BMJ  2006;333:260 (29 July), doi:10.1136/bmj.333.7561.260

Letter

Female genital mutilation: whose problem, whose solution?

Psychological damage is immense

EDITOR—Conroy's concerns about cosmetic surgery in the West are understandable, but he seems to have missed the fundamental differences between it and the genital mutilation of children.¹ When a child is mutilated by adults the procedure constitutes a sexual assault in that the child does not understand what is happening, has no control over it, and does not consent to it. On the other hand, if adults choose, however misguidedly, to reconstruct their genitalia it is with knowledge and agreement. The effect on the psyche of the two processes is quite different.

I found that psychological trauma was correlated with several factors: feeling powerless to influence the event, lack of information given to the patient, the experience of physical pain, a perceived unsympathetic attitude on the part of the examiner, and a lack of clearly understood consent for the procedure.² Other forms of attack on women, such as rape, childhood sexual abuse, and sexual torture, also cause post-traumatic stress disorder.³

Conroy suggests that the "high social value" of female genital mutilation somehow means that it is not forced on unwilling young girls. However, social value is an adult concept whereas the child understands the experience only subjectively. A World Health Organization report states that for many girls genital mutilation is a major experience of fear, submission, inhibition, and suppression of feelings and thinking.⁴ This experience becomes a vivid landmark in their mental development, the memory persisting throughout life. For some, nothing they have subsequently gone through, including pain and stress in pregnancy, has come close to the painful experience of genital mutilation. Their tension and tears reflect the magnitude of emotional pain they silently endure at all times; the resulting loss of confidence and trust in family and friends can affect the child-parent relationship and has implications for future intimate relationships between the adult and her own children.⁴

Victims of childhood abuse may idealise the trauma and become perpetrators to overcome their anxieties, thus ensuring transgenerational continuation of the practice.⁵

Bulkington Surgery, Bulkington, Bedworth, Warwickshire CV23 9HF janet.menage{at}lineone.net

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Competing interests: None declared.

References

1. Conroy RM. Female genital mutilation: whose problem, whose solution? BMJ 2006;333: 106-7. (15 July.)[Free Full Text]
2. Menage J. Traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 1993;11: 221-8.
3. Duddle M. Emotional sequelae of sexual assault. J Roy Soc Med 1991;84: 26-8.[ISI][Medline]
4. World Health Organization. Female genital mutilation, report of a WHO technical working group. Geneva, 1996: 10.
5. Denniston GC, Hodges FM, Milos MF, eds. Male and female circumcision: medical, legal and ethical considerations in paediatric practice. New York: Kluwer Academic, Plenum, 1999.

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