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Correction
to
Toubia,
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Carol R. Horowitz, M.D.
J. Carey Jackson, M.D., M.P.H.
Mamae Teklemariam, M.S.W., M.P.H.
University of Washington
Seattle, WA 98105
References
``Female genital mutilation'' is a descriptive and definitive term. ``Circumcision,'' without the sex being specified, is appropriately defined as removal of the penile foreskin.2 The term ``female circumcision'' can denote various procedures but, as Toubia points out, generally refers to clitoridectomy with or without removal of the labia. The equivalent procedure in males is penile amputation and removal of the scrotum. The problem with describing female genital mutilation as female circumcision is that the latter can be confused with the circumcision of newborn boys, a low-risk procedure with medical benefits.
As chair of the American Academy of Pediatrics Task Force on Circumcision, I have received correspondence from anticircumcision groups, particularly the National Organization of Circumcision Information Resource Centers and the National Organization to Halt the Abuse and Routine Mutilation of Males. The report by the task force3 indicated that the medical benefits of circumcision in newborns include prevention of penile cancer, infantile urinary tract infections, balanoposthitis, and phimosis. There is also evidence that infection with the human immunodeficiency virus is less prevalent among circumcised men than among those who have not been circumcised.4 Use of the term ``female circumcision'' to describe female genital mutilation helps the organizations that oppose circumcision, which now demand the prohibition of all circumcision.
Ironically, Toubia, a physician, calls these procedures ``female circumcision,'' yet Schroeder, a member of Congress, is more precise in advocating the elimination of female genital mutilation. Medical accuracy is better served by political savvy.
Edgar J. Schoen, M.D.
Kaiser Permanente Medical Center
Oakland, CA 94611-5693
References
Although circumcision is required for all male Jewish children, in observance of God's commandment to Abraham in the Bible, female circumcision is certainly not a Jewish practice. In fact, any form of female circumcision would be considered bodily mutilation and forbidden under Jewish law.
If female circumcision is indeed practiced by the Falashas, the reason may be that as a persecuted and isolated Jewish enclave for thousands of years, the Falashas did not have access to either definitive Jewish texts or informed rabbinical sources. Many of the religious rituals they practiced had no valid basis in accepted Jewish law.
Daniel D. Buff, M.D.
St. John's Episcopal Hospital
Far Rockaway, NY 11691
References
Jean-Marie Weydert, M.D.
Centre Hospitalier de Luxembourg
L-1210, Luxembourg
The supporters of routine, nonreligious neonatal circumcision in this country have never been short of justifications for imposing this practice on children. Clearly, the circumcised man who supports this practice has deep psychological motives behind his irrational demand that others suffer the same mutilation. It is not necessary to argue against his justifications, nor is it necessary to explain to him the unique and irreplaceable sexual functions of the prepuce and intact, natural penis. The genital mutilation of boys and girls must be opposed for the simple reason Representative Schroeder gives: The amputation of healthy genital tissue is a violation of the person's right to an intact body. No one asks to have his or her genitals removed. Indeed, the infant's shrieks of pain are an obvious indication of protest against the procedure. We as adults must do our part to prevent those screams by upholding the basic human right to an intact body, to which all people, whatever their age or sex, are entitled.
Paul M. Fleiss, M.D., M.P.H.
1824 N. Hillhurst Ave.
Los Angeles, CA 90027
George J. Gilson, M.D.
University of New Mexico School of Medicine
Albuquerque, NM 87131-5286
To the Editor: I use the term ``female circumcision'' to acknowledge its cultural importance, the positive perception of this procedure on the part of those who practice it. These characteristics constitute the main similarity of female circumcision to male circumcision. The difference is that, unlike male circumcision, the most commonly described types of female circumcision are anatomically and functionally mutilating.
There is no universal consensus that routine circumcision of male children is an acceptable medical procedure for preventive care. It remains a religious practice for some and a selective nonreligious practice for others, with or without medical consent. Whether male circumcision is medically harmless or even beneficial remains a matter of debate and study.
During 20 years of clinical experience with thousands of women from Sudan, Egypt, Ethiopia, and Eritrea, I have not seen a case of ritualistic childhood circumcision in which only the skin around the clitoris was removed, not the glans. As a pediatric surgeon, I cannot imagine how a traditional practitioner of circumcision could dissect and remove the few millimeters of skin in a screaming, unanesthetized girl. However, if such cases were appropriately documented, I would stand corrected and might suggest a different term.
Removal of the skin around the clitoris is performed occasionally in adults in the United States as a questionable means of treating sexual problems. This procedure is ethically and legally different from ritualistic circumcision of children. In this country, adults have the right to provide or withhold consent to any surgical procedure on any part of their bodies for cosmetic or curative reasons. In the draft bill introduced by Representative Schroeder, we recommend that 18 years be established as the age of consent for female circumcision. This would allow immigrant women from Africa the American right to make their own choice.
In Africa the history of or reasons for ritual genital surgeries in females have long been lost. The fact remains that African followers of the major world religions practice these customs. Male circumcision is an absolute requirement of Islam and Judaism, whereas female circumcision is not even mentioned in any religious text. However, scholars of African cultures would testify that on our continent traditional and tribal rituals commonly supersede religion.
Nahid Toubia, M.D.
Research Action and Information Network for the Bodily Integrity of Women
New York, NY 10276
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