Erroneous Belief Systems Underlying Female Genital Mutilation in Sub-Saharan Africa and Male Neonatal Circumcision in the United States: a Brief Report Updated
Hanny Lightfoot-Klein Presented at The Third International Symposium on Circumcision, University of Maryland, College Park, Maryland May 22-25, 1994.

       I first became aware of the existence of what at that time was still euphemistically called "female circumcision" in 1979. I was then a middle-aged school teacher on sabbatical, back-packing alone through some of the less frequented areas of sub-Saharan Africa, in search of I knew not what.        The effect of this eye opener being suddenly thrust upon me was so profound, that when I returned to the United States a number of months later, I retired from my job in order to devote myself full time to researching this subject. Thus began my quest for insight into the highly complex network of belief systems that underlie the continuing prevalence of this ancient and brutal blood ritual.        As things turned out, I was to continue trekking in and out of Africa in pursuit of this phenomenon for the next six years, painstakingly collecting my data by means of first-hand observation and in-depth interviews, whenever the opportunity to do so presented itself.

The Practices
       In sub-Saharan Africa, female genital mutilation rituals have been customary for millennia, and tenaciously continue to hold sway on all social levels, even now, at the very close of the 20th Century.        The immediate and long-term effects of the ritual procedures perpetrated on African girls, generally well before puberty, are so devastating to their health and well being, that they all but destroy the quality of their lives.        Horrendous pain, massive bleeding and raging infection may be expected to result from the procedures themselves, which are still carried out in the majority of cases without even local anesthesia. Normal passage of urine and menstrual blood are rendered all but impossible by infibulation, a sewing up of the vaginal orifice, down to a match stick sized opening, after the child's clitoris and labia have been cut away. Urinary and menstrual debris accumulating behind this "chastity belt of skin and scar tissue" create a perfect breeding ground for infection. Events such as defloration and childbirth, when these infibulations must be forcibly torn or cut open, are once again fraught with pain, infection, and almost inevitably, massive and often fatal blood loss.        While accurate statistics on "circumcision" related deaths are unobtainable and can at best only be estimated, they

are unquestionably proportionate to the wild squirming of frantic children under the knife, the use of unsterile instruments, inadequate for performing delicate surgery even under the best conditions, the unavailability of effective antibiotics, and the failing eyesight of old women performing the procedures under poor lighting conditions.        As I progressed more deeply into my study of the subject, I was to make a number of amazing discoveries. I learned that the number of women afflicted by these practices lay somewhere between an estimated 60 and 100 million, a figure so enormous that it was almost impossibly to grasp.        Equally shocking was the fact that this taboo subject had been so successfully hidden from outsiders that its mere existence was all but unknown to the Western World. Even when scraps of information regarding the current status of these blood rituals somehow managed to leak into medical journals, they had always been deprecated by African officials.        Such reports were laughingly dismissed as: "something that is still found sporadically only among the most primitive and isolated remnants of remote tribes, somewhere in the outback." These same officials insisted that all educated and mainstream Africans had many generations ago abandoned the practice. My manifold observations of women's genitalia in delivery rooms, where I had achieved access, ostensibly to watch births, proved the contrary to be true. Female genital mutilation had been carried out on every single one of these patients, without exception.

Attitudes and Belief Systems Underlying the Practices
       Contrary to all my expectations, I discovered that this ancient custom as adhered to and defended most resolutely not by men, but by its survivors, the women elders. It was these women that insisted most vehemently on its perpetuation and it was they who also wielded the knife.        Among the elite, the mutilation was often plotted by "the grandmothers," and carried out at the first unguarded moment that presented itself, in spite of all efforts that the child's educated parents had exerted in order to prevent it.        To nearly all the population, male and female alike, the mere idea that a girl should not be "circumcised" was altogether unthinkable. Not only would such a girl find no one who would marry her, but it was generally believed that all sorts of evils in respect to her sexual behavior, her health, and even more importantly in these cultures, the health of her husband and babies, would inevitably follow.        Eighty-seven percent of men and 83 percent of women voiced their unqualified approval of the practice, according to Dareer's extensive statistical study in Sudan. Taking into consideration that these mutilations are illegal under current Sudanese law, it is almost inevitable that the true approval rate is far closer to 100 percent for both men and women.        I learned that only a tiny handful of the most highly educated Africans had any notion whatsoever that in most of the world "female circumcision" was not practiced at all. Certainly, in the part of sub-Saharan East Africa where I researched the topic most intensively, a vulva left in its natural state stigmatized the woman as a slave, a prostitute, an outcast, an unclean being unworthy of the honor of continuing a respected family lineage.        Among the many people in all walks of life that I interviewed on the subject of female genital mutilation in Sudan, the epicenter of the most extreme excisions and infibulations, there was a young veterinarian who related the following to me:
"It had simply never occurred to me that there was anything wrong with the practice. Nor had this apparently ever occurred to any of my contemporaries, with whom I had at one time or another discussed it. It was only when I studied at a European university and saw how much less complicated things were for women there, that I finally understood how terrible a thing it is."

