by Ayaan Hirsi Ali
"The Daily Beast"


Update: After only a month of criticism—including from Nomad author Ayaan Hirsi Ali, below—the American Academy of Pediatrics has reversed a policy that advised American doctors to give a ceremonial pinprick to girls of immigrant families so that they would avoid seeking a full circumcision.

The American Academy of Pediatrics recently put forward a proposal on female genital mutilation. They would like that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls born into communities that practice female genital mutilation.

Female circumcision is a custom in many African and Asian countries whereby the genitals of a girl child are cut. There are roughly four procedures. First there is the ritual pinprick. This is what Pediatrics refers to as the “nick” option. To give you an idea of what that means, visualize a preteen girl held down by adults. Her clitoris is tweaked so that the circumcizer can hold it between her forefinger and her thumb. Then she takes a needle and pierces it using enough force for it to go into the peak of the clitoris. As soon as it bleeds, the parents and others attending the ceremony cheer, the girl is comforted and the celebrations follow.

There is a more sinister meaning to the word “nick” if you consider the fact that in some cases it means to cut off the peak of the clitoris. Proponents compare “nicking” to the ritual of boy circumcision. But in the case of the boys, it is the foreskin that is all or partly removed and not a part of the penis head. In the case of the girls, the clitoris is actually mutilated.

Then there is the second method whereby a substantial part of the clitoris is removed and the opening of the vagina is sewn together (infibulation). The third variation adds to this the removal of the inner labia.

Finally, there is a procedure whereby as much of the clitoris as possible is removed along with the inner and outer labia. Then the inner walls of the vagina are scraped until they bleed and are then bound with pins or thorns. The tissue on either side grows together, forming a thick scar. Two small openings roughly equal to the diameter of a matchstick are left for urination and menstruation respectively.

Often these operations are done without anesthesia and with tools such as sharp rocks, razor blades, knives or scissors depending on the location, family income, and education. It is thus more accurate as does the World Health Organization to speak of female genital mutilation (FGM) instead of the obscure and positive-sounding “circumcision.”

According to the American Congress of Obstetricians and Gynecologists, more than 130 million women and girls worldwide have undergone some form of female genital cutting.
Some of them sneak their daughters out of the country during the long school summer vacation so that they can be subjected to any one of these forms of FGM.

Congressman Joseph Crowley (D-NY) recently introduced a bill to toughen federal laws by making it a crime to take a girl overseas to be circumcised. He argued, rightly, that FGM serves no medical purpose and is rightfully banned in the U.S.

Following the Aug. 10, 2010, publication of an Associated Press article, "Female circumcision victims seek out Colo. doctor," by Catherine Tsai, Clitoraid and Dr. Marci Bowers MD wish to clarify where donations should be sent and explain Clitoraid's role in the surgical process.

Nowhere in her article did Tsai mention Clitoraid, the parent, non-profit organization Dr. Bowers has been generously volunteering for since 2007. Therefore, the article failed to give a complete picture of the program's international implications. To be clear, Clitoraid (clitoraid.org) offers a humanitarian program to restore damage done by Female Genital Mutilation (FGM) in North America, Asia and especially in Africa. Clitoraid is in the final stages of building a hospital in Burkina Faso (West Africa) to treat all FGM victims free of charge. Dr. Bowers will inaugurate the hospital once it is ready.

Donations will go toward the Burkina Faso hospital. It is in that vicinity that the largest number of FGM victims reside and where such surgery represents a two-year salary if the average patient were to pay for it. Clitoraid has been a 501 (c) 3 non profit organization since 2006.
Therefore, circumcised women seeking repair and those making donations should contact Clitoraid at , not Dr. Bowers.

"Clitoraid should be given first consideration when considering a donation of any kind, especially out of respect for our busy staff," Dr. Bowers said, adding that she wants to thank those who have written to her office to make donations following publication of Tsai's article.

It's also important to note that Clitoraid handles all post-surgical sexual therapy care under the guidance of sex therapist Dr. Betty Dodson.

Both Clitoraid and Dr. Bowers' office request that the Associated Press publish this joint statement to properly inform the public about Clitoraid and Dr. Bowers' involvement in this far-reaching, humanitarian endeavor.

Sincerely,

Dr. Brigitte Boisselier, PhD, President of Clitoraid
Dr. Marci Bowers, MD, head Clitoraid Surgeon

CATHERINE TSAI, Associated Press Writer

TRINIDAD, Colo. (AP) — This picturesque southern Colorado town known for decades as the sex-change capital of the world — thousands of gender-reassignment operations have been performed here — is becoming a beacon for victims of female genital mutilation.

Dr. Marci Bowers has performed about two dozen reconstructive surgeries on mostly African born women victimized as children by the culturally driven practice of female circumcision. Bowers is believed to be one of the few U.S. doctors performing the operation.

Bowers, who underwent a gender reassignment operation in the 1990s at age 40, said she relates to what her mutilation patients describe as a loss of identity, of not feeling whole.

"It took me so long to get there in my own life. I know what the feeling is like, seeking my own identity," she said.

Massah, a patient who grew up in a village in Sierra Leone and now lives in Australia, said the surgery "is like giving us a second life. Actually it's starting to live."

Wearing a blue-and-white striped shirt, dark blue pants and sneakers to her pre-surgery exam, Massah asked that her full name not be used because she hasn't told most friends and even family that she was having the surgery, or that she was circumcised as a girl in Africa.

