EXCISION (WOMEN'S CIRCUMCISION)

Umm Iman : We undertook the circumcision of my son, Muhammad, while he was very young (before he reached one month of age). Now Iman has reached the age of ten. I would like to have her undergo excision. What is your opinion ?

Dr Ahmad :

Before you have her undergo excision, I would like to discuss in detail the matter of al-khafD (excision).

Al-khafD is the extraction or the cutting off (ablation) of some of  the external parts of the reproductive apparatus of the woman. These parts may include the following (based upon the degree of excision):

1. Al-buDhr (the clitoris) : It is an organ which resembles the male organ, with a length between 1 to 3 cm (at the puberty age). It is located in the middle section of the vulva, directly on top of the orifice of the urinary duct. It is composed of two contracted elements, each of which reaches the connecting parts of the pelvian bone at one of its sides, and then the outermost gland. This latter contains the endpoints of the sensory nerves. It is also partially covered by the little labia.

2. The little labia :  They are two small rectangular folds which lie between the large labia and the vaginal orifice (or entrance). They contain many endpoints of the nerves and blood vessels which increase the sexual  sensation during intercourse.

3. The large labia :  They are two rectangular folds of skin lying on both sides of the vulva and are the most protruding of the woman's genital parts to the outside.

Umm Iman :  Are there degrees or types of excision ?

Dr Ahmad :

Yes. There are degrees and types of excision. They differ in accordance with the environment, the educational level and the society's perception of excision. Some communities view it as one of the religious obligations. Others consider it as an embellishment operation for this part of the body. Still others view it as one of the means to prevent engaging in erotic intercourse on the part of the girls prior to marriage. Finally, there exist communities that look at excision as being an operation of disfigurement and torture for the girls. The excision types are as follows:

- The first type : It is associated with the ablation of the foreskin on top of the clitoris.

- The second type : Through it are excised part of the clitoris and parts of the little labia.

- The third type : Through it are excised all of the clitoris and all the little labia.

- The fourth type : Through it are removed all the clitoris, all of the labia (large and small). There remains only the orifice of the vulva. It is called the "pharaonic circumcision". Its practice is widespread in some countries.

There exist some cases where only the little labia are excised.

Umm Iman : Are there medical reasons for excision ?

Dr Ahmad :

Yes. There exist some situations - although rare - which require medical intervention (e.g. surgery). Some examples are:

1. The abnormal swelling of the labia (i.e above their natural size).

2. The swelling of the clitoris.

3. The narrowing and sticking of the foreskin on top of the clitoris head, which leads to the accumulation of discharges and germs, and the occurrence of inflammations.

Umm Iman : Are there any complications stemming from excision ?

Dr Ahmad :

Yes, there are many complications. Some of them are :

1. Haemorrhage : Many doctors recall well how they spent, and still spend, the nights of festivals and holidays -when many excisions are performed- treating haemorrhage cases. These are occasioned by the excision of the girls. This haemorrhage may be very severe, which requires a surgeon's stitches in order to stop it. In some cases, the girls need blood transfusion.

 2. Psychological shock : This requires treatment. The shock stems from pain, in view of the fact that the excision operation is performed -in most cases- without any anesthesia.

3. The inflammation and the contamination of the wound : Excision is performed, frequently, by medically unqualified people using primitive and non-disinfected tools. This leads to the contamination of the place of the wound.

4. Urinary disturbances : These are, for example, urine incontinence and its complications, and the inflammation of urine evacuation ducts and its complications.

5. Visible disfigurement : It is not rare that, a short while before marriage, the girl goes to see a doctor and complain about a number of aspects of disfigurement, which require performing another operation destined to remove them. Sometimes she goes to see a doctor after marriage in order to rid herself of the disfigurement (occasioned by excision) which may interfere with sexual intercourse. She may also request the removal of aspects of disfigurement during child delivery, which may force the doctor to open up a cleaving part stuck because of a wrong excision operation.

6. Psychological effects : It is customary that the excision operation is performed on a girl between the age of four and nine or ten. This makes her suffer from all sorts of sexual problems.

7. Other effects : There are other effects. However, it is not easy to guess concerning when they have come about; yet, proofs exist about their existence. Some examples are: (a) the inability to engage in sexual intercourse through the normal means, which may lead to its performance in abnormal ways running contrary to the Shari‘a ; (b) delay in getting pregnant and difficulty in delivering babies(8).

8. Some iniquitous types : These types lead to the occurrence of fistulae in the urinary duct or in the anus. This may provoke lack of control over the urine flow (enuresis) or that of defecation. This, in turn, causes acute and chronic inflammations in the woman's reproductive and urinary apparatus.

Umm Iman : But there are those who say : "excision protects the girl from (sexual) deviance."

Dr Ahmad :     

Those who undertake the excision operation thinking that this may lead to a decrease in sexual desire and also protection from deviance are ignorant of an important medical truth: excision does not decrease sexual desire as this latter is located in the brain and is influenced by the senses like sight, smell, touch, and other things. The result, with excision, is the presence of sexual desire with the difficulty to quench its thirst physically.

I would like to assure you that it is a sound family education that is most important for the preservation of chastity and not the ablation of an organ whose presence is essential for enjoying a happy married life.

Umm Iman : They also say: "excision is cleanliness and purification."

Dr Ahmad :

This is not true. Amongst the functions of the little labia is the protection of the skin of the vulva against inflammations resulting from the flowing of urine and vaginal discharges over it. The surface of this skin contains many glands which secrete a fatty substance for the purpose of protecting it. Likewise, amongst the functions of the little labia is to direct the flow of the urine and to prevent the wetting of the clothes.

Umm Iman : I have decided not to have Iman undergo excision. I thank you very much for clarifying all the above truths to me.