The Western World

       Upon my return to the United States at the end of my long, peripatetic research, I established contact with Dr. John Money, Professor Emeritus at Johns Hopkins University, who willingly became my scrupulously exacting mentor. Under his tutelage, I began to publish my findings in scientific journals, and in the course of events, presented the first of my many papers on the subject at the International Academy of Sexology, in Cambridge, England in 1984.        At this conference, I met Dr. Heino Meyer-Bahlberg, a sexologist of German origin, who added an important dimension to the rapidly expanding consciousness of a sexologist-in-the-making. Through conversing with him, I was made aware that penile circumcision, which is practiced routinely on male infants in United States hospitals, is not customary in most of the Western World. In point of fact, nearly the whole of Continental Europe has never practiced it at all.        Next I was made aware of Edward Wallerstein's ground-breaking, meticulously researched and documented monograph on male circumcision, published in 1980. It decried the previously unchallenged mass amputations of altogether healthy foreskins of male neonates in United States hospitals as a contemporary medical scandal without equal. Wallerstein vehemently denounced the practice as being not only medically unnecessary, but not even medically justifiable.

History of Male Circumcision in the English Speaking World
       Male circumcision first arose in England during the early part of the 19th century as a "cure" for masturbation, to which a prescientific medical establishment attributed a plethora of diseases. For well over a century, circumcision's reign as a so- called "health measure" put 99% of all British male infants to the knife. By virtue of the mother country's example, the procedure had also been embraced with equal enthusiasm by the medical profession in the rest of the English speaking world, most notably in the United States.        By the 1940's, the British upper classes had virtually discontinued the practice of male circumcision. Interestingly enough, they had also been first to instigate it originally. This demonstrated the innovative first-in, first-out behavior, characteristic of the leaders of any given society, ultimately followed by the less advantaged, in stages and over a protracted period of time.        This predictable social phenomenon was unexpectedly accelerated when male neonatal circumcision virtually disappeared among the rest of England's population in the late 1940's. At this time, Britain's newly instituted, post-war Socialized Medicine System took effect. The reason for the truly dramatic abandonment of this by then deeply entrenched practice was almost ludicrously simple. The newly established medical insurance system had failed to include the procedure in its list of paid for surgeries.        In the course of events that followed, it soon became evident in England that all of the dire predictions of medical disasters believed to inevitably follow if the infant penis was left in its natural state were without foundation. In spite of this, circumcision continued to be practiced on newborns as a "health measure" in the United States hospitals as before.

The Common Denominator
       While my personal concerns had long centered predominantly around women's issues, I had never been quite comfortable with the entire concept of infant male circumcision. I had long suspected that there was something basically very wrong with unanesthetized surgery performed on immobilized, screaming infants, no matter how much these aspects of the procedure had always been trivialized by its advocates. Much like my Sudanese veterinarian counterpart, I had never pushed my awareness in that direction sufficiently to formulate exactly what it was that on a gut level I sensed to be wrong. Being a product of my time, I had accepted, as young women of my era generally did, that this was "men's business," which I, as a woman, was incapable of understanding and, which in any event, did not concern me.        When my own son was born, an extremely difficult, prolonged and badly mismanaged in-hospital labor had already subject both of us to tremendous trauma, neither my husband nor I had any stomach to add yet further injury

to our first-born by way of a religious circumcision on the eighth day of his life. It was left to my father to come sailing unto the scene, take over all arrangements, and make certain that the rite was performed to his satisfaction. Although the experience of three days and nights of labor without analgesic, followed by a Cesarean section had temporarily robbed me of all strength, I have never quite come to terms with not having been able to prevent this, although my son has never borne me any malice.        Over the years, the more insight I gained into the various forms of genital mutilation of children, both in the prescientific societies I studied in Africa and the technologically advanced United States, the more I was struck by the similarities in rationale structures invented and proliferated by both to justify such mutilations. These rationale structures served as well to trivialize and justify the damage they contrived to perpetrate upon the bodies and psyches of their non-consenting and defenseless offspring.        In brief, I present here some of the most striking among these similarities: Clitoridectomy and Infibulation in Africa "She loses only a little piece of the clitoris, just the part that protrudes. The girl does not miss it. She can still feel, after all. There is hardly any pain. Women's pain thresholds are so much higher than men's." "The parts that are cut away are disgusting and hideous to look at. It is done for the beauty of the suture." "Female circumcision protects the health of a woman. Infibulation prevents the uterus from falling out [uterine prolapse]. It keeps her smelling so sweet that her husband will be pleased. If it is not done, she will stink and get worms in her vagina." "An uncircumcised vulva is unclean and only the lowest prostitute would leave her daughter uncircumcised. No man would dream of marrying an unclean woman. He would be laughed at by everyone." "Leaving a girl uncircumcised endangers both her husband and her baby. If the baby's head touches the uncut clitoris during birth, the baby will be born hydrocephalic [excess cranial fluid]. The milk of the mother will become poisonous. If a man's penis touches a woman's clitoris he

Infant Male Circumcision in North America "It's only a little piece of skin. The baby does not feel any pain because his nervous system is not developed yet."

