Intended for healthcare professionals


Female genital mutilation: whose problem, whose solution?

BMJ 2006; 333 doi: (Published 13 July 2006) Cite this as: BMJ 2006;333:106

Advancing the cause against female genital mutilation

Ronan Conroy, in an editorial[1] that grabbed the media’s attention, tells
us that female genital mutilation (FGM) is “on the increase nowhere in the
world except in our so called developed societies.” How he knows this is
not stated, but he then quotes from the advertising literature of a
commercial clinic in order to synthesise a claim that “women are being
mutilated to fit male masturbation fantasies”, before concluding that
western medicine “is driving the advance of female genital mutilation”.

This is emotive, sensationalist, and inaccurate and I take issue with
respect. There are two big differences between the labial reductions that
have become sought after by some western women, and FGM in developing
countries. The former are matters of adult choice, usually treating
unusually pendulous labia, whilst the latter are imposed upon
juveniles. The former do not damage the clitoris, the latter often
(intentionally or otherwise ) do.

By conflating these two very different situations Conroy creates a
very easy windmill to tilt at. FGM is a very complex subject: he
illustrates his editorial with a picture of a Pokot woman (who
presumably, but who knows how, gave informed consent for her picture to be
published in this context) on the occasion of her proud ceremonial
emergence after FGM, and rightly concludes that there is a cultural hill
to climb if we are to stop this practice. In addition the very use of the
word mutilation is tendentious: that the WHO classification would label
women who wear a piercing in their labia as mutilated (WHO type IV)[2]
somewhat devalues the concept.

Finally, of interest is that Mr Conroy avoids comparison with ritual
or religious circumcision of male infants (who also are obviously unable
to exercise choice) in two of the major Abrahamic religions, in both the
developed and developing worlds. This is a deeply complex subject both
ethically and politically, but surely raises many of the same issues. In
choosing a simple target, conflating such different examples, arguing from
the ridiculous specific to the serious general, and ignoring the wider
comparisons with “legitimate” genital mutilation, Conroy risks harming the
cause of those who wish to halt FGM.

Professor Simon Kay
Journal of Plastic Reconstructive and Aesthetic Surgery

1. Conroy R M Female Genital Mutilation: whose problem, whose
solution? BMJ 2006;333:106 – 107

2. Elmusharaf S, Elhadi N, Almroth L reliability of self reported
form of female genital mutilation and WHO classification:cross sectional
study. BMJ 2006 124 - 127

Competing interests:
Editor of Journal of Plastic, Aesthetic and Reconstructive Surgery

Competing interests: No competing interests

24 July 2006
Simon P Kay
Consultant Plastic Surgeon, Editor
St James University Hospital, Leeds, LS97TF