Female Genital Cutting versus Female Genital Cosmetic Surgery - Q&A part one

It’s been a busy week since we released the special edition of SiA Magazine on Female Genital Cosmetic Surgery. I asked one of the individuals who contacted me through my website to post his comment on the blog so that I can answer it for the general public. 
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Q: First I want to say well done you for producing another great issue of SiA. Your showing photos of vulvae, both black and white, circumcised and un-cut will help people to see the obvious similarities between the effects of traditional FGC (female genital cutting) and modern western cosmetic genital surgery. But the surgeries are not the same in one respect, in that the clitoral glans and shaft are retained in western FGC. In both traditional and western FGC the inner labia are trimmed. In western FGC the clitoral hood is sometimes trimmed too, whereas in traditional FGC the clitoral hood, glans and shaft are often excised along with the inner labia. At a glance, the results look similar, but on closer inspection you would find the western woman’s clitoral glans.

​A: Thanks for your thoughtful response.  I do think it is important to show readers actual images in questioning the use of the term “mutilation”.  The point of this teaser edition of SiA was to show that Female Genital Cosmetic Surgery (FGCS) procedures fit the WHO definition of Female Genital Mutilation (FGM), “All procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs to for non-medical reasons.” 
 
But to your point that Female Genital Cutting (FGC) and FGCS are not the same “in that the clitoral glans and shaft are retained in FGCS”, I disagree. The clitoral glans and shaft is retained in the most common forms of traditional FGC, WHO Types I and Type IIa.  Also, the clitoral glans and shaft are reshaped in various forms of Female Genital Cosmetic Surgery (FGCS). To me it seems obvious from the pictures that what is being advertised in western countries as “labiaplasty” (removal of the inner labia) involves much more than just the inner labia.  

The pictures clearly show labial and clitoral reductions (see magazine link below). In western clitoroplasty procedures, the surgeon operates on the external shaft to reduce or completely flatten the outward appearance of the glans. In many cases, this gives a near identical appearance with forms of Type II excision. WHO Type IIb excision flattens the external clitoris by removing the protruding glans and shaft, as shown in the pictures. However, the shaft or body of the clitoris extends internally and is hidden behind the vulva.  In Type IIa, it is only the labia minora that is removed (which is equivalent to actual western labiaplasty).

In Types I, which is performed on millions of girls and women in sub-Sahara Africa, Indonesia, India and other parts of the world, only the hood around the glans is partially or completely removed; you would find the non-western woman’s clitoral glans.  Type I is equivalent to clitorplexy or hoodectomy in western FGCS. For most women who have experienced FGCS and FGC, the external vulva (including the site of operation) retains the same sensitivity and sex is more enjoyable because women prefer the post-op appearance.    ​

Q: The clitoris has been discovered to be much more than the little shaft and glans beneath its hood. It’s a much larger inverted “V” shaped organ situated beneath the labia and surrounding the vulva, with the shaft and glans forming the anterior extremity. During masturbation most (uncut) women massage the shaft and glans directly, and those parts are still assumed to be necessary for satisfying sex. Respected sex research tells us that the clitoris (meaning the shaft and glans) gets indirect stimulation during penetrative sex. In your personal story you have said that removal of your clitoral shaft and glans did not leave you unable to enjoy sex or achieve orgasm. This directly challenges accepted (western) ideas about the clitoris and suggests that without the clitoral glans and shaft there is still plenty of erotic tissue and that orgasm is just as easily triggered? 
 
A: Exactly, the clitoris is far more extensive than western popular imagination and feminist folk models of biology would have the world believe. My colleagues and I put together the Public Policy Advisory on Female Genital Surgeries in Africa, which was published in the Hastings Center Report in December 2012.  The PPAN as it has been referred to, is a critical review of the vast literature that exists on female circumcision and impact on reproductive health, sexuality and so on. This report lists several studies showing that many women who have gone through excision do experience orgasm during masturbation, oral sex and sexual intercourse; for these women stimulation of the area of excision and the subcutaneous shaft lead to orgasm. In an essay I wrote in 2007, I cited a study that states that western women who have had their external clitoral glans and shaft removed for health reasons continue to experience orgasm through masturbation or manual stimulation of the site of excision.
 
Surgeons also perform clitoroplasty to “reverse” excision or infibulation.  In this procedure, a part of the internal clitoral shaft is lifted out and exposed to create the appearance of an external glans.  Western doctors assert that this “restores” sexual sensitivity to the clitoris. However, I think this raises the question of whether sensitivity was ever “eliminated” in the first place.  In one comparative sexuality study of FGC versus non-FGC, the authors argue that many of these women do not report any change in their sexual response but prefer the appearance of “reversal” of their previous FGC.    
 
Certainly, there are circumcised women who do not enjoy sex; but there are also uncircumcised women who do not enjoy sex or have never experienced orgasm. The anti-FGM campaign is way too clitorocentric and reduces women to the amount of flesh and erectile tissue on the external vulva. This is degrading and objectifying.  Instead of fighting about what women should or should not do to their bodies, we should embrace the incredible complexity of female sexuality and diversity of our cultures and experiences.  Our brain, and not our vagina, is the key to pleasure and satisfying sex.
 
My personal story is not at all unique. Orgasm is easily triggered for women with positive body and genital self-image, who love and desire sex, are comfortable with their partners, have skillful lovers who pay attention to their sexual needs and most important, for women who feel they deserve to be pleased. There is obviously so much more to female sexuality than the presence or absence, weight, shape, length, or contour of external flesh and tissue.
 
Q: Will you be providing more evidence to allay fears about clitoridectomy?
 
A: I’m glad you asked this and I will try and put this as delicately as I can.  Whose fears?  Most circumcised women are sexually confident and pleased with their bodies and, until they travel to western countries, they do not see themselves as “mutilated”. So, I do not see it as my job to allay uncircumcised women’s fears about female circumcision or what you refer to as clitoridectomy. As this edition of SiA shows, many uncircumcised women are already opting for so-called FGCS and their doctors are fooling them that their post-op vulvae are somehow still functionally different, morally better, or more civilized than ours.  
 
Circumcised women are not minors or mutilated females who have to explain ourselves to uncircumcised women.  Uncircumcised women are not our moral arbiters or legal custodians though some may feel this way. My ultimate concern is not for western women to understand or sympathize with this practice.  My message is aimed at affected women to wake up and be our own women.  We need to understand the origins of this practice, it’s rootedness in our dual sex (matriarchal and patriarchal) traditional sociopolitical structures and religious beliefs as well as what these bodily practices tell us about our own cultural views of sex and gender.  Whether or not uncircumcised women agree with our traditions is not our problem; it’s theirs. Just like it’s not the job of homosexuals to allay fears of heterosexuals about the former’s sexual preference. Our concern as circumcised women ought to be whether we agree to inherit and pass on our genital aesthetic traditions as well as our individual rights to opt out. 

Fuambai Sia Ahmadu, PhD 

Fuambai Sia Ahmadu is an anthropologist, feminist, Bondo activist and passionate advocate for intragender equality worldwide.  fuambaisiaahmadu.com or awafc.org ​.