"An uncircumcised penis is a real turn-off. Its disgusting. It looks like the penis of an animal."

"An uncircumcised penis causes urinary infections and penile cancer. It generates smegma and smegma stinks. A circumcised penis is more hygienic and oral sex with an uncircumcised penis is disgusting to women."

"An uncircumcised penis is dirty and only the lowest class of people with no concept of hygiene leave their boys uncircumcised."

"Men have an obligation to their wives to give up their foreskin. An uncircumcised penis will cause cervical cancer in women. It also spreads disease."

will become impotent." "A circumcised woman is sexually more pleasing to her husband. The tighter she is sewn, the more pleasure he has." "All the women in the world are circumcised. It is something that must be done. If there is pain, then that is part of a woman's lot in life." "Doctors do it, so it must be a good thing." Sudanese grandmother: "In some countries they only cut out the clitoris, but here we do it properly. We scrape our girls clean. If it is properly done, nothing is left, other than a scar. Everything has to be cut away." 35 year old Sudanese woman: "Yes, I have suffered from chronic pelvic infections and terrible pain for years now. You say that all if this is the result of my circumcision? But I was circumcised over 30 years ago! How can something that was done for me when I was four years old have anything to do with my health now?" "Circumcised men make better lovers because they have no more staying power than uncircumcised men."

"Men in all the 'civilized' world are circumcised."

"Doctors do it, so it must be a good thing." My own father, a physician, speaking of ritual circumcision inflicted upon my son: "It is a good thing that I was here to preside. He had quite a long foreskin. I made sure that we gave him a good tight circumcision."

35 years old American male: "I have lost nearly all interest in sex. You might say that I'm becoming impotent. I don't seem to have much sensation in my penis anymore, and it is becoming more and more difficult for me to reach orgasm. You say that this is the result of my circumcision? That doesn't make any sense. I was circumcised 35 years ago, when I was a little boy. How can that affect me in any way now?"

       A detailed statistical analysis is not the purpose of this article. Yet, the beliefs I have listed above tend to be verbalized predictably, consistently and in formula-like recital, generally in a specific order, much like any other platitude. Example: "It's not the heat, it's the humidity." Example: (Response obtained consistently from historically non-circumcising tribal women when asked why they have now begun to mutilate their daughters:) "This is the modern and hygienic way that educated people do it." Example: (Response from American mothers:) "A circumcised penis is easier to keep clean. Besides we don't want him to be laughed at in the locker room."        I have just returned from Mainland China, where the ground-breaking First Sino-North American Symposium on Sexology took place in October of this year. I was one of 55 participating sexological delegates from the U.S.A., Canada, Mexico and the Netherlands. I was highly impressed by the Chinese doctors' advanced technology in the treatment of male sexual dysfunction, and their blending of certain aspects of traditional Chinese medicine with modern Western techniques. Female sexual dysfunction is not being studied as yet, as one might well have expected.        In addition to being impressed, I was also much saddened to find these same Chinese doctors to be embarrassed and evasive when asked to demonstrate their acupuncture techniques, which the Chinese medical establishment has begun to abandon as old fashioned (and which we in the West are busily learning how to use more and more

effectively.) I was further saddened to be proudly informed that they have now begun to circumcise male infants, in the Western mode (very much along the lines of: "This is the modern and hygienic way that educated people do it.")        I introduced a cautionary note, hopefully serving to dampen their obvious enthusiasm for the newly adopted procedure, by informing them that recent preliminary research findings in the United States point to a significant degree of sexual dysfunction in later years among circumcised males. It might be best, I suggested, that they not go overboard in their zeal to be Westernized until the results of a larger study on the relationship between circumcision and later sexual dysfunction are known.        Such a relationship should come as no great surprise, once one is able to get past the "It's only skin" argument, and one concentrates instead on the functional analogues of male and female genital structures. The "It's only a little piece, the woman does not miss it" argument loses out very quickly with men when they are informed that the clitoris is analogous to the penis, and how would they feel about having "just a little piece" of their penis removed. By the same token, removal of the male foreskin is functionally analogous to removal of the female labia, whose function is to protect the clitoris and to keep it moist. The mere thought of an unprotected and dry clitoris would make any woman cringe. It is also highly unlikely that such a clitoris would have retained much of its original sensitivity by the time a woman reaches the age of 30.

       One may well speculate on what mental shifts the victims of the painful and sexually mutilating procedures inflicted in infancy and early childhood discussed here must make in order to process and come to terms with what they have suffered. Such shifts must be understood if we are to also understand how these victims eventually arrive at the conclusion that what has been perpetrated upon their bodies has been necessary, to their personal benefit, and that the custom which has dictated that this be done to them, must at all costs be perpetuated.

Dareer, Asma el, (1982) Woman Why Do You Weep? London: Zed Press. Lightfoot-Klein, Hanny, (1989) Prisoners of Ritual: An Odyssey Into Female Genital Circumcision in Africa, Binghamton, N.Y., Haworth Press. Wallerstein, Edward (1980) Circumcision: An American Health Fallacy, New York, Springer Publishing Co.

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