Female Circumcision

Female genital mutilation (FGM) concerns an estimated half a million women in Europe. The studies based in countries where migrant women have settled highlight the need for more accurate information on FGM health consequences, in a European health care context. Excision and Handicap (ExH) is a multicentric survey based on caseecontrol methodology and conducted in France to assess the long-term consequences of FGM, sampling both FGM and non-FGM adult women. The interviews were conducted in 74 mother-and-child health centres and hospital departments providing gynaecological and family planning services in five French regions. The two groups were compared on health indicators (selfperceived health, illnesses, symptoms) and functioning indicators (daily, sexual and reproductive life) for cases (n ¼ 678) and controls (n ¼ 1706). Multivariate logistic models highlighted FGM-related health problems. Among women living in France, FGM was significantly associated with poor health indicators: gynaecological and urinary infections (OR ¼ 2.0), sleep disorders (OR ¼ 1.4), intense pain (OR ¼ 1.5), difficulties in daily life (OR ¼ 1.5) and in sexual life (OR ¼ 1.7) or tearing during childbirth (OR ¼ 1.6). Our results suggest that, even in a favourable healthcare context, FGM exposes women to long-term health problems, including in areas neglected in previous research. They confirm the need to establish recommendations to help physicians understand these women's needs.

In discussions about sexuality in relation to circumcision, one often finds a kind of lip service, where it is declared that sexuality is multifaceted and relies on all kinds of psychological and social dimensions. Yet few authors discuss, in depth, the implications of a sexual-pleasure research approach that moves beyond the state of the genitalia. We would like to discuss exactly this: Sexual pleasure cannot be reduced to a question of genital tissue – sexuality is a more complex phenomenon than that. It is obvious that current quantitative approaches to investigating sexuality after FGC are inadequate. Generally speaking, they place too much weight on that which has been done to a woman’s genital tissue. We call such assumptions the fallacy of genital determinism (Johnsdotter 2013).
Western understandings of sex rely heavily on ideas emanating from researchers that created the model of the Human Sexual Response Cycle (Masters and Johnson 1966), which has been criticized for its simplistic focus on genitals (and not on people). Physiological aspects are thus over-emphasized at the expense of psychological, social and cultural aspects of importance for outcome.
Sexual scripting theory, introduced by sociologists in the 1970s (e.g. Gagnon and Simon 1973), highlights the cultural and social dimensions of lived sexuality, demonstrates how sexuality is embedded in social and cultural contexts and how people learn how to enact their sexuality. In addition, anthropological research on sensations (e.g. Hinton et al. 2008) suggests that culturally based learning also takes place when it comes to how we perceive bodily sensations, whether we notice bodily signals or not, and how we interpret and give meaning to sensations. Based on these findings, we will discuss possible implications of current campaigning for immigrant women and girls, who have to deal with these public expectations about erased possibilities to feel sexual pleasure after genital cutting.
In summary, we suggest that research, preventive work and rehabilitation care better take into consideration that sexuality is a complex phenomenon, and we stress the need to avoid reductionist one-track approaches that may be more harmful than helpful.

References
Gagnon, J.H. and Simon, W. (1973). Sexual conduct. The social sources of human sexuality. London: Aldine.
Hinton, D. E., Howes, D. & Kirmayer, L.J. (2008). “Toward a medical anthropology of sensations: Definitions and research agenda.” Transcultural Psychiatry, 45(2),142–162.
Johnsdotter, S. (2013). “Discourses on sexual pleasure after genital modifications: The fallacy of genital determinism (a response to J. Steven Svoboda).” Global Discourse, DOI 10.1080/23269995.2013.805530 (e-pub ahead of print).
Masters, W. H. and Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.

In this chapter, we contrast legal and ethical perspectives on two forms of nontherapeutic female genital cutting: those commonly known as "female genital mutilation" and those commonly known as "female genital cosmetic surgeries." We begin by questioning the usefulness of these categories—and the presumed distinctions upon which they rest— stressing the shared features of the two sets of practices. Taking UK legislation as a case study, we show that there are troubling inconsistencies in the way in which female genital cutting is understood in Western contexts. Specifically: (a) all nontherapeutic genital alterations to female minors are criminalised, typically with harsh penalties for transgressing the law, while even more invasive nontherapeutic genital alterations to male and intersex minors are permitted and almost entirely unregulated; and (b) genital alterations of adult women regarded as "cosmetic" in nature are treated as legal, while in some jurisdictions, anatomically identical procedures classified as "mutilation" are illegal. This chapter highlights these and other inconsistencies, speculates as to why they arise in Western contexts, and explores the scope for more consistent and constructive attitudes and legislation.