt, that FGM is a religious requirement. Gruenbaum has argued that practitioners may not distinguish between religion, tradition, and chastity, making it difficult to interpret
14835-404: The twenty-first century the availability of the other treatments has made it less necessary. A UTI affects parts of the urinary system including the urethra , bladder , and kidneys . There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ideal evidence that circumcision of babies reduces
14964-680: The type of FGM is often linked to ethnicity, so is the mean age. In Kenya, for example, the Kisi cut around age 10 and the Kamba at 16. A country's national prevalence often reflects a high sub-national prevalence among certain ethnicities, rather than a widespread practice. In Iraq, for example, FGM is found mostly among the Kurds in Erbil (58 percent prevalence within age group 15–49, as of 2011), Sulaymaniyah (54 percent) and Kirkuk (20 percent), giving
15093-407: The use of analgesia is advocated. Ordinary procedural pain may be managed in pharmacological and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective. The ring block and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than
15222-458: The vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood. Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III: The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and
15351-474: The vagina and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra (where the vagina and uterus fill with menstrual blood). The swelling of the abdomen and lack of menstruation can resemble pregnancy. Asma El Dareer , a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family. FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with
15480-449: The vagina to tighten it. Labia stretching is also categorized as Type IV. Common in southern and eastern Africa, the practice is supposed to enhance sexual pleasure for the man and add to the sense of a woman as a closed space. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia. A definition of FGM from
15609-492: The virus cause genital warts , and other types, if untreated, cause various forms of cancer, including cervical cancer and penile cancer . Genital warts and cervical cancer are the two most common problems resulting from HPV. Circumcision is associated with a reduced prevalence of oncogenic types of HPV infection, meaning that a randomly selected circumcised man is less likely to be found infected with cancer-causing types of HPV than an uncircumcised man. It also decreases
15738-502: The women's confusion over which type of FGM they experienced, or even whether they experienced it. Studies have suggested that survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that 73 percent had undergone it. In Sudan in 2006,
15867-524: The wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. Type III is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia, and Sudan (although not in South Sudan). According to one 2008 estimate, over eight million women in Africa are living with Type III FGM. According to UNFPA in 2010, 20 percent of women with FGM have been infibulated. In Somalia, according to Edna Adan Ismail ,
15996-477: Was attacked by a group of Somali immigrants, both male and female, who shouted at her that she was trampling the Koran. This biographical article about a Norwegian activist is a stub . You can help Misplaced Pages by expanding it . Female genital cutting Female genital mutilation ( FGM ) (also known as female genital cutting , female genital mutilation/cutting ( FGM/C ) and female circumcision )
16125-499: Was attributed to evil spirits. When informed of the causal relationship between FGM and ill health, Mackie wrote, the women broke down and wept. He argued that surveys taken before and after this sharing of information would show very different levels of support for FGM. The American non-profit group Tostan , founded by Molly Melching in 1991, introduced community-empowerment programs in several countries that focus on local democracy, literacy, and education about healthcare, giving women
16254-544: Was expanded to routine neonatal circumcision, as long as those undergoing the procedure received assent from their parents. In 2020, the World Health Organization again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy, in addition to other preventive measures, for the prevention of heterosexually acquired HIV infection in men. Eastern and southern Africa had
16383-470: Was less consistent in regards to the potential association of circumcision with women's risk of HPV and HIV. The accumulated data show circumcision does not have an adverse physiological effect on sexual pleasure, function, desire, or fertility. There is some evidence that circumcision has no effect on pain with intercourse , premature ejaculation , intravaginal ejaculation latency time , erectile dysfunction or difficulties with orgasm . According to
16512-568: Was practiced in the Middle East by the fourth millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq from the North and West. The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at Saqqara , dating to about 2400–2300 BCE. Circumcision was possibly done by
16641-443: Was written by Dara Carr of Macro International in 1997. Questions the women are asked during the surveys include: "Was the genital area just nicked/cut without removing any flesh? Was any flesh (or something) removed from the genital area? Was your genital area sewn?" Most women report "cut, some flesh removed" (Types I and II). Type I is the most common form in Egypt, and in the southern parts of Nigeria. Type III (infibulation)
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