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

Psychological damage from FGM

Whilst I can understand Ronan Conroy’s concerns regarding cosmetic
surgery in the West, he appears to have missed the fundamental differences
between that and the genital mutilation of children.

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
an adult chooses, however misguidedly, to reconstruct their genitalia it
is with knowledge and agreement.

The effect on the psyche of the two processes is quite different.

In my published research,’Post traumatic stress disorder in women who
have undergone obstetric and/or gynaecological procedures’ (1),
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.
Other forms of attack on women, such as rape, childhood sexual abuse and
sexual torture, are also known to cause PTSD (2).

Mr Conroy suggests that the, “high social value”, of FGM somehow
means that it is not, “forced on unwilling young girls”. However, ‘social
value’ is an adult concept whereas the child only understands the
experience subjectively. Indeed, a WHO report states, “For many girls
genital mutilation is a major experience of fear, submission, inhibition,
and suppression of feelings and thinking. This experience becomes a vivid
landmark in their mental development, the memory of which persists
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 their own children.”(3)

Victims of childhood abuse may idealise the trauma and become
perpetrators as a means of overcoming their anxieties, thus ensuring
transgenerational continuation of the practice (4).

It must be remembered that some medical commentators will themselves
have been circumcised and, unwilling to acknowledge their victim status,
may unwittingly introduce bias into their analyses.


(1) Menage, J.(1993) Post traumatic stress disorder in women who have
undergone obstetric and/or gynaecological procedures, Journal of
Reproductive and Infant Psychology, Vol.11, pp221-228

(2) Duddle,M. (1991) Emotional Sequelae of Sexual Assault, Journal of the
Royal Society of Medicine, 84: 26-28

(3) WHO Female Genital Mutilation, Report of a WHO Technical Working
Group. Geneva, 1996: 10

(4) Denniston et al (1999) Male and Female Circumcison, Kluwer
Academic/Plenum Publishers, New York

Competing interests:
None declared

Competing interests: No competing interests

17 July 2006
Janet Menage
Bulkington Surgery CV23 9HF