She paid a $1,700 hospital fee, plus lodging and travel expenses for the surgery last month.

"I will spend my whole life savings," she said, "even if it's for one minute of feeling complete."

The World Health Organization estimates 100 million to 140 million girls and women worldwide have been circumcised.

Cultural, religious and social factors have helped keep the practice alive among those who believe it will reduce promiscuity and take away sexual pleasure or desire. The World Health Assembly passed a resolution in 2008 urging an end to the custom.

The restorative surgery practice in this town of 9,500 people near the New Mexico border began in early 2009.

Last month, at a guest house a short drive from Bowers' office, Massah and six other patients talked late into the night, sharing stories that they'd found difficult to voice even with best friends. All requested not to be identified.

One 37-year-old woman from Richmond, Va., was circumcised as an infant in Nigeria and realized in college during a biology class that she didn't look like her textbook diagrams. She said she would still like to ask her mother why.

"Why did you allow it to happen? What were you trying to prevent?"

Massah said she was circumcised at age 11 by a village woman. She was with about a half dozen of her sisters and cousins.

She was placed before the woman and was held down before being cut with what she thinks was a razor. She still remembers her screams.

"Nightmarish," she said.

She has felt ashamed, incomplete and apprehensive toward sex, she said.

"It's embarrassing going for Pap smears," Massah said haltingly, trying not to cry. "Just the look on people's faces."

She said she was hoping for "wholeness" from the surgery. A week into her recovery, she said she felt "ecstatic."

"Some people get another chance in life through organ transplant, but for me, this is it," she said.

Bowers learned her techniques for operating on FGM victims with Dr. Pierre Foldes, who performs the procedure in France.

Typically, patients have not had the entire clitoris removed, Bowers said, and the surgery exposes what remains, uses remaining tissue to reconstruct labia that may have been cut away, and clears scar tissue.

She said the surgery typically results in improvement in sensation as well as cosmetic benefits.

Bowers hopes to form a teaching program so other doctors can serve FGM victims.

"Somewhere, at some point, women have got to hold hands and say, 'No, no more. We're not going to do this anymore,'" she said.

Bowers' patients pay their own hospital fees and travel and lodging expenses, unless an insurer agrees to cover the hospital fee. Bowers donates her services.

Just how long that will continue here is uncertain. Bowers has announced plans to move to California this fall, and Mt. San Rafael Hospital where she operates says it has no immediate plans to add a new gender reassignment surgeon. That would be a big change for Trinidad, where Bowers' mentor, the late Dr. Stanley Biber, performed more than 5,000 sex change surgeries over more than 30 years.

Attitudes toward female circumcision are changing, the women patients said.

But, said Massah, "It's changing, but too slow. It's going to take a lot of generations."

Iman, a mother from the Twin Cities area in Minnesota who was circumcised, is grateful for Bowers and the chance to talk with other patients who underwent FGM.

"I left all that baggage at the guest house, all the things that tormented me," she said. "Imagine dealing with your worst demons and then meeting six other people who are dealing with the exact same issues you are. Then you get to leave all your baggage there, with no judgment."

Unlike other women who were blindfolded and cut in village ceremonies, with drumming and singing in the background, Iman was excised at age 12 in Kenya, in a doctor's office.

She had localized anesthesia. "I remember everything," she said. "My mom was there. I don't blame her because she did what was done for her. It was a rite of passage."

Later, she was taken to her grandmother, who checked whether the doctor had done a good job, she said.

After her grandmother died, her mother didn't take her three younger sisters to be circumcised. "I give her credit for that," she said. "It stopped with me."

___

Online: http://www.google.com/hostednews/ap/article/ALeqM5jSMnS303G8Z5t4-z8cXMviLcyO6QD9HGI8S80


Associated Press

Sydney June 2nd, 2010

"While the International Raelian Movement is based on the protection of cultural rights of any groups, the line is clearly drawn at any form of violence, disrespect or in this case, outright sexual mutilation!" explains Jarel, leader of the Raelian Movement in Australia. "There can be no justification for such a proposal, what is needed is education and support for women that belong to these cultural groups to help them break free and reclaim what they were rightly born with; a beautiful sex and a functioning clitoris. After all, every human being has been designed to experience pleasure."

“The purpose of genital mutilation is one of cultural sacrifice not religious, and its only purpose is to remove any sexual pleasure the woman might experience,” states Zabou, the coordinator for Clitoraid in Australia. "Australia should aim to be the leaders in the reconstruction of the women who have been rendered a life of pain and suffering due to this barbaric practice, and not be part of its survival"

Clitoraid is a non-profit organization that is currently setting up a hospital in Burkina Fasa, run by volunteer doctors dedicated to the reconstruction of the damage millions of women who struggle to live with the painful consequences of female genital mutilation. Clitoraid’s goal is to inform the population, and also to collect funds to finance the construction of this hospital, where the patients will be operated on for free!!

Zabou: “If some group were to remove the hands of children for cultural reason, would the government offers to do it in hospital under the premise that is safer? of course not. the problem lies in the fact that a clitoris is still considered as dirty and useless. This prejudice has led 170 million women in the world to feel incomplete, ignoring the pleasure of orgasm that is now known as contributing to a healthy life . We cannot let our government be an accomplice to such barbaric practice."
Clitoraid has received several requests from Australian women willing to be repaired. One of them will be operated on by our leader surgeon in Colorado this coming Summer. (dear Nadine, please give Eden the status on that ok?)

For further information contact Eden Bates on +61 425 235